Posts Tagged ‘violence’

Gun Violence In America Is An Example Of The Worst Form Of Insanity

Tuesday, May 31st, 2022

Beginning in 1959, and as it has every year since, the Gallup organization polled Americans with this question: “Do you think there should or should not be a law that would ban the possession of handguns, except by the police and other authorized persons?”  When Gallup asked that question in 1959, 60% of Americans said “Yes.” Thirty-two years later, in 1991, the “Yes” group had decreased to 43%, and thirty years after that, in 2021, only 19% of Americans were still saying “Yes.” A whopping 80% now said “No.”

Since 1959, when Gallup also reported 78% of American saying laws covering the sale of firearms should be made more strict, the decline in support for banning guns has been inversely proportional to the 63-year steady, linear rise in gun violence. The result is what we have today. Gun violence has become a cancer eating away the heart and soul of our society.

It may interest you to know that the proposition reflected in Gallup’s question precisely mirrors the law in the UK. No one is allowed to own a gun except “police and other authorized persons.” Exceptions are made for hunting and target shooting, but these are highly regulated and controlled by government. There is very little handgun violence in the UK. To this, you may say, “Without guns, people will just find another way to kill.” To which I reply, “I’d rather try to outrun a knife than a bullet.”

Last week, immediately following the massacre of 19 little children and two teachers at Robb Elementary School in Uvalde, Texas, a British reporter asked Texas Republican Senator Ted Cruz why the US suffers a seemingly intractable and growing slaughter of innocents through mass shootings. The reporter pointed out America is the only highly developed country in the world where this occurs. So, why America? Rather than attempting to address, much less answer, the question, Cruz launched into platitudes about what a great country America is. When the reporter continually pressed him for an answer (US reporters should take this as a learning experience), the Senator, after trying the platitude thing again, simply avoided the reporter and hurriedly left the area.

I viewed this exchange as an important one. It highlighted the societal dichotomy we face. The US dwarfs the 28 most economically developed countries in the 38-member OECD* in deaths by firearms. In our country, 98 people die by firearms every single day. In those other 28 OECD countries, with a combined population more than twice that of America (712 million vs. 331 million), that number is 19.

Thinking about the British reporter’s question to Senator Cruz, I decided to dive into the actual statistics to compare our gun violence experience with that of the 28 OECD countries cited above as a whole. The year I’m using as a benchmark is 2015, because a number of peer reviewed and credible studies were done that year. I assure you, as I will note below, the situation has only gotten worse in the succeeding six+ years.

2015 (Rates per 100,000 persons)

All Homicides
US – 5.6
Other 28 countries – 0.7

Homicides by firearm
US – 4.1
Other 28 countries – 0.2

Non-firearm homicide
US – 1.5
Other 28 countries – 0.6

Accidental firearm death
US – 0.2
Other 28 countries – 0.0

Firearm death rate
US – 11.2
Other 28 countries – 1.0

Total deaths by firearm
US – 35,769
Other 28 countries – 6,965

Population
US – 331 Million
Other 28 countries – 712.3 Million

Not only is our firearm death rate nearly 25 times higher than our OECD companions, our total homicide rate is eight times higher. We are a violent country.

And what about the mass shootings that, like a knife to the heart, horrify us every time one happens?

The FBI found an increase in active shooter incidents between 2000 and 2020. There were three such incidents in 2000; by 2020, that figure had increased to 40. There have been 27 thus far in 2022.

In 2020, the FBI reports, 513 people died in mass shooting incidents. In that year, according to the CDC, 45,222 of our neighbors died by firearms. Note how that is nearly 6,000 more than we reported above for 2015.

The number of deaths from mass shootings is paltry compared to the number of total deaths by firearms nationally (0.011%).

So, now, in the face of all this mayhem, we hear that our elected legislators may be willing to take some action at an unknown time in the future regarding gun control. We know Americans support this.

Politico/Morning Consult poll published last Wednesday showed “huge support” for gun regulations in that 88% of voters strongly or somewhat strongly support background checks on all gun sales, while only 8% strongly or somewhat strongly oppose such checks. That’s a net approval of +80.

Preventing gun sales to people who have been reported to police as dangerous by a mental health provider is supported by 84% of voters while only 9% oppose it, a net approval of +75. I’m forced to wonder about those 9%ers.

A national database for gun sales gets 75% approval and 18% disapproval, a net approval rate of +57.

Banning assault style weapons like the AR-15 has an approval rate of 67% while only 25% disapprove. That’s a net approval of +42.

And fifty-four percent of voters approve of arming teachers with concealed weapons, while only 34% oppose it, a net approval of +20. Wait—armed teachers. Think about that for a moment. I can just see Sister Mary Stellan, my 2nd grade teacher, packing heat.

These numbers may lead to some kind of legislation. However, as long as we have more guns (393.1 million) in this country than there are people (331 million), do you really believe things will improve significantly?

