Hospitals, like schools, are generally not designed to guard against the threat of a determined gunman entering the building to kill.
The vulnerability of healthcare facilities was highlighted by a gunman who killed four people and then killed himself Wednesday at a hospital in Tulsa, Oklahoma. The attacker safely entered a building on the Saint Francis Hospital campus just hours after purchasing an AR-style rifle, authorities said.
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Here’s a look at what’s known about the safety of the Tulsa facility and other US hospitals:
Did the shooter have to go through security?
No, the 45-year-old man identified as the shooter, Michael Louis, of Muskogee, Oklahoma, parked his car in an attached garage and then walked through the unlocked doors of the medical building, authorities said.
“It’s an entrance open to the public,” Tulsa Police Chief Wendell Franklin told reporters Thursday. “He was able to come in without any type of challenge.”
It was just steps from that entrance to the office where Louis fatally shot his primary target, Dr. Preston Phillips. Police said Phillips recently operated on Louis and Louis blamed the doctor for the chronic pain he still suffered.
Once Louis entered, “he started shooting anyone who got in his way,” Franklin said. At least one person holding a door open for others to escape was killed.
Could better security have stopped the shooter?
The president and CEO of Saint Francis Health System said nothing could stop someone with guns “out to do harm.”
Dr. Cliff Robertson did not provide details on hospital security. He said the facility had procedures for dealing with “difficult and disgruntled patients”, although he did not elaborate.
Hospital officials planned to review their safety procedures in the coming days. There “will be a thousand questions” to answer regarding the shooting, Robertson said.
According to official accounts, the reaction time of the officers could not have been much better. Wendell said officers responded to the shooting within minutes and the shooter apparently took his own life as police approached.
Is it normal for hospitals to leave certain entrances open?
Yes, because some urgent medical situations require rapid movement of patients. But some hospitals, especially those that have faced violence on their grounds, have improved security in recent years.
Chicago’s Mercy Hospital has tightened security after a 2019 attack in which a man fatally shot an attending physician who was her ex-fiancé in the parking lot. He then entered the hospital, where he shot and killed a resident of the pharmacy and a policeman before shooting himself to death.
Now, security guards are posted at each entrance and the hospital has a system that electronically notifies employees of any armed intruders.
How common are hospital shootings?
From 2000 to 2011, there were 154 hospital-related shootings, according to a 2017 guide from the International Association of Chief Emergency Medical Officers that cites the Annals of Emergency Medicine.
Nearly 60% of those shootings took place inside hospitals and about 40 outside on hospital grounds, the guide said.
The attacks injured or killed 235, according to the guide, which also cites data from the Bureau of Labor Statistics that indicates violence is four times more likely in health care than in other industries.
What are the unique challenges for hospitals?
Some patients have reduced mobility and many staff members are forced to stay with them in dangerous situations, sometimes making rapid evacuations impossible.
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Additionally, hospital buildings are often labyrinths, with many doors that lead to other doors. The Tulsa police chief said that was the case during Wednesday’s shooting, when the sheer size of the building created echoes, making it harder for officers and others inside to know precisely where the shots were coming from.
What else have hospitals done to improve safety?
Even before the 2019 Chicago Mercy shooting, the hospital had begun training employees on what to do in an active shooter situation. This included instructions for retreating to rooms, locking doors and turning off lights.
Training sessions at the hospital that used to take place every year before the 2019 shootings are now held four times a year, said Paul Stewart, a spokesperson for the hospital, which is now called Insight Hospital and Medical Center.
Out of concern for people entering with firearms, some hospitals have also installed metal detectors. At Chicago’s UI Health, which is affiliated with the University of Illinois, metal detectors have been installed in the emergency room, but not as many as nurses and other healthcare workers have requested.
Nurses complain that patients entering with guns are far too common.
“They did this after someone brought in a semi-automatic weapon and he was making a video on his phone about how he was going to kill nurses,” said Paul Pater, a nurse at the hospital.