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Friday Jul 14, 2017

Hospital Shooting Raises Questions About Safety, Mental Health

I can still feel the sense of shock and horror I experienced recently when I heard that a disgruntled physician had killed another doctor and wounded six others(www.nytimes.com) at Bronx-Lebanon Hospital Center in New York.

[Crime scene tape stretched down hallway]

That was my program.

I was a family medicine resident at Bronx-Lebanon from 2010-2013, on the very floors where the shooting took place, so this event had a heart-wrenching effect on me. Bringing the tragedy even closer to home was the fact that the shooter, Henry Bello, M.D., was a graduate of my alma mater, Ross University School of Medicine in Dominica.

Bello started working at Bronx-Lebanon shortly after I graduated. He was employed as a night-covering physician in 2014 and 2015, working alongside family medicine residents. As an international medical graduate awaiting entrance into a residency program, he had received a limited permit to practice as a house officer.

While in residency at Bronx-Lebanon, I worked with such interim medical staff and was often impressed by their skill because many had already practiced in their own countries before coming to the United States. Bello had followed his own path from Nigeria and Dominica to what he had hoped would be a new beginning in New York. Unfortunately, he reportedly suffered from mental illness and was eventually asked to resign following a series of instances of misconduct.

After the shooting, I spoke with several colleagues from Bronx-Lebanon to give my condolences and support. They shared the terror of their experiences but emphasized the heroism and resolve of their colleagues. There were stories of medical and nursing staff and students rushing to the aid of the injured, EMS workers barricading themselves in rooms with patients, and others carrying the wounded down many flights of stairs to safety.

One physician Bello blamed for his loss of employment was not on duty at the time of the shooting. Another doctor the shooter reportedly held a grudge against was at work and escaped a close call when a bullet pierced his backpack.

Tracy Sin-Yee Tam, D.O., was not as fortunate.(www.nytimes.com) Tam usually worked in clinic but had volunteered to cover another doctor's shift that day. She was 32.

Russell Perry, M.D., who runs an HIV and hepatitis C specialty clinic out of the Bronx-Lebanon Hospital Wellness Center, told me that Tam was like an angel with her sweet spirit and calming presence. He was mentoring Tam in HIV and hepatitis C treatment, which she had grown to love and intended to make a big part of her practice. A GoFundMe account(www.gofundme.com) has been set up to help cover her funeral costs and related family expenses.

I can only imagine the difficulty of returning to work after experiencing the trauma of this event, but that is what most of the physicians and staff chose to do as soon as they could.

Douglas Reich, M.D., chair of the Bronx-Lebanon Hospital Department of Family Medicine, invited residents to a gathering at his home to debrief them and discuss their future in the program. The hospital also is providing free trauma counseling services for employees.

Bello attempted to set himself on fire after his rampage but was thwarted by the sprinkler system. The ensuing water damage temporarily closed the 16th and 17th floors, but the hospital opened two other floors to family medicine residents and medical students. The hospital already has transitioned from the quiet shell it was in the immediate aftermath of the shooting back to the bustling center of medical care it has always been.

Bronx-Lebanon was my first choice for residency after I rotated there as a medical student. I chose it because of the inner-city experience, the intensity of the training and the diversity of the patient population, and I have great admiration for the true heroes who continue to care for patients there every day. I was also impressed by its leadership in adopting the medical home model of care and its success in utilizing community health workers for in-office and in-home patient support and education.

Like many medical students transitioning into residency, I wondered if I was up to the task. The hardest part was working on the family medicine inpatient unit, and that is where I started on day one. I felt like I was a recruit in boot camp, but I am grateful for the experience.

The horrific shooting leaves much to contemplate and discuss. Amid the innumerable obstacles and stressors we face daily in our incredibly demanding field, employee safety is a growing concern. It is an unfortunate and disconcerting fact that workplace violence has become increasingly common.

In my own rural clinic in southwest Missouri, I have faced backlash from disgruntled patients, mostly related to restricting their access to narcotics. We have put security measures and numerous precautions in place, but I still wonder if my workplace is truly safe. This is the paradox physicians face: putting our comfort and possibly our lives on the line to help others.

Too often, we function as workaholics who are accustomed to pushing past our physical, mental and emotional pain to get the job done for the benefit of our patients and careers, but do we do this at our own expense or to the detriment of those close to us?

In some states, such as New York, there are laws that make assault against nurses(www.nurse.com) and other medical staff(www.nysut.org) a felony. However, in many states -- including New York -- no such law specifically protects physicians.

Although I have heard it said that a hospital should not be fortress, I do think that more attention should be paid to the security features and protocols implemented in our places of work. We need to provide safe, locked work spaces; metal detectors for main entrances; security cameras where appropriate; well-trained, well-equipped security guards for each clinical location; and safe, well-lit parking lots. We also need to have protocols for dealing with disgruntled or violent patients and staff. All protocols and procedures must be reinforced with frequent education and training exercises. When it comes to social media, attention needs to be paid to protecting medical professionals and staff from cyberbullying.

As physicians, it is second nature to consider the psychiatric needs of our patients, but we may easily neglect our own mental health or that of our colleagues. This is a cautionary tale to be mindful that mental illness can sometimes be a silent disease that acquaintances, friends or colleagues could be struggling with. We must recognize the red flags and make sure that those who need psychiatric care receive it.

Finally, I want to reiterate my deepest sympathies for those who suffered trauma or loss because of the Bronx-Lebanon shooting. My sincere admiration and respect go out to those resilient souls who strive every day to find a way forward after such a life-altering event.

Kurt Bravata, M.D., is a family physician who practices primary care, geriatric medicine and addiction recovery in rural southwest Missouri.

Posted at 10:01AM Jul 14, 2017 by Kurt Bravata, M.D.

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