Among US states, the rate of firearm deaths varies widely. In 2020, Mississippi had the highest firearm death rate in the nation, 28.6 per 100,000 Mississippians, according to the Centers for Disease Control and Prevention, as opposed to 0.2 in our OECD comparison (I continue to ask, “What goes on in Mississippi?”). New England states fared better, and Massachusetts, where I live, had the second-lowest rate of gun deaths in 2020 at 3.7 per 100,000, trailing only Hawaii at 3.4. However, the Massachusetts rate was still 5.3 times higher than the combined rate of gun deaths in the other 28 countries.

To put a period on this: At less than half the population, the US has 83.7% of all the deaths by firearms in the 29 most highly developed OECD member countries. If our firearm death rate mirrored that of just an average OECD country, deaths by firearm in America would drop 96%. At 45,222 deaths in 2020, that would be 43,413 folks who would still be with us.

I can only conclude that what the NRA paid-in-full Congress is thinking about doing maybe at some point in the possible near term is nothing more than nibbling at the edges of a monstrous problem, and they’re nibbling in ever so tiny bites.

This is insane.

 

*The Organization for Economic Co-operation and Development, founded by the US and it allies shortly after the close of the Second World War. Its members are the most economically developed countries.

 

It’s Time For Some Morality In Leadership

Wednesday, May 25th, 2022

Nineteen young children and three adults including the 18-year-old shooter. Slaughter on a grand scale, American style.

What can one say that hasn’t been said before and is being said again right now? Nothing. We have run out of new words.

Gun law advocates will say are saying, have said — we need tighter gun control laws. Second Amendment obsessives will say are saying, have said— No, we don’t; it’s not the guns. It’s the demented people using them.

These positions are not mutually exclusive, but that is how we treat them. Result? Nothing ever gets done, and the killing goes on.

I wrote about this back in 2019, and, because not a thing has changed since then, I thought I couldn’t do better than to share a portion of that column.

September, 1970

Let me tell you a story.

We call it “going back to the world.” Home in the USA. And I’ve arrived in one piece. For the last couple of years I’ve been running around the jungles of Vietnam. My new orders direct me to report to the Army’s Officer Candidate School at Fort Benning, Georgia. I know the place well. It’s where I was trained and Commissioned a 2nd Lieutenant. Then on to Airborne and Ranger schools. Now a Captain, the job is to train the next bunch of happy warriors. My wife and I settle into the house at 3660 Plantation Road in the fine city of Columbus. It’s a nice neighborhood.

A few months after moving in a new civilian worker shows up at my office in the Infantry School. His name’s Bob. He’s a GS12 research analyst and I have no idea why he’s here, but he has a disability that makes it hard for him to walk or move even moderately weighted stuff. He’s rented a house in Columbus and is trying to figure out how to move his junk in. My wife and I offer to help.

So, on a sunny Saturday morning in the deep south we get into Marilyn’s red Corvair Corsa with its turbocharged engine and dual carburetors, show up at Bob’s new place, and find a UHaul truck in his driveway packed with everything he owns. We get to work toting box after box into the house and putting it all where Bob wants it to go. It’s taken us all morning, but around noon we’re done and we sit down on Bob’s new furniture to celebrate the end of Bob’s beginning. Marilyn’s never met Bob, whom I’ve charitably described as being “a little strange.”  So, being a curious person she nicely asks about his life. This goes on for a while until the big moment.

The big moment is when Bob says to Marilyn, “Wanna see my hair-trigger Colt 45s?”

It’s like an E. F. Hutton commercial. Everything stops. I freeze for a second and then say, “Bob, do you really have hair-trigger Colt 45s?” He says, “Sure do. Two of ’em. They’re pearl-handled, too. Want to see?”

He’s asking a guy who’s just finished two years dodging bullets and other bad things in a spot where serious people really wanted to kill him and his men. To say I have developed a healthy respect for any kind of gun is not giving that phrase the value it needs. Having seen up close what they can do, the accidents that can happen, actually did happen, makes me scared to death of them. I’m not scared when they’re in my hands, but in somebody else’s who probably doesn’t know what he’s doing? I’m not scared yet, though, because Bob has yet to produce the firepower, but my tension level rises like a Goddard Rocket.

I look Bob dead in the eye and say, “Bob, please don’t get the 45s. Leave em’ right where they are. Marilyn and I have to be going. Hope you like your new place.” And with that, we leave.

We get back into the red Corvair Corsa with the turbocharged engine and dual carburetors and drive home. When we get to the house on Plantation Road I pay the babysitter and look at the two-year-old daughter I’m just getting to know. And I think about the pearl-handled, hair-trigger Colt 45s in Bob’s house.

