Increasing Violence in the Dental Workplace – What Would You Do?

You're listening to the Phil Klein Dental Podcast. This year, tragically, there has been a few horrific incidents of workplace violence in the dental office. In one case, an assistant was attacked and stabbed in the eye by a patient. And in another incident, a dentist was shot to death in his own treatment room. Both victims were young and just starting their dental career. Absolutely tragic. So with the rise in violent crimes across the country, We as dentists are not immune to this disturbing trend. So the question is, what can we do to be better prepared? How does OSHA fit into all of this? To help us put this in perspective and tell us what we should be doing to prepare and respond to a violent crime in our dental office is our guest, Mary Govoni. Mary is an internationally recognized speaker, author, and coach focusing on infection prevention and control, OSHA and HIPAA compliance, and ergonomics. She's a certified dental assistant and registered dental hygienist with 50-plus years of experience in the dental profession. Mary will be joining us in a second, but first, are you looking for an air-driven handpiece that rivals the power and torque of electric? Well, I have good news. It's finally here. It's called the T-Mac Z and it's from NSK, a company we all know and trust as a world leader in dental handpieces. In addition to being lightweight and ergonomic, this revolutionary air-driven handpiece delivers unprecedented 44 watts of power, allowing it to cut through tough zirconia smoothly and quickly. In fact, the T-Mac Z reduces overall cutting time by 30%. That means less chair time, reducing the burden on you and your patient. Take a test drive of the TMAX Z air-driven handpiece from NSK. For a free 10-day trial, go to nskdental.com and find your local rep to inquire. Experience the power and excitement of the TMAX Z series. Mary, thanks so much for joining us on our show. Thank you, Phil. I'm happy to be here. Although we have some sort of scary and I guess a little bit sad things to talk about today. No doubt that it's very sad and tragic, these types of things that we're going to be talking about today, but it is the world we live in and it's better to be prepared the best we can in the event something like this happens. So recently, two dentists have been brutally attacked in their dental offices. The thought of that is just hard to imagine. What can you tell us about those two incidents? Absolutely. And it is just terrifying to think about. The first one happened in the beginning of February in New Orleans. And both of these were young dentists just at the start of their careers. And this particular dentist was working on a patient who we don't really know from the details that have been released yet, but something set him off, so to speak. And he pulled a knife. And he stabbed her multiple times, once in the eye. And from all the reports, it looks like she is not going to be able to keep that eye. She's probably already lost that. And so she's got a long rehab ahead of time. So what the description of the news reports is that he reached in his pocket and then reached back with the knife. So it may not have even been. possible to try to restrain this patient at that point um and the other one happened just a few weeks later in california where again young dentist just starting out his career was shot to death in the office that he worked in by a disgruntled former patient there has been some scuttlebutt in the investigative reports that have indicated there may have been some political overtones there as well but this person came in with a gun shot the office manager did not kill the office manager and then proceeded to um a treatment area and shot the dentist to death and then left the office was caught um there were witnesses that knew what the truck was and what he looked like and so forth and so he was caught and arrested so the this all begs the question were there some kind of warning signs that someone maybe missed when they first came into the office the patient who stabbed the doctor in new orleans did they come in already agitated or was there something that happened while they were in the chair we don't fully know yet but scary scary things yeah awful these are tragedies especially these two young dentists and one lost his life he graduated dental school in 2022 i think he worked for his father And his father wasn't there. That's my understanding. Yeah, his father was a dentist and went to work for his father. And then this horrible tragedy happened. So when it comes to warning signs, it seems to me that often it could be very difficult to pick up a warning sign from someone that might do something horrible. The obvious warning signs, of course, in those instances where they are shown and displayed when the patient walks in is someone very agitated, someone who looks very nervous. Those kind of things raise a red flag. But generally speaking, even if someone's a little bit agitated, you know, you can't go up to them and check their pockets for a gun or a knife. You can't ask them to leave the practice without a substantial reason. So tell us about the possible warning signs and what do you do when those warning signs raise a red flag? Well, the first thing I would say is that there are some resources that we're going to make available to to your listeners that come from the Department of Homeland Security and from the FBI and other agencies, law enforcement agencies that help us to know. But there's no substitute for contacting your local police department and have an officer come to your practice in. tell you specifically what to look for. How agitated does somebody have to be when they come in, when we start to think something's wrong? But I always say, go with your gut. If someone comes in, they do not have an appointment scheduled. They seem to be angry. Maybe they have a hand in a pocket. Tell somebody, let somebody else in the office know, because you can always be making a very discreet call to law enforcement, telling them that you have a concern. Can they please respond, but without lights and sirens, so it's not going to upset or trigger something in this person, but any kind of strange behavior. What you're talking about is typically referred to as situational awareness, which is exactly the case where you have to be aware of any kind of warning signs. But unfortunately, the way it is, at least here in Austin, Texas, and probably many other cities, if you call for police support, they'll ask you, you know, is anybody posing a deadly threat? Are you in any major danger? And just because of the shortages of law enforcement personnel, for them to come to your office in a case where you are saying that someone looks suspicious is probably unlikely. So unfortunately, what are your thoughts on that? And I think in any large metropolitan area, that is