The recent shooting death of a Barnes-Jewish Hospital patient wielding knives has renewed a debate over armed guards in health care settings.
As many as half of U.S. hospitals employ security guards armed with handguns, according to one national survey. The estimate in Missouri is much lower — about 14 percent, said a spokesman for the state hospital association.
Some hospital executives believe that having armed guards sends a conflicting message and adds danger to an already tense and emotional setting. Others say the threat of workplace violence should be handled the same as in any other setting, and that armed guards act as a deterrent.
Security guards at Barnes-Jewish on Jan. 11 shot and killed a patient who refused to drop two knives after pushing his way out of a treatment room. Police said the man, Andrew Merryman, 46, of Ballwin, had been suicidal, but they declined to say why he was being treated at the Center for Advanced Medicine.
The death comes as violence in the health care setting has soared. With more than 11,000 reported assaults a year, health care workers account for about 75 percent of the victims of workplace violence, according to the U.S. Department of Labor.
Several local hospital officials declined to be interviewed on the subject of security. An informal tally shows that aside from Barnes-Jewish, BJC HealthCare hospitals do not equip their guards with guns. Guards at SSM Health hospitals carry Tasers but not handguns. Some Mercy hospital guards have Tasers or handguns. At St. Luke’s Hospital in Chesterfield, security guards carry handguns and are trained by St. Louis County police.
“In a perfect world, a hospital would be the antithesis of where you would think guns would be necessary,” said Dave Dillon, spokesman for the Missouri Hospital Association.
Hospitals are for healing, by their “first, do no harm” tenet. But sometimes protecting both staff and patients comes into conflict, Dillon said.
“These are hard conversations with ourselves,” Dillon said. “There’s no line in the sand on the appropriate intervention.”
The labor department has general guidelines for preventing workplace violence in health care settings, but does not take a stance on armed guards. Emergency preparedness requirements from the Centers for Medicare and Medicaid Services, which inspects hospitals, mainly focus on natural disasters and disease outbreaks.
The stressors that can spark violence include a lack of mental health care options, long wait times in the emergency room and the delivery of bad news about a medical condition.
“We’ve got patients and families who come to the hospital under the influence of substances or seeking drugs, domestic conflicts, patients coming in escorted by police,” Dillon said. “There are a lot of things that create an environment where individuals are feeling more comfortable physically harming or verbally abusing health care workers.”
While assaults against health care workers are increasingly common, shootings in hospitals remain relatively rare. There are an average of 14 shootings on hospital grounds in the U.S. each year. The emergency room is the most common site for shootings, followed by parking lots and patient rooms, according to researchers at Johns Hopkins University.
Violent perpetrators in hospitals, as opposed to campuses or other crowded locations, tend to have specific targets. Most shootings in patient rooms, for example, involve terminally ill relatives. Suicides, family conflicts and personal grudges are other primary motives. The size of the hospital and the crime rate of the city have little or no effect on the risk of violence, according to the study.
Further complicating the issue of armed guards is the study’s finding that 23 percent of ER shootings involve someone taking a security guard’s gun. In one high-profile case last year, a nurse was held hostage and raped in a hospital outside Chicago after an inmate who needed medical care took the gun of the corrections officer guarding him.
In October, gunfire erupted in the parking lot of SSM Health Cardinal Glennon Children’s Hospital on South Grand Boulevard. No one was hurt, but the shooting caused the hospital to lock down for half an hour.
There have been at least two other instances of violence in local hospitals involving knives. In 2008, Carlos Roberts, of Bel-Ridge, stabbed his girlfriend to death outside St. Louis Children’s Hospital while they were visiting the woman’s granddaughter, a patient. Mary Colletta, 30, died in a 2010 stabbing in the parking garage at St. John’s Mercy Medical Center in Creve Coeur, now called Mercy Hospital, where she worked as a tech. Her estranged husband, Christopher Colletta, was sentenced to life in prison for the murder.
While the Missouri Hospital Association provides training for active shooter situations, the primary focus has shifted to violence de-escalation seminars for health care workers.