Under the Knife

Even legislation can't end violence in Valley hospitals

"At Desert Sam, we see a lot of methamphetamine cases in which people become violent and require physical restraint," says Borgadus. "At Good Sam, you see more of the knifing and shooting victims. Two years ago, we had a lot of rival gang shootings where you get gang members from opposing sides in the same ED."

The violence is concentrated in Level 1 trauma centers, which have sufficient staff and equipment to treat serious injuries such as penetration traumas caused by guns or knives.

"We get the stabbings, the shootings, the psych patients--all the worst cases in the city come here," says Tom Pernot, the security manager at John C. Lincoln Hospital in north Phoenix. "Unfortunately, violence is a problem here. You see the worst side of people in the ED. People don't want to be here. They're waiting, getting tests, poked and prodded. You've got a lot of anger, you've got people who might have been convicted of a crime and you've got family members who are upset 'cause something happened to their relatives. The ED is a very emotional place."

Lincoln has installed bullet-resistant glass on the front of the ED and often hires off-duty police officers to roam. "One thing we have here is real good cooperation from the police," Pernot says. "We give them free doughnuts and coffee in the emergency room, so they're here all the time."

Each of the Valley's five Level 1 trauma centers--Lincoln, Good Samaritan Regional Medical Center, Maricopa Medical Center, St. Joseph's Hospital and Medical Center, and Scottsdale Healthcare (formerly Scottsdale Memorial Hospital)--has round-the-clock security officers and panic buttons in the emergency department, as well as lock-down capabilities on all doors leading into the treatment area.

Maricopa, a county hospital that ministers to 2,000 traumas per year, of which 25 percent are penetration traumas, deploys security officers armed with guns, Mace and handcuffs in the ED. All of Maricopa's security officers are trained marksmen and many are ex-police officers, a necessity since the hospital houses Station 41, a secured area for prisoners requiring health care.

Although a quarter of trauma patients, their families and friends carry handguns and other weapons, according to an OSHA report, metal detectors have been excluded from security programs in Arizona, given that they're costly--estimated at more than $100,000--and require 24-hour monitoring.

In other states, metal detectors have proven effective in controlling weapons. Henry Ford Hospital in Detroit, Michigan, reported that in the first six months of its screening operation, 33 handguns and 1,324 knives were confiscated.

The catch, says Pernot, is metal detectors won't prevent someone from assaulting an employee with an IV pole or a scalpel, or punching or sticking an employee with a needle.

Drew weighs 72 pounds, has piercing amber eyes and razor-sharp teeth. A 7-year-old German shepherd, he's the senior canine in a security program that was instituted at all four Samaritan hospitals six years ago.

Drew's handler, senior officer Tom Knowles, is loading blanks into a small black revolver in the parking lot at Maryvale Samaritan Medical Center in preparation for a training exercise. Drew is all wags and smiles.

Knowles passes the gun to canine officer Frank Lopez, who bolts toward a parked pickup truck and pretends to break into the truck. Drew tenses his withers, draws his ears forward and rolls back his upper lip.

Knowles yells, "Pakhum!" (the German word for "attack") and Drew torpedoes toward Frank and clenches his jaws around the shield, shaking his head from side to side. Lopez fires off a round of blanks, but Drew won't let up. Then Knowles commands, "Oust!" and Drew retreats as if he were being reeled in by an invisible string.

"Our crime statistics have decreased every year on the property at all four hospitals since we got the canines," says Knowles, who's trained attack dogs for 26 years. (Knowles recently left Good Samaritan for a security job at John C. Lincoln Hospital.)

"The dog changes every scenario. One day a lady who had a heart attack was brought in by ambulance with three of her sons. The fourth son was at a bar getting drunk. The doctors stabilized mom and transferred her from the ER to the special-care unit. By this time, son No. 4 came in to see mom and the other three explained he couldn't see her. A fight broke out and they were yelling, swearing and punching in the hallway. Drew and I got the call and went up to where they were fighting. I yelled, 'Stop or I'll send the dog!' You've never seen eight arms and eight legs move so fast.

"Dogs also have a calming effect," adds Lopez. "At Good Sam, we had a psych patient in the ER beating up on a doctor and a nurse. I went up with my dog, Bahd [also known as Badass Hospital Dog], and the guy forgot all about beating anybody up, leaned down and hugged the dog."

In 1994, the year after Pauline Hanusosky was assaulted, Arizona became the first state in the nation to raise the penalty for assaulting a health-care worker or an emergency medical technician from a misdemeanor to a Class 6 felony. The bill was introduced by the Arizona chapter of the Washington-based ACEP, but it was shot down by the Senate more than once before becoming a law.

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