Under the Knife

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"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.

"Our philosophy was simple," says ACEP member Dr. Todd Taylor, an emergency physician at Good Samaritan. "On the grand scale of things, how many times do you hear about an assault occurring at a police station? Never. Why? Because you'd have to be deranged to perpetrate a crime at a police station. That was our attitude about the ED. It's supposed to be a safe haven for someone who is down on their luck, ill or injured, and anyone who violates that should be penalized."

Taylor and another ACEP member, Dr. Patrick Connell, were also concerned that hospitals were minimizing incidents to deflect a negative image. "We all know stories about health-care workers being physically threatened or assaulted by a patient," Connell says, "but several years ago, we knew we'd get stonewalled when we did anything about it. The hospital administrators wanted the violence kept quiet 'cause it was bad publicity."

Police did little to encourage hospital workers to hold attackers accountable. "Several of our nurses had been assaulted and the police just blew it off. One had been punched by a patient. They said if we booked the perpetrator they'd come back in less than 24 hours with a submachine gun, so just ignore it."

Connell remembers a time when hospital emergency departments were practically immune to violence. When he began his medical practice at Maryvale 22 years ago, the janitor doubled as a part-time security officer.

"Sadly, we have evolved to where they are no longer hallowed healing places. The number of weapons and violence has escalated tremendously to the point where we now need trained, professional security forces," Connell says.

"I work in a part of town where there is a lot of violence in general," he says. "People are subject to gun violence and domestic violence and you end up with a lot of people impaired by drugs and alcohol. There's a climate here that is ripe for violence. Physicians, nurses and techs are particularly vulnerable. In order to effectively deal with patients, you have to get physically close to examine them. You don't know who they are or if they're armed."

Connell was recently threatened by a gang member whose buddy had suffered a chest wound.

"I was told, 'If anything happens to Homeboy, you're history.'"
Connell says half the assaults at Maryvale have been committed by family members. "They become frustrated with the system. Often they don't realize that we help people in the order of how serious their illness is, that we'll care for the person with a heart attack before someone who's been waiting three hours with a sore throat. Or they have unrealistic expectations of what we can provide them with and lash out when those expectations aren't fulfilled."

The availability of narcotics also poses a safety threat. Connell says he sees people on a daily basis looking for drugs.

"They'll go from ED to ED. Some are very creative. They'll say, 'My dog ate my prescription' or 'I came here for the weekend for my aunt's funeral and forgot my medicine.' I've had people threaten me if I didn't give them what they wanted."

In November 1993, a vicious incident occurred at John C. Lincoln Hospital which sent a shudder throughout Arizona's medical community. The assault happened at 4:30 on a quiet Sunday afternoon.

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Leigh Silverman