May, 2022

A University of Washington 2017 study found that three million Americans carry a loaded handgun daily; nine million do so at least once a month. According to the recently completed U.S. Census, there are somewhere around 390 million guns in the hands of civilians in America. According to the CDC, nearly eight-in-ten (79%) U.S. murders in 2020 19,384 out of 24,576 involved a firearm. That marked the highest percentage since at least 1968, the earliest year for which the CDC has online records.

Unfortunately, all the CDC can do is report the numbers. Why? Because a 1996 appropriations act contained something that has come to be known as the Dickey Amendment. That amendment is interpreted to prohibit the CDC from doing any research into gun violence. The amendment says federal funding could not be used to “advocate or promote gun control.”  Since more than 38,000 people die by gun violence per year (murder and suicide), is it too much to ask that the Centers for Disease Control and Prevention spend a few million of its $5 billion budget to research and analyze gun violence. Seems a modest proposal to me.

The Houston Chronicle reports the shooter in yesterday’s massacre bought his AR-15 rifle the day after he turned 18. That would be par for the course, because in mass public shootings, the weapon of choice is the assault rifle. The National Shooting Sports Foundation has estimated that approximately 5 million to 10 million AR-15 style rifles exist in the U.S. Regarding assault rifles, I know a thing or two. And I can say with complete certainty and a good deal of experiential credibility that there is not a single reason on God’s lovely earth why anyone other than police and my military brothers and sisters should have one, especially one with automatic fire capability. Anybody who tells you differently is chock full up to their eyeballs with what makes the grass grow green and tall.

We all know that this country is not going to take firearms from its citizenry. However, there are sensible things we can do now —  sensible things that most Americans support. For instance, weapons need to be better controlled through age restrictions, permit-to-purchase licensinguniversal background checkssafe storage campaigns and red-flag laws — measures that help control firearm access for vulnerable individuals or people in crisis.

No one in their right mind commits a mass shooting, but people not in their right minds seem to manage it, and carnage results. And we do nothing. It is a terrible thing to say, but I can only conclude that a majority of our legislative leaders have been bought and paid for by gun lobbyists. No other explanation for inaction seems plausible after the year after year after year slaughter of innocents.

It is high time to force our leaders to ditch the “thoughts and prayers” and find the spot somewhere in their hypocritical, opportunistic, power-hungry being where they have hidden their sense of decency, their morality, presuming they ever had any.

How Far We Must Go

Wednesday, April 21st, 2021

In 1675, the first and one of the deadliest wars ever fought on what is now American soil began. Fifty-six years after the sailing of the Mayflower, the tenuous Native American-Puritan bonds, built with careful distrust, burst asunder with disastrous results for everyone.

In 1616, European traders had brought yellow fever to Wampanoag territory, which covered present day Provincetown, Massachusetts, to Narragansett Bay, Rhode Island. The epidemic wiped out two-thirds of the entire Wampanoag Nation (estimated at 45,000 at the time). So, when the first batch of Puritans landed in 1619, Massasoit, Sachem of the Wampanoags, was on high alert. He waited until 1621 to meet the new immigrants, and then forged a guarded relationship between his people and theirs. In late-March, 1621, he and Governor John Carver signed the Wampanoag-Pilgrim Treaty. In the Treaty the two peoples agreed to do no harm to each other, to come to each other’s aid if attacked by third parties and to have equal jurisdiction over offenders: if a Wampanoag broke the peace, he would be sent to Plymouth for punishment; if a colonist broke the law, he would be sent to the Wampanoags. In addition, the Wampanoag leaders agreed to tell neighboring indigenous nations about the treaty.

For fifty years, the entente, occasionally fraying, held. But as more and more English immigrants arrived with weapons native Americans had never seen, and as the new immigrants began asserting themselves more and more over the indigenous nations, it became a when, not an if, a war would break out.

When Massasoit died in 1665, his son Philip became Sachem. Philip had few of his father’s diplomatic skills, and his people were becoming more and more angry at the dictatorial actions taken by the white people. After three of his trusted lieutenants were executed by the pilgrims in a woeful miscarriage of justice, Philip had no choice but to go to war if he wished to remain in power. In 1675, he did just that.

King Philip’s war brought tragic consequences for all. As so often happens, the white settlers of Plymouth Colony grossly underestimated the tactical skill of the warring indigenous nations, but in the end European firepower won out. Before the war, historians estimate about 80,000 people lived in New England. Nine-thousand died during the fourteen months of King Philip’s War, more than 10% of the total population. Proportionately, that’s more than in both the Civil War and the Revolution. One-third of the towns in New England lay in ashes, farms were abandoned and the fields lay fallow. Philip was hunted down in Rhode Island’s Misery Swamp and killed. His body was quartered and pieces hung from trees. The man who killed him, John Alderman, sold his severed head to Plymouth Colony authorities for 30 shillings.

And so we come to war’s end in 1676, and Josiah Winslow, the governor of Plymouth Colony, had a problem. Namely, what to do with hundreds of native Americans—surviving leaders of King Philip’s War and their families.

