DISCLAIMER: This article discusses attacks in places of business and workplace violence. While somber in nature, the purpose of this piece is to analyze factors that may contribute to such incidents and encourage dental practices to uphold measures that increase team and patient safety. Please be advised that this content may be emotionally challenging for some readers.
In early February 2024, a New Orleans, Louisiana, dental practice was taken by surprise when a woman entered the building without an appointment and asked to speak with the dentist. Within a few short moments of her arrival, chaos ensued as the individual unveiled a small knife and allegedly stabbed Dr. Katie Tran and two employees multiple times before fleeing the scene.1 Dr. Tran sustained life-altering injuries to her left eye and hand and has been given a guarded prognosis on her recovery.
A few weeks later, a man opened fire inside a dental practice near San Diego, California, fatally injuring Dr. Benjamin Harouni and seriously injuring two other employees.2 News outlets describe the alleged suspect as a “disgruntled former patient” who was apprehended nearby shortly after the incident.
These are not the first attacks to have happened in a dental setting; in fact, acts of violence have been increasing in frequency over the years. Senseless crimes have either injured or taken the lives of a significant number of oral health-care professionals in the United States.
The simple truth is that dental professionals should not have to be concerned about becoming victims of violence while serving the public’s health-care needs. While it’s not healthy to live in a constant state of fear surrounding one’s work environment, it is important to consider the factors that may threaten team safety as well as preventive measures that can be implemented to potentially avoid tragedy.
Mental health: A common thread
One thing that many previous public acts of violence have shared—whether they involved a dental practice or not—is a perpetrator with a history of mental health concerns and/or violent tendencies. Dental patients with mental illness should not be viewed with prejudice or discriminated against; history has shown us that stigmas and stereotypes against any group of people are morally and ethically wrong. Instead of fixating on previous diagnoses of mental illness, behavior issues, or personality disorders, disturbing behavior witnessed during in-office visits is what should be acknowledged and discussed with the dental practice’s leadership.
Violent statements, verbal or physical threats, emotional outbursts, aggressive behavior, intimidation, or suspicions of active substance abuse should be recognized and dealt with appropriately.3 An appropriate response might include calmly discussing behavioral expectations with the patient, dismissing them from the practice, or calling for emergency assistance from law enforcement authorities. Practice owners also must remember that they have a legal obligation to respond to reports of this type of patient (or coworker) behavior with team members and take necessary action to promote a safe workplace.
Every practice needs a plan
Whether it be a public attack, power outage, natural disaster, fire, equipment malfunction, or some other unexpected event, dental practices need to have a strategic plan in place that protects their team and patients. One plan will not apply to every type of emergency, so it’s important that practice leadership develops a specific plan for each scenario and routinely reviews it with the dental team.
In the case of a violent attack, team members should become familiar with potential warning signs of violence, ways to discreetly communicate the threat to the rest of the team, the safest rooms to hide, all possible evacuation exits, and verbiage that can potentially assist in de-escalating the situation. The Occupational Safety and Health Administration (OSHA) states that an emergency action plan must be written and accessible for businesses of 11 or more employees, or at least verbally communicated for businesses of 10 or fewer employees.4
Dental professionals should not have to provide patient care in a constant state of fear. The oral health-care services that we offer to the public are vital, valuable, and greatly appreciated by the vast majority of patients. Still, practices need to be made aware of potential warning signs of violence, their options for managing threatening patient behavior, and have an appropriate plan in place to respond to an active attack. Everyone deserves to work in safety, and a strategy for any adverse situation can help to ensure that.
Editor’s note: This article first appeared in Clinical Insights newsletter, a publication of the Endeavor Business Media Dental Group. Read more articles and subscribe.
Additional resources
References
- Killett G. Community rallies around New Orleans dentist stabbed by patient. Nola.com. February 9, 2024. https://www.nola.com/news/crime_police/community-rallies-around-new-orleans-dentist-stabbed/article_306657f4-c7a6-11ee-b9dc-63b186c9e968.html
- Li DK. Suspect in fatal dentist office shooting is a “disgruntled” former patient, policy say. NBC News. March 1, 2024. https://www.nbcnews.com/news/us-news/suspect-fatal-dentist-office-shooting-disgruntled-former-patient-polic-rcna141434
- Rueve ME, Welton RS. Violence and mental illness. Psychiatry (Edgmont). 2008;5(5):34-48.
- Evacuation plans and procedures tool. Emergency action plan: minimum requirements. Occupational Safety and Health Administration. U.S. Department of Labor. https://www.osha.gov/etools/evacuation-plans-procedures/eap/minimum-requirements
Bethany Montoya, BAS, RDH, is a practicing dental hygienist, editorial director of DentistryIQ's Clinical Insights newsletter, and a key opinion leader. She has advanced knowledge and training in complex cosmetic dentistry, dental sleep medicine, and implant dentistry. Recently, she has devoted her time to dentistry’s personal and interpersonal aspects through her social media brand, @humanrdh. Contact Bethany at [email protected].
