With October designated as both Domestic Violence Awareness Month and Healthcare Safety and Security Month, there is no better time to talk about how the risk of domestic violence effects the safety and security of healthcare organizations. When we in the healthcare security industry talk about workplace violence prevention in healthcare, the conversation most often revolves around the risks associated with and potential mitigations organizations can implement to protect their care givers and other staff members from physically assaultive or threatening behavior by patients and patients’ visitors. We often ignore the very real risk associated with domestic violence occurring in our workplaces. Based on research into shootings occurring at US healthcare facilities over the past twenty years, domestic violence is the motivating factor for nearly one quarter of the shootings that have occurred at US healthcare facilities between 2004 and 2023.

With over three quarters of the 13.5 million healthcare workers in the United States being female, [1] and women experiencing a rate of domestic violence victimization more than double that experienced by men (25% of women will be the victim of domestic violence over the course of their life versus 11% of men)[2] more than 2.9 million US healthcare workers will experience domestic violence at some point within their lifetime. While domestic violence most often occurs outside of the workplace, there are many examples of times when domestic violence has followed an employee into their workplace and resulted in a serious incident occurring on the healthcare facility’s property. The risk of an abuser following their victim to the workplace becomes even more pronounced when the victim is in the process of leaving the abusive relationship. Once the victim has left a possibly shared home and is avoiding contact with their abuser, there is one place the abuser typically knows that they will be able to find their victim, and that is the workplace.

This is what occurred at a Detroit area hospital in May of 2023, when a nurse who was in the process of ending her relationship with her boyfriend was ambushed by him and shot to death in her car in the parking lot of the hospital as she was leaving work after her shift;[3] and at a Seattle area hospital in 2020 when the estranged husband of an employee arrived at the hospital and demanded to speak to her and another employee who he believed her to be in a romantic relationship with, the estranged husband then shot and killed the other man and then himself while standing just outside the main entrance of the hospital.[4]

Domestic violence victims in healthcare are not limited to employees, the stress placed on patients and their family members can also bring domestic violence to a head in healthcare facilities. In 2022 a convicted felon who was free on parole began assaulting his girlfriend, who had just given birth to their baby, in the maternity ward of a Dallas area hospital. When two hospital staff members entered the room to investigate the disturbance they were both shot and killed.[5] In addition to these types of incidents which are more typical of what we consider domestic violence, healthcare facilities must also take into consideration domestic violence which takes the form of “mercy killings”, such as the incident at a Daytona beach area hospital in 2023 where a 76 year old retired school teacher shot and killed her terminally ill 77 year old husband in his hospital bed

While the risks associated with domestic violence are present in nearly all healthcare facilities, there are a number of measures that healthcare organizations can take to reduce their risk of experiencing domestic violence or reduce the consequences of an incident if it does occur. These include:

·       Educate all employees on recognizing signs of domestic violence.

·       Provide domestic violence resources to both patients and employees who may be experiencing domestic violence.

·       Develop a policy that encourages, or even requires, any employee who is aware of a coworker who is  potentially a victim of domestic violence to report the concern.

·       Provide support for employees who are victims. This may include security measures such as

o   Allowing the victim to temporarily transfer to an alternate work location or take a leave of absence,

o   Providing security escorts to and from parking areas,

o   Allowing the victim to park in areas different than those they are typically assigned, and

o   Providing assistance to staff who are seeking protective orders.

·       Implement a formal Behavioral Threat Assessment and Management (BTAM) process including standardized intake, fact finding, and assessment by a trained multi-disciplinary BTAM team who can effectively assess the risk of violence associated with each reported concern of domestic or other targeted violence.

·       Ensure that sound physical security processes are in place to reduce the risk of an abuser gaining inappropriate access to their victims, these may include measures such as:

o   Providing for regular patrol of exterior and public areas of the campus by Security staff to identify suspicious activity,

o   Limiting number of entrances that can be used by non-employees,

o   Securing “back of house” employee work areas from public spaces,

o   Providing employees training on identifying and reporting suspicious activity.

o   Developing processes for distributing BOLO (be on the lookout) notices and/or using facial identification analytic software on security camera systems to provide for alerting if a person of interest enters the facility.

Through recognizing the risk that domestic violence presents to their patients, employees, and visitors and implementing measures to reduce that risk, healthcare organizations can improve the protection of everyone on their property.