Health-care violence: Urologists on edge; motivations under scrutiny

10 Mar

Losing colleagues under tragic circumstances is something Dr. Eugene Rhee has become accustomed to. All told, the San Diego-based doctor was personally acquainted with four urologists shot while on the job since 1999.

Two lost their lives.

“I have a friend who’s a Navy SEAL,” Rhee said. “This is a guy who has been to war. He told me that none of his colleagues have ever been shot. Well, four of mine have been.”

Rhee, the former president of the California Urological Association and current physician at Kaiser Permanente in San Diego, said he has often felt threatened while on the job. And the loss of two colleagues, with two more wounded, has reinforced the idea that something is wrong.

Two recent shooting deaths in particular have sent shockwaves through the urologist community.


Rhee said about 80 of the 600-member CUA responded to a March 2013 survey regarding health care violence. When asked if they or their staff had feared for their personal safety, about 75 percent answered yes. The group also discussed how they could protect themselves.

Motivation for the survey came after one of the more notable losses for Rhee. In January 2013, Dr. Ronald Gilbert was killed in his Newport Beach medical office. Rhee said Gilbert had been a close friend for about 15 years.

Stanwood Elkus, 75, who is accused in Gilbert’s death, claimed a botched surgery as the fuel for his rage. A lawyer representing the Gilbert family, however, said the slain doctor had never treated Elkus.

Then it happened again.

Dr. Charles Gholdoian, another of Rhee’s friends, was killed under similar circumstances in December at his Reno office. Police say Alan Oliver Frazier, 51, walked into the clinic where Gholdoian worked, told several patients to leave, then began firing a 12-gauge shotgun at doctors. Frazier’s neighbors told police he was angry about a vasectomy, but like the Gilbert case, Gholdoian’s family says the doctor didn’t perform Frazier’s procedure. Gholdoian’s colleague, Dr. Christine Lajeunesse, was also shot, but survived.

“There aren’t that many urologists out there,” Rhee said. “So I got acquainted with Ron and Garo (Gholdoian) after attending the same conferences and meetings.”

Gilbert and Gholdoian, Rhee said, were not only highly skilled urologists with impeccable records. They were also likeable men, leaving him to wonder what would drive a patient to harm them.


Rhee said he’s uncertain if it was the personal and often delicate nature of urologists’ work – including performing vasectomies and treating prostate cancer – that propelled those patients toward violent acts.

“It is of concern that we are seeing more patients who are angrier as a whole and frustrated with our health care system in light of changes, good and bad,” Rhee said. “I also think it’s a reflection of the mind-set of people in this country. People are simply responding to bad news in a way that is off-kilter.”

According to a report issued by the U.S. Bureau of Labor Statistics, three doctors were killed on the job between 2011 and 2012, while 103 police officers were killed during the same time period. Three fast-food counter workers were killed in that span.

In a 2010 report issued by the same agency, it was reported that nearly 60 percent of assaults in the workplace occurred in a health care setting. About 75 percent of those assaults, the report read, were perpetrated by patients or health facility residents.

Dr. Praveen Kambam, a forensic psychologist and adjunct professor at UCLA Medical Center, said violence against doctors hasn’t necessarily become more frequent. It’s simply been underreported.

“I think there’s a culture of impassivity with doctors in regards to threats or physical harm,” Kambam said. “It’s kind of part of the job description, more with mental health professionals – but really with all doctors – that we should just endure people who are in pain and suffering, that they are going to yell and get angry with us. A lot of medical students and nurses I’ve talked to have been hit by patients. I’ve even been hit. And we typically don’t report it. I think that culture may not be right. … I mean you wouldn’t do that on the street.”

Others, including Duarte-based City of Hope Medical Center urologist Dr. Laura Crocitto, feel the violence is often a culmination of many factors, including previous mental health issues, combined with long wait times, a perceived lack of communication with doctors and negative experiences with staff.

Coupled with the fact that many doctors see 30 or more patients per day with little security and virtually no screening, predicting violent behavior is a daunting challenge.


This is especially true in the case of Dr. Reynaldo Hernandez, another colleague and friend of Rhee’s.

When Hernandez, a Baldwin Park-based Kaiser Permanente urologist, was shot by a patient in 2003, he said the man never displayed any violent or erratic behavior. Other than a few eccentricities, such as not wanting to shake hands or not touching doorknobs in the office, Hernandez said the man seemed rational.

Hernandez was treating Eugene Guevara, 73, for prostate cancer. But when Hernandez told him his cancer treatment was ineffective, Guevara expressed disbelief. Hernandez suggested he get a second opinion.

Two days later, Guevara appeared unannounced at Hernandez’s Baldwin Park office.

“When I saw him, my initial feeling was fear. And I had never felt that way before,” Hernandez recalled. “But I didn’t understand why I had that fear, so I ignored it.”

Hernandez greeted Guevara and invited him into his office. By the time he got behind his desk, Guevara had closed the door and had a gun pointed at him. Guevara said nothing and fired three shots, hitting Hernandez in the neck and chest. As he lay bleeding on the floor, Guevara fled.

Guevara killed himself in front of an Echo Park restaurant two days later.


It took Hernandez several months to return to work. A decade later, he said he feels his senses are keener while on the job. While telling police officer friends about the feeling he ignored when he saw Guevara the day he was shot, they told him the same instincts are what keep them alive on streets each day. Now, Hernandez suggests doctors hone in on those gut feelings.

“If I feel uneasy, I don’t ignore it,” he said. “But sometimes it’s difficult because in health care, we’re not focused on our care. We’re focused on the care of someone else. That can create a false sense of security.”

Hernandez said he’s seen small changes in security procedures at Kaiser since his injury, including self-closing and locking doors, which can protect staff from people trying to walk in and out. And while he said he feels more can always be done to ensure the safety of staff, he understands that short of metal detectors being installed, the risk of violence will always be there.

Kaiser Permanente spokeswoman Socorro Serrano said the health care provider, which serves about 9 million members, employs a threat management team that conducts training and drills, threat assessments and periodic reviews of security equipment, technology and procedures.

Serrano added that Kaiser trains staff to pay attention to their surroundings, including reporting any threats. They are also trained to create escape routes in case of an incident, and Kaiser holds active shooter drills at each of its medical centers in cooperation with local law enforcement.

One overriding conclusion of the CUA survey, Rhee said, was a need for better communication among doctors and staff. Hernandez agrees, adding that in the days before he was shot, Guevara had articulated to a cafeteria worker at Kaiser that he was upset with his diagnosis and that he felt Hernandez was a bad doctor. While he made no threats, Hernandez feels the information could have served as a warning.

The CUA members surveyed also expressed a need for some legal type of private alert system, in which urologists could notify colleagues of potentially dangerous patients. But much to the chagrin of doctors such as Rhee, the Health Insurance Portability and Accountability Act, which protects elements of patient diagnoses and information from distribution, makes such a system unlikely.

“Federal law has done a great job protecting patients,” Rhee said. “But I think it’s time to start protecting physicians as well.”


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