Winslow decided to get rid of them by loading them all, including Philip’s wife and nine-year-old son, onto several ships bound for the Caribbean, one of which, ironically, named Seaflower.

As Nathaniel Philbrick writes in his masterful Mayflower (Viking Penguin, 2007):

In a certificate bearing his official seal, Winslow explained that these Native men, women and children had joined in an uprising against the colony and were guilty of “many notorious and execrable murders, killings and outrages.” As a consequence, these “heathen malefactors” had been condemned to “perpetual slavery.”

Thus, joining Rome and other ancient societies, our white ancestor enslaved a conquered people.

Yesterday, 345 years after the Seaflower sailed from Plymouth harbor, a jury of his peers, a diverse jury, convicted Derek Chauvin on all three counts of murder in the death of George Floyd. What struck me most, the image that cannot be unseen, is the smirk on Chauvin’s face as he kneeled the life out of a man who did not look like him. I imagine it to be the same look Governor Winslow had on his face as he signed the certificate condemning hundreds of indigenous people, who did not look like him, into perpetual slavery.

How far we’ve come. How much, much farther we must go.

 

This Is What Happens

Thursday, January 14th, 2021

This is what happens when leaders sell their souls for power.

In the last week, our country and the very concept of democracy have come perilously close to being crushed by the triumph of insurrection. Every day, every hour, we learn more about the plot to bring down the government and establish Donald Trump as de facto dictator. That this was predictable, yet still happened, will be analyzed for years. That it failed (so far), should give no comfort to anyone.

Sabateurs, terrorists in the literal sense of the word, hiding in the belly of the mob, were on a mission to kill Nancy Pelosi, Mike Pence and probably others if they could find them. The FBI is discovering a carefully planned attack, and we are fortunate, indeed, that the traitors’ targets survived. It could easily have gone the other way.

This is what happens when monumental hubris and blind ambition turn the leader of a political party, the party of Abraham Lincoln, into Christopher Marlowe’s Doctor Faustus. Four years ago, a Kentuckian named McConnell agreed to a deal with the Mephistopheles who rode the golden escalator in June of 2015 as The Music of the Night, from Andrew Lloyd Webber’s Phantom of the Opera, blasted through the basement of Trump Tower. How fitting.

In this Faustian bargain, the Kentuckian’s deepest desires were granted: remaking the nation’s judiciary; changing tax laws to benefit corporations and the wealthy; dismantling environmental regulations; eviscerating the country’s immigration system; abandoning global partnerships; solidifying a populist base. In exchange for this unholy alliance, Marlowe’s devil-in-chief ran amuck around America preaching authoritarianism, white supremacy and “American carnage,” which he “alone could fix,” to a congregation of millions of vulnerable citizens long fearful of the way life was changing and leaving them behind. They swallowed it whole.

This is what happens when, in April, 2021, armed white supremacists, Neo-Nazis calling themselves Proud Boys, but acting more like “Brownshirts,” stage a rehearsal for last week’s coup attempt in Lansing, Michigan, invading and taking over the state’s capital with plans for capturing and killing the governor, after which they face zero criticism from our modern-day Mephistopheles. What a boost to their movement.

This is what happens when a country, bombarded with more than 34,000 presidential tweets and 323 fan-the-flames presidential rallies over four years, becomes so desensitized to the stoking of racism and intense polemical bullying that politicians, elected to serve their constituents and the Constitution, become too fearful to denounce such behavior, let alone suggest it should never be condoned in America.

This is what happens when, taking a page from the propaganda manual of Joseph Goebbels, lies are told loud enough and often enough that gullible people believe with biblical certainty that the most secure election in our history was rigged and riddled with fraud. Polls continue to show more than 60% of Republicans believe this.

This is what happens when no one but toadying sycophants, whose moral corruption knows no bounds and whose sole job requirement is total devotion to the whims of their Mephistophelean leader, are placed in senior positions of authority. Now, as their deal with the devil unwinds, they are deserting the ship of state with nary a lifeboat in sight.

This is what happens when hate replaces kindness and a willingness to work collaboratively toward the common good to the extent that winning requires annihilation of one’s opponent. The result is a deep crack to the nation’s foundation.

This is what happens when the worst pandemic in a century is allowed to kill more than 400,000 of our fellow citizens by the time Joe Biden utters the solemn words of his oath of office. A pandemic during which never once has Donald Mephistopheles addressed the nation with words of comfort, empathy or even hope. A time in which the Oval Office has become an oval room of mirrors, where everywhere he looks he sees only himself. There’s no one there, Donald.

This is what happens when leaders sell their souls for power.

 

 

Today’s Class: Impeccable Timing 101

Monday, June 15th, 2020

No one will ever accuse the Republican Party of being overburdened with sensitivity. In two stick-in-the-eye moves just oozing with impeccable timing, the Grand Old Party is telling the world just what it can do with its Black Lives Matter folderol.

