In the two years since the horrific 2010 murder-suicide shooting at Johns Hopkins Hospital, administrators at the Baltimore-based health system have used the deficiencies identified in their crisis response planning as a roadmap to a more comprehensive workplace violence prevention and mitigation program, according to Johns Hopkins Health System risk manager Jeffrey Natterman.
On Sept. 16, 2010, 50-year-old Paul Warren Pardus shot Dr. David Cohen in the stomach with a small-caliber handgun before locking himself in a surgical recovery room with his mother, 84-year-old Jean Davis, for whom he was the primary caregiver. As several nurses and other hospital staff tended to Cohen, Pardus shot his mother in the back of the neck, killing her, and then shot himself.
During a presentation at the American Society for Healthcare Risk Management's 2012 conference in National Harbor, Maryland, Natterman said one of the hospital's critical failings was its ability to recognize warning signs in Pardus' behavior that began revealing themselves several days prior to the shooting.
Erratic, irrational behavior
After his mother suffered complications during surgery, Pardus spent the next several days in and out of the hospital. Natterman said several nurses, doctors and other hospital staff made note of Pardus' erratic, often irrational, behavior but never communicated any concerns that he might be dangerous.
Perhaps most disturbingly, Natterman recalled one incident in which a nurse bent down to pick up a black satchel that Pardus had fiercely insisted no one was to touch. Pardus screamed at the nurse and snatched the bag away from her, but not before the nurse had held the bag long enough to feel its weight. Natterman said the nurse later told her co-workers she thought Pardus might have a gun in the bag, but her concern was never relayed to hospital administrators or security.
Following the shooting, part of the hospital's efforts to enhance its violence prevention planning included instructive courses with the FBI's Behavioral Analysis Unit on identifying certain behavioral patterns that often predict a violent outburst.
"It was incredibly important for us, because it helped us to understand how to recognize and piece together these little elements of someone's behavior to put together the bigger picture," Natterman said.
Although Dr. Cohen survived the shooting and has long-since returned to work at the hospital, Mr. Natterman said the experience took a deep emotional toll on the Johns Hopkins nursing and support staff. Mr. Natterman said it took a considerable amount of time and several readjustments to the hospital's counseling and outreach efforts for employees to begin talking opening about the incident.
"One of the things that gets overlooked quite a bit, but has gotten some traction here, is the 'second victims' concept," Natterman said. "Out of this event, as you might imagine, we had a lot of staff members that were distraught not just by the larger fact of what happened but, for many of them, what they actually saw."
Another crucial element of the hospital's crisis response planning that proved in need of significant improvement, Natterman said, was the degree to which hospital administrators were able to control the flow of information to the media.
"Among the most troublesome things for us was that we had a bunch of reporters on the scene trying to get past security lines and get the scoop," Natterman said. "And unfortunately, we had a number of our people willing to give them that scoop. That's tough. It's very hard to control people when they're scared and they're just trying to get information to their family any way they can, but the media focus on this event was insanely intense."
For more coverage of the ASHRM conference, click here.