- A gunman shot his doctor and several others in Tulsa, Oklahoma, on June 1 after an operation.
- The gunman blamed the doctor for his pain. Doctors told Insider that the shooting "hit home."
- They said threats on the job are common — especially in the emergency room.
Doctors across the country were saddened but not shocked when a disgruntled patient walked into a Tulsa clinic and shot his surgeon and three other people.
"It's scary, but it's not unfamiliar," Dr. Hasan Gokal, a Houston-area emergency room doctor, told Insider.
Physicians told Insider that patients often start threatening healthcare workers if they're not being prescribed the medication they want, or in situations where a family member is in a critical condition — especially in places like the emergency room.
Pain management is the biggest fuel for threats
On June 1, a gunman killed Dr. Preston Phillips and wounded several others inside a medical building at St. Francis Hospital. The gunman blamed Phillips for post-surgical pain after an operation.
Gokal told Insider that similar to the Tulsa case, the most common reason for a threat is someone upset about a pain management plan.
Associate Chief Medical Officer Dr. Kevin Torres at Yale New Haven Health told Insider that it's not uncommon for patients to be upset when he won't prescribe them their medications of choice or feel they weren't helped.
"There's always a bad apple, but no physician or nurse gets out of bed and says, 'I think I'm going to hurt somebody today. You know, I think I'm not going to help them today.' I mean, that's why we went into what we do — to help people," Torres said. "It is a grind in the sense of you can't help everybody."
Gokal said there's a familiar pattern to these threats and attacks. He explained, for instance, that has it become harder for patients looking for opiate medications to get them because of stricter policies to control prescription drug abuse.
"But for those legitimate patients who require these pain meds, suddenly this was incredibly difficult. And that's the big problem that we run into," he said. "Often physicians have to figure out whether this is a legitimate source of pain, or if this is completely fictitious. It's not very obvious often and often they get it wrong. And it's not surprising that you get such violent reactions to this sometimes."
Threats and violence are not a surprise for healthcare workers
Torres said the Tulsa shooting "hit home" for himself and other doctors.
"We deal with people at their worst, unfortunately, and they're in pain, they may have psychiatric issues," Torres told Insider. "So you're at your absolute worst, you're scared, you're nervous, you're physically uncomfortable a lot of the time and so, yeah, people do get upset."
The World Health Organization estimates that somewhere between 8% and 38% of health workers worldwide suffer physical violence at some point in their careers, and significantly more deal with verbal threats and aggressions.
"Violence against health workers is unacceptable. It has not only a negative impact on the psychological and physical well-being of healthcare staff but also affects their job motivation. As a consequence, this violence compromises the quality of care and puts health-care provision at risk," the agency said.
Torres said in one instance, he had a patient jump off a stretcher and lunged at him.
"Luckily, EMS, the ambulance guys were right there and caught him. I mean, it was just a matter of time. So yeah, I mean, there's no question about it. It happens and it does lead to unfortunate burnout and everything else," Torres said.
Gokal told Insider this has been an ongoing issue for decades but has gotten worse during the pandemic — especially as patients got upset over COVID-19 protocols. In one instance, he said a patient got angry, stormed out of the ER, and threatened Gokal after he suggested he take a COVID-19 test. The patient believed the virus was a hoax and lashed out at Gokal.
"The nature of the threats has taken more of a political overtone over the last two years. I don't know if that's going to simply dissipate as COVID goes away or whether it's going to take some other form," Gokal said.
Very limited safety protocols in hospitals
Torres and Gokal both said that most hospitals don't have any security and a physician would have to call 911 if they felt a threat was serious.
"You have to really think that the threat is very real to have to call 911, otherwise you would be calling on a very regular basis," Gokal said, adding that there were many instances where the ER had to go on lockdown because of a threat.
He also said, in his experience, he has seen an individual make a threat to shoot up the hospital only to come back days later into the ER with a self-inflicted gunshot wound.
Torres explained that some hospitals — mostly in urban settings — may have metal detectors at their entrances but for the most part, many don't.
Easy access to firearms and limited mental health services play a role, experts say
Both Gokal and Torres added that access to firearms was a part of the conversation, but said their unsure what protocols need to be in place to balance "culture" and safety.
"We live in Texas, guns are part of the culture here," Gokal said. "And without changing anybody's culture, how can we find ways to make everything safer?"
Torres said expanding mental health care is also necessary so people who need help don't get discharged without receiving it in addition to a stricter screening process for people seeking to acquire firearms.
However, Torres said while there may be efforts to discuss mass shootings after several, he says this isn't a problem that will simply go away.
"We all know of patients that we would certainly be concerned about or interactions that we had. There's no question you used to hear about shootings and it was kind of a removed thing and (now) it seems to be hitting home," he said.
"Now you're talking about the grocery store. I've got kids in schools, and now in the hospital – your work. It just doesn't seem to have any limits. It's really incredible."