First, the GOP’s unquestioned leader, President Donald Trump, like a too long cooped up horse, has decided to resume his rallies, which for him seem to be better than crack cocaine. This week in Tulsa Oklahoma he and as many of his followers as campaign officials can cram into the 19,000-seat BOK Center will gather for a couple of hours of The Best Of Trump as if the COVID-19 pandemic had never happened, neither masks nor social distancing required. Reminds me of Ebenezer Scrooge discussing innovative methods to “decrease the surplus population.”

In the first of his two impeccable timing decisions, Mr. Trump announced he would hold his Tulsa rally on 19 June, known as Juneteenth, the date on which in 1865, the last of the South’s slaves were notified of their freedom under the Emancipation Proclamation. It would take until the following December and the 13th Amendment to officially abolish slavery in America.

Juneteenth is recognized as a state holiday or ceremonial holiday in 47 states and the District of Columbia (what are you waiting for Hawaii, North Dakota, and South Dakota?) and is the oldest celebration marking the end of slavery, dating from 1866.

According to the Associated Press, Trump was unaware of Juneteenth, let alone the significance of it to the Black community, when he announced his rally’s date. Consequently, he did not anticipate the blowback he would get. But get it he did. Even from his own supporters.  In a rare instance of backing down, he moved the rally to the next day, the 20th, still in Tulsa at the BOK Center.

But in America’s Black consciousness, Tulsa is known for a lot more than Juneteenth, as significant as that is. On another day in June, the 1st June day of 1921, Tulsa was the site of the worst race massacre in American history.

The day before, police had arrested a young black man by the name of Dick Rowland for allegedly attacking a white woman in a Tulsa elevator. Soon after Rowland’s arrest, rumors began to spread about a group of whites planning a lynching party. To protect Rowland, African American World War 1 veterans surrounded the jail holding him. There was a standoff with a mob of whites. Somebody fired a shot, and a firefight ensued. The much larger white mob pushed the black vets all the way to Greenwood, Tulsa’s black section.

Greenwood was the wealthiest black neighborhood in the country. Oil had made it rich. Racism was about to destroy it. Over the course of the day, 6,000 homes and businesses and 36 square city blocks were turned to ash. Pilots of two airplanes dropped turpentine bombs on buildings, instantly igniting them. Three hundred African Americans were slaughtered, most thrown into mass graves. Not a soul was ever prosecuted for anything. Then Tulsa, population 100,000, swept it all under the rug. Two generations later nobody knew a thing about it. It was never taught in schools, no books were written, no oral history passed down. It was as if it never happened.

Tulsa’s current mayor, G. T. Bynum, wants to take the rug up to see what’s hiding under it. He’s committed to investigating what happened and determining accountability. He thinks he’s found a couple of the mass graves and is having them excavated. The goal is to at least identify as many victims as possible through DNA analysis.

For the people of Tulsa, especially the black people of Tulsa, this is a deep, open, festering wound, and next Saturday Donald Trump will come riding into town on his big, very white horse to preach the gospel of Trump to 19,000 of his followers. It’ll be an interesting day.

There is one more incident of impeccable timing.

The Republican National Covention had been scheduled for North Carolina, but because North Carolina’s Democratic Governor Roy Cooper, concerned about the spread of COVID-19, would not guarantee a full house for the late August event, the Republican party has moved most of the convention to Jacksonville, Florida. The Coronation of Mr. Trump is set for the night of 27 August.

And, you guessed it, there is a black history story about 27 August and Jacksonville. It is known as Ax Handle Saturday.

The year is 1960 and the Jacksonville Youth Council of the National Association for the Advancement of Colored People (NAACP) is holding peaceful lunch counter sit-ins. Peaceful demonstrations. A group of outraged whites taking exception to this level of daring, begin spitting on the demonstrators and calling them names no one should ever be called. Then ax handles, mercifully without ax heads, suddenly appear along with baseball bats, and the demonstrators begin to get hit. Things go downhill from there. When it is all over dozens of young African Americans would be wounded in various ways. On a brighter note, nobody died, but that was probably blind luck.

To give you an idea of racial relations in Jacksonville at the time, a year earlier, in 1959, the year before Ax Handle Saturday, Nathan Bedford Forrest High School opened in Jacksonville, celebrating the memory of a Confederate General and the first Grand Dragon of the Ku Klux Klan.

The 60th anniversary of Ax Handle Saturday will be celebrated on 27 August in a park about a mile away from the convention at about the same time the balloons come down. Impeccable timing.

 

 

Violence In The ER: A Big Problem Getting Worse

Monday, November 26th, 2018

Men and women who yearn to follow in the footsteps of Hippocrates, Galen and Banting are taught many things in Med School, but there is no course called Violence In The ER, And What To Do When It Happens To You. 

