A troubled Vietnam veteran with a 9mm handgun held police at bay for 10 hours last month inside the emergency department of the Veterans Affairs Medical Center in East Orange, N.J.
At University Hospitals of Cleveland last November, a disgruntled patient, clad in a physician's lab coat and toting a .38 caliber pistol, shot and injured his orthopedic surgeon in the abdomen because medical treatments the physician had prescribed failed to cure the assailant's back pain.
And last August, a woman with a .38 caliber handgun walked into a nursery at Corona (Calif.) Regional Medical Center and shot and wounded a nurse with whom she was upset because of a man both women were believed to be involved with romantically.
The terror attached to these incidents has become all too familiar in medical centers that once were considered safe havens from violence. They are among the most recent of some 2,300 assaults reported by 335 hospitals since 1990, according to the Chicago-based International Association for Healthcare Security & Safety.
At the VA Medical Center in East Orange, the terror began about 10: 30 p.m. on Jan. 26, when Isslam Kurbansade, 47, was being examined by a physician in the hospital emergency department. The suspect later pulled out a handgun, demanded treatment and then barricaded himself in the emergency department, threatening to harm himself and others.
Negotiators kept in touch with Mr. Kurbansade through an intercom system, and some 31/2 hours after the siege began, he was coaxed into surrendering with the help of a Newark policeman brought to the facility at his request. The suspect was charged with aggravated assault. He also faces two other charges of possession of a firearm by a convicted felon and use of a firearm during commission of a crime of violence, according to the prosecutor.
Tonianne Bongiovanni, the assistant U.S. public defender appointed to represent Mr. Kurbansade, said he had been treated at the hospital for various ailments, including asthma and diabetes, during the past decade. Mr. Kurbansade also had been a patient in the VA hospital's 12th-floor psychiatric ward, where he was diagnosed as suffering from post-traumatic stress disorder.
Although this incident didn't end in tragedy and none of the VA's 450 other patients were injured, the suspect did manage to enter the hospital carrying a loaded weapon and fire it at least five times during the episode.
That kind of event, and the fear that the hospital and its workers may not emerge unscathed by future incidents, have terrified healthcare administrators around the country into shoring up safety and security measures.
In California, where a string of shooting sprees plagued hospital emergency departments last year, fear has pushed the healthcare industry into creating a public policy movement to reduce violence in hospitals and improve security tactics.
Two key pieces of legislation, endorsed by the California Association of Hospitals and Health Systems and signed last fall by Gov. Pete Wilson, aim to minimize the risks and dangers affecting hospital personnel, patients and others in emergency department settings.
CAHHS co-sponsored SB 587, which is designed to curb violence in California hospitals by increasing criminal penalties for incidents of violence committed in or near public hospitals. Previously in California, only violent acts committed in schools and parks carried stiffer penalties.
The healthcare association also supported AB 508, which requires that all acute-care, psychiatric and specialty hospitals develop a security plan addressing safety procedures for patients and staff. The new law requires special security training for all workers who are regularly assigned to the emergency department.
Healthcare executives are hoping these legal measures, plus added structural changes to hospital facilities-installing closed-circuit monitoring, panic buttons and bulletproof glass, and restricting entrances to buildings during late-night hours-will help deter violence inside hospitals and ensure patient safety.
Many of those measures were taken last year by Los Angeles County-USC Medical Center after the highly publicized five-hour shooting spree and hostage ordeal by a gunman who opened fire inside the medical center's crowded emergency department.
The assailant, 40-year-old Damacio Ybarra Torres, walked into the hospital's outpatient clinic and began shooting, critically wounding Richard May, M.D., and two other emergency department physicians. All three physicians eventually recovered from their wounds.
The jury trial for the assailant, who faces three charges of attempted murder and two of false imprisonment, was scheduled to begin last week.
LAC-USC embarked last year on a $2 million security plan designed to reassure the public and workers of the safety of the facility. So far, $1.5 million has been spent.
Under the plan, 35 security guards were hired, bulletproof glass was installed in the hospital's walk-in clinic, and panic buttons were placed in the emergency department. The plan also expanded the hospital's security force on the building's first floor to include 24-hour coverage of the structure's 22 entrances.
Security measures taken at LAC-USC were a part of steps taken by Los Angeles County officials to upgrade security at all six county-operated hospitals.
The violent incident at LAC-USC sent other Southern California healthcare providers scurrying to review and revise security procedures.