It took just a minute and a half for a disgruntled patient to leave his deadly mark on a Nevada urology clinic, irreversibly changing the lives of everyone inside.
In the time it would have taken staff members at the Reno office to copy a couple of insurance cards or set someone up in an exam room, the man left a doctor dead, two others injured, and employees and patients shouldering the weight of grief, shock, and fear.
That ordinary afternoon in December 2013 turned terrifying when the man entered Urology Nevada carrying a shotgun, passed through the waiting room with a warning that patients should leave, and marched into the practice’s clinical area, where he shot two physicians—one of them fatally—and accidentally wounded a patient.
Then, catching sight of the clinic’s office manager and mistaking her for a doctor, the man followed her to her office and pounded on her locked door with the butt of his gun, screaming. From under her desk, the manager called 911, and when sirens sounded outside the building, the gunman went back into the reception area and committed suicide.
It was all over in a moment, but for some, nothing would ever be the same. Charles Garo Gholdoian, MD, 46, was killed in the attack. Surgeon Christine Lajeunesse, MD, FACS, had a shattered right arm—her operating arm—that continues to require intensive physical therapy.
Yet the clinic was “eerily quiet,” with everyone hiding in place. The practice’s chief operating officer, Irene Heinemeier, FACMPE, recounted the tragedy during a recent talk to urologists, in which she urged the doctors to be aware of the recent shootings of several of their colleagues across the country, and to take precautions to protect themselves, their employees, and their patients against similar attacks while there’s still time to intervene. She gave the talk with Eugene Rhee, MD, chief of Urologic Surgery at Kaiser Permanente San Diego Medical Center during a Practice Management Conference at the Annual Meeting of the American Urological Association (AUA) in May.
The shootings at Heinemeier’s clinic were among four across the nation over the past 11 years that have targeted urologists, she and Rhee said, including one at a Newport Beach, California medical office, in which Ronald Franklin Gilbert, MD, was killed in January 2013, and one at Kaiser Permanente in which the doctor survived. Another Kaiser Permanente urologist was wounded by a patient in a shooting 20 years ago, a spokeswoman for the institution confirmed, and a urology clinic in Colorado Springs was the site of violence in 2012, when a gunman held three people hostage before being shot by police.1
“I could go on for 4 hours about the aftereffects of an incident like this, and I hope you never have to go through it,” Heinemeier said. But in case it happens, she urged, urology practices should “please take this seriously and put [safety measures] in place.”
Violence in Health Care: Facts and Motivations
According to a paper released in 2010 by the US Bureau of Labor Statistics,2
nearly 60% of the nonfatal workplace assaults and violent acts between 2003 and 2007 occurred in the health care and social assistance industry, with patients or residents of healthcare facilities responsible for the violence in nearly three-fourths of those cases.
Furthermore, according to the paper, a worker in health care or social assistance is nearly 5 times more likely to be the victim of a nonfatal assault or violent act by another person than the average worker in all industries combined.
As far as job-related fatalities within the industry, 22% of those in 2007 were the result of assaults or violent acts, the paper stated.
While there is no data on whether urology is more affected by workplace violence than other medical specialties, Rhee said, “The numbers are really compelling. So, we ask ourselves the question: Is there something that we really need to take a close look at? Are we in a specialty that requires us to be sensitive to the patient encounter more so than other specialties?”
Even short of a definitive answer, it makes sense for urology practices to lead the healthcare world in learning to protect against workplace violence—whether that takes the form of a shooter or a verbal assault, Rhee and Heinemeier agreed. Urology clinics not only need to have physical safeguards in place, but should train doctors and support staff in how to best handle such situations, the speakers said.
Ironically, Heinemeier’s practice had planned a training session on how to handle a shooting incident for mid-January of this year; the tragedy occurred a month before that.