Until recent times that hasn’t been much of an issue for the doctors and nurses who take care of us when we need critical care in a hurry. But in the 21st century, violence in the ER has become less the exception and more the rule.

In a 2018 American College of Emergency Physicians (ACEP) survey of 3,539 ER doctors, 47% reported being assaulted at work, 60% of those within the last year.

Why is this happening? According to ACEP, there are at least three problems with no easy solutions causing the sharp uptick in ER violence.

First, America has a tremendous shortage of psychiatric beds for people in profound mental stress. That means people in serious need of behavioral and mental health care can languish on a gurney in the ER for days, even weeks until a bed becomes available somewhere. Second, patients who’ve become addicted to opioids often show up in the ER demanding medication, and when they don’t get it things can get dicey in a hurry. Third, hospitals haven’t done enough to protect physicians and nurses from attacks by highly-stressed knife and (sometimes) gun wielding patients. Some hospitals have installed metal detectors at entrances, but the detectors and the labor required to screen incoming people can be pretty expensive, especially to a cash-strapped community hospital. Even with the metal detectors, many doctors in the ACEP study reported being kicked, punched, bitten and spit upon by deranged patients. This is a difficult issue for hospital risk managers to confront successfully.

We’ve known for many years that nurses and nursing aides are much more likely than other professionals to be victims of violence in the workplace. According to the US Bureau of Labor Statistics, “intentional injury’’ by another person rose nearly 50%, from 6.4 per 10,000 hospital workers in 2011 to 9.0 per 10,000 hospital workers in 2016, the most recent year of data. The rate across private industry is 1.7. OSHA has analyzed this and published Guidelines for dealing with it. But the ACEP survey is one of the first to shine a light on the stark potential for violent harm confronting Emergency Physicians.

One wonders if the threat of violence in the ER will dissuade med school graduates from specializing in Emergency Medicine. This would certainly be unfortunate, because a shortage already exists for rural ER physicians as documented in a June 2018 study published in the Annals of Emergency Medicine. At the time of the study, more than 27 percent of US rural  counties did not have emergency medicine clinicians and 41.4 percent of counties did not have any emergency physicians reimbursed by Medicare fee-for-service Part B, according to the study.

We’ll continue to follow this phenomenon and occasionally report on progress or lack of it in protecting these highly trained and dedicated life savers. For, now, consider this graphic from the aforementioned ACEP study.

One of America’s Most Dangerous Jobs

Wednesday, September 13th, 2017

Kicked, pummeled, taken hostage, stabbed and sexually assaulted … would you want a job that included these risks? In One of America’s Most Dangerous Jobs, the Washington Post shines a spotlight on the dangers in the nursing profession, specifically around the violence that they encounter on the job. Citing a recent GAO report on violence in healthcare profession, the article notes that, “the rates of workplace violence in health care and social assistance settings are five to 12 times higher than the estimated rates for workers overall.”

Here’s one excerpt from the article:

“In Massachusetts, Elise’s Law, which is named for the nurse who was attacked in June, is already on the fast track to set state standards for workplace protection. Legislators were working on this months before Wilson was stabbed.

Nurses in Massachusetts were attacked more frequently than police or prison guards. When association members testified about the violence epidemic this spring, they said nurses had been threatened with scissors, pencils or pens, knives, guns, medical equipment and furniture in the past two years alone, according to the Massachusetts Nurses Association.”

OSHA reports that in surveys conducted by various nursing and healthcare groups:

  • 21% of nurses and nursing students reported being physically assaulted and over 50% verbally abused in a 12-month period
  • 12% of emergency department nurses experienced physical violence and 59% experienced verbal abuse during a seven-day period
  • 13% of employees in Veterans Health Administration hospitals reported being assaulted in a year

 

While 26 states have workplace safety standards for health-care facilities, there are no federal standards. Nursing groups say that state efforts have helped increase awareness.

NIOSH worked with various partners – including nursing and labor organizations, academic groups, other government agencies, and Vida Health Communications, Inc. – to develop a free on-line course aimed at training nurses in recognizing and preventing workplace violence. The course has 13 units that take approximately 15 minutes each to complete and includes “resume-where-you-left-off” technology. Learn more about the courses at Free On-line Violence Prevention Training for Nurses and the actual course can be accessed here: Workplace Violence Prevention for Nurses CDC Course No. WB1865

Related

 

 

 

Healthcare providers struggle with violence-related risk management

Wednesday, March 23rd, 2016

There’s no question but that healthcare workers face a growing threat of violence from patients while going about their day-to-day jobs. In a 2015 survey, the International Healthcare Security and Safety Foundation reported a 40% increase in violent crime from 2012 to 2014, with more than 10,000 violent incidents mostly directed at employees. High stress, armed patients and visitors, drug and alcohol intoxication, mental health issues and more all contribute to an increasingly dangerous environment. OSHA reports that:

From 2002 to 2013, the rate of serious workplace violence incidents (those requiring days off for an injured worker to recuperate) was more than four times greater in healthcare than in private industry on average. In fact, healthcare accounts for nearly as many serious violent injuries as all other industries combined.

