I’ve contributed to The Health Care Blog a couple of times and follow its posts to stay on top of issues relevant to health care. Dr. Al-Agba wrote this article recently in relation to the recent shooting at Bronx-Lebanon Hospital in the Bronx (see link here). I think Manson was wrong; I think we are, indeed, still in Wonderland as it pertains to mass killings.

Dr. Al-Agba makes the very good (and one might argue rather obvious) point that organizations we work for have an obligation to take threats to our personal safety seriously. Today, if an individual threatens suicide, most people know that such threats should be investigated. Lives have been saved as a result.

Still not so with homicidal threats despite the carnage (and I’ve been maintaining this to anyone who will listen since I studied school shooters in the late 1990s while a student at John Jay College of Criminal Justice; it has been discouraging to know that not many have listened). This is the most pertinent line from Dr. Al-Agba’s article: “After his resignation, Dr. Bello warned former colleagues he would return someday to kill them.” Bronx-Lebanon did what in response to this threat? It’s not clear but so far I have found no evidence to suggest they took any action (i.e., reporting it to police? Seems like that would have been a good place to start).

Dr. David Lazala, who worked with Dr. Bello, described him as “very aggressive, talking loudly, threatening people,” and said that he had been threatened by Dr. Bello via email after Dr. Bello had been terminated. I could not find out if Dr. Lazala told Bronx Lebanon about these threats. But even if he had, consider what Bronx Lebanon would have done after you read about my experiences working as a clinician in New York City since 2003.

I studied mass murder and spree killing in depth in the late 90s while a student at John Jay College of Criminal Justice. I found that almost all of the school shooters made threats prior to their murderous rampages, and that those threats were mainly ignored. This was true of Kip Kinkel in Springfield, Oregon in 1998, and the infamous Columbine killers in 1999. One of the Columbine kids was essentially advertising what he was about to do on the internet.

I maintain if one makes a homicidal threat, one should not expect one’s home or person to be sacrosanct. At minimum, the home ought to be turned inside out for weapons and such weapons ought to be confiscated. The person should be taken to a hospital, and be evaluated psychiatrically. Not all lives will be saved, but some will. Those lives matter. It makes no difference if the alleged threat was simply someone “venting” or a “joke.” One ought not to vent or joke about such things, and if one does, one ought to be prepared for the consequences.

I challenge anyone to take an in-depth look at the preceding events of most mass murders. What one will often find is that the individual or individuals involved made threats beforehand. During my studies, I had always seen such threats as subconscious cries for help that authorities ignored. And I’ve always maintained that we should treat homicidal threats exactly as we do suicidal threats. The problem is that, all too often, when one does sound the alarm, one is punished for sticking one’s neck out.

This happened even within my own family when I was concerned about an emotionally-disturbed family member who made a threat to do violence to another. I was punished for acting on that concern to ensure the safety of the intended victim. It was seen as a betrayal. I was not willing to take a chance with a young person’s life, and to this day, I know I did the right thing. Despite this, my family has never forgiven me for taking action that essentially ensured our troubled family member did not get into even more trouble than he was already in. We can’t know if my family member would have done anything, but what we do know is that a threat was made, it was paid attention to, and both parties are alive today.

What if he had meant what he said, and I had ignored that threat? What if I had buried my head in the sand as the rest of my family did? I should add that he went on to again make homicidal threats directed towards family members years later, and I again took action by calling police (I’ve been told since I was wrong to do that as well). So, one can imagine the message being sent to those who commit homicide in such circumstances. If the messenger is persecuted and blamed, what message is being sent to the disturbed person who intends to kill?

That said, this was my response to Dr. Al-Agba’s well written article:

I worked for many years as both a mental health caseworker and a community mental health clinician in the Bronx, Brooklyn, and in Manhattan. My life was repeatedly put at risk by the non-profit corporations I worked for, corporations whose clinics or case management operations were either licensed or certified by New York State. My OHSA complaint against a so-called “non-profit” case management agency went nowhere. That agency was sending me into the homes of suicidal and/or homicidal patients with NO safety plan or backup whatsoever. My employer rarely knew where I was or if I was safe and apparently could have cared less. I was sent into homes in the most dangerous neighborhoods in the city. OHSA’s Washington lawyers refused to prosecute what their own NYC-based investigator thought to be a solid case.

When I worked with the developmentally disabled, I had to work in a closet, alone, with male adults one of whom acted out sexually with women. Had he chosen to rape and kill me, no one would have heard my screams for help. Since the closet was in a noisy work center, nothing that happened behind that closed door would have been heard. I was often petrified but what could I do? I needed a paycheck. I had already learned that a state-certified agency was allowed to put my life at risk and then fire me for complaining about it. I already knew that the State did not consider my safety worthy of its attention. So, I had no choice but to allow yet another state-licensed clinic put my life at risk every day (the other “choice” was to stop eating). Eventually, I couldn’t take the abuse and neglect anymore, stuck my neck out again, and that time, since I was an independent contractor, my contract was suddenly “terminated.”

I then worked in community mental health with the mentally ill chemically addicted. As one can imagine, with that population, we often had to deal with drug-seeking individuals who were extremely dangerous and threatened staff. There was no security even with such a dangerous population, and it was not unusual that our patients attacked each other. The police were called afterwards, but there was no one to stop these attacks when they happened.

When I was threatened by a client and fighting against being locked in my office with him, the only person I could count on to help me, our janitor, laughed. To be fair to him, he wasn’t a security guard. He was probably very nervous, and didn’t know what to do. I think, though, that he didn’t choose to believe that it was possible I was at risk in that moment because then he would have had to take responsibility to make a choice and actually DO something. And that something might have cost him his job if the client had complained. So better risk my life than his job or the client’s rights or dignity.

We often get our heads chopped off when we stick our necks out in situations like these. Dr. Al-Agba is right on point. I blame New York State for the Bronx-Lebanon deaths and injuries. My entire career in New York showed me that the state turns a blind eye to the constant danger healthcare employees are exposed to. New York State cannot possibly have any type of requirements that these facilities have adequate security because if they did, I would not have been placed in such needlessly dangerous situations across the board and in every single agency I worked with.

Profits came before protection, and it’s not much of a leap to assume that they still do. Let’s not kid ourselves about that. It will take a motivated legislator who actually cares about constituents for this to change. Who could that be I wonder? Denial is a powerful thing, and so is inertia.

There’s only one thing we can all be assured of and that’s that more people will die.