Recently, Susannah Levine reported on the challenge that healthcare facilities face in her Risk & Insurance article, Hospitals Struggle with Security Risks. The article discusses the pros and cons of an armed approach to healthcare security, as well as the insurance implications of various risk management and security measures. Liability insurance may be a determining factor as to whether healthcare facilities opt for armed security or rely on less lethal tools like Tasers and sprays.

“Barry Kramer, senior vice president, Chivaroli & Associates, a health care insurance broker, said that armed security in health care settings is more of a risk management concern than a coverage issue.

“It would be highly unusual for our clients’ liability policies to exclude claims involving security guards, whether or not they’re armed with guns,” he said.

He said many health care risk managers are not equipped to manage exposures associated with licensing and certifying guards or registering the facility’s own firearms.

For facilities that lack the bandwidth to manage, train and track certifications for in-house security staff, Kramer said,third-party vendors, such as local law enforcement or private security companies, can be contracted, since they have firearms experience as well as liability insurance coverage.”

In February, the New York Times discussed various approaches and philosophies that healthcare facilities employ to mitigate risk. The article by Elisabeth Rosenthal – When the Hospital Fires the Bullet – centers on the case of a 26-year-old mental health patient who was shot by police in a Houston hospital. In the course of the article, Roenthal presents various approaches to security:

To protect their corridors, 52 percent of medical centers reported that their security personnel carried handguns and 47 percent said they used Tasers, according to a 2014 national survey. That was more than double estimates from studies just three years before. Institutions that prohibit them argue that such weapons — and security guards not adequately trained to work in medical settings — add a dangerous element in an already tense environment. They say many other steps can be taken to address problems, particularly with people who have a mental illness.

Rosenthal contrasts the approach of Boston’s Massachusetts General Hospital, where the strongest weapons its security officers carry is pepper spray to that of the Cleveland Clinic, which has its own fully armed police force and also employs off-duty officers.

Guns in hospitals

Meanwhile, as risk managers struggle with the dilemma of whether to arm or not to arm, patients and visitors are often armed, enabled by state and local gun laws – just one more factor that healthcare facilities are coping with. At of the beginning of the year, Texas law allows for guns in state mental health hospitals. Campus Safety Magazine reports on how Kansas College Hospitals are preparing to allow guns on campus to comply with a new law. Gun laws in health systems vary by state – while a federal law bars guns from schools, there is no such law about firearms in hospitals.

Healthcare Violence Prevention Resources

OSHA: Worker Safety in Hospitals – Caring for our Caregivers

OSHA: Preventing Workplace Violence: A Road Map for Healthcare Facilities

OSHA: Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers

Mitigating Workplace Violence at Ambulatory Care Sites

Emergency Department Violence Fact Sheet

Healthcare Crime Survey 2015

Prior related posts

More perils for healthcare workers

Violence in healthcare: 61% of all workplace assaults are committed by healthcare patients

Report on violence & aggression to Maine’s caregivers; Injuries include bites, kicks, being hit

Annals of Risk Management: Guns and Mental Illness in New York

Wednesday, January 16th, 2013

New York has just signed into law a new gun control measure [S. 2230] that comes as a direct response to the incomprehensible tragedy in Sandy Hook, CT. While the bill touts its “first in the nation” status, with respect to its approach to mental illness, it is by no means a model for other states to follow.
The bill addresses three distinct issues relating to mental illness: first, limiting access to gun licenses for those diagnosed as mentally ill and dangerous. Second, the bill requires gun owners who reside with a mentally ill and “dangerous” individual to keep guns under lock and key. Finally, and most disturbingly, the bill requires mental health professionals to report any patient who is “likely to engage in conduct that will cause serious harm to
him- or herself or others.” In other words, the bill assumes that any individual with suicidal tendencies is a potential mass murderer. Such stereotyping is not what is needed in the mental health community.
Double Bind
S.2230 places a formidable burden on mental health professions – who not only must treat their patients, they are held accountable for predicting future behavior:

A new Section 9.46 of the Mental Hygiene Law will require
mental health professionals, in the exercise of reasonable
professional judgment, to report if an individual they are treating
is likely to engage in conduct that will cause serious harm to
him- or herself or others. A good faith decision about whether to report
will not be a basis for any criminal or civil liability.

If we have learned anything in the all-too-frequent incidences of random slaughter, the “likelihood” of homicidal acts is usually only revealed retroactively, long after the fact.
The bill goes on to read:

When a Section 9.46 report is made, the Division of Criminal Justice
Services will determine whether the person possesses a firearms
license and, if so, will notify the appropriate local licensing
official, who must suspend the license. The person’s firearms will
then be removed.

After a therapist reports a potentially violent patient to the state – once again, this rather large population includes people who only threaten to hurt themselves – New York will run the names through the data base of licensed gun owners. All hits must result in license suspension. Of course, bureaucracies being what they are, it might take months for the suspension to take place. Hence, the individual who at one time exhibited psychotic symptoms or discussed violent feelings with a therapist might find him or herself months later confronted by cops on the doorstep. Such encounters will hardly be helpful for people trying to establish mental equilibrium.
Finally, the image of forcefully removing guns from the home surely presents enormous risk to gun owners and public safety officials alike. Who will do this and under what circumstances? My guess is that, given the profound implications of reporting patients to the state, most therapists will err on the side of non-reporting and rationalize their inaction, when necessary, under the heading of acting in “good faith.”
The Wrong Cohort
It is important to note that only individuals receiving treatment for mental illness will be subject to this onerous standard. Given the fractured and fragmented nature of mental health treatment in this country, the vast majority of mentally ill individuals have never received and are not about to receive any treatment. And among the violent individuals who might well contemplate an attack of homicidal proportions, few would bother to discuss it with a therapist or go through the formality of securing a gun license before buying an assault weapon.
The relatively small subset of people impacted by the New York bill – people diagnosed with mental illness who are licensed gun owners – is likely to prove statistically insignificant, as is the probability that a single mass murder can be prevented by this radical undermining of the doctor-patient relationship. Surely, there is a better way to manage what has become a remote but appalling risk of life in the 21st century.

News Roundup: Holiday Health Wonkery, Claims Webinar, Firefighter Hazards & more

Thursday, December 6th, 2012

Holiday Health Wonkery – Just a spoonful of latkes makes the medicine go down? Hank Stern hosts a Chanukah-themed Festival of Lights edition of Health Wonk Review at InsureBlog – it’s fun, interesting, and contains substantial wonkery.
Claims Webinar – Mark Walls, who many of you may know from his LinkedIn Work Comp Analysis Group fame, is hosting a complimentary 90-minute webinar on Tuesday, December 11: Take your Workers’ Compensation Claims Handling from Good to Great. Mark’s been plying his profession for 22 years, so you can’t get a better claims guide. Click through to see topics or to register.
Firefighter hazardsStop, drop, and roll: workplace hazards of local government firefighters, 2009 (PDF) – “When compared with all workers, firefighters are injured in similar ways but at a much higher rate, with work-related injuries caused by “stress, exertion, and other medical-related issues” accounting for the largest number of deaths and with risks of fatal injuries 25.7 percent higher and nonfatal injuries and illnesses over two times greater.” – BLS report by Gary M. Kurlick, economist in the Office of Compensation and Working Conditions, Division of Safety and Health Statistics, at the Bureau of Labor Statistics.
Chimp attack – Roberto Ceniceros of Business Insurance brings us the most recent development in the sad saga of the CT woman who was attacked by her employer’s pet chimp: Woman disfigured in chimp attack settles with owner’s estate for $4M. We’ve written about aspects of this horrific case in the past – see: the crazed chimp case, Exclusive Remedy” for Losing Your Face?, and (Uncompensable) Nightmare at Work.
Depression and Work Comp – Does your organization offer depression screening for injured workers? Risk Scenarios: Down for the Last Time offers case in which missed cues and poorly handled communication made a difficult workers’ compensation case much more painful than it should have been.
Mind over Matter – Osteoarthritisis is “the most common joint disorder” and occurs “due to aging and wear and tear on a joint.” Will arthroscopic surgery relieve related pain? Read about prior studies in Kneedless Surgery. For more debunking, see Gary Schwitzer’s HealthNewsReview, which has a mission of “helping consumers critically analyze claims about health care interventions and by promoting the principles of shared decision-making reinforced by accurate, balanced and complete information about the tradeoffs involved in health care decisions.” The site offers commentary, evaluations, and grading on health care journalism, advertising, marketing, public relations and other messages – a great consumer resource.
Fraud – Two pretty large cases of fraud hit our radar this week, proving that work comp fraud perpetrators can come in many flavors, even among those you pay to trust. On WorkCompWire, we learned about $2.7 million Florida fraud case involving a former correctional officer and at Managed Care Matters, Joe Paduda blogs that Pennsylvania County was defrauded by its risk manager to the tune of $490,000.
Telecommuting – In a recent Human Resource Executive, Carol Harnett makes the case that Telework is Good for Business, and she uses the experiences that many businesses had with Hurricane Sandy as examples. At LexisNexis, attorney John Stahl looks at work comp issues related to the mobile workforce and home-based employees.
Workplace Violence – The current issue of Risk Management Magazine has a Time Line of Workplace Homicides and at Risk Management Monitor, Ralph Metzner posts about preventing workplace violence.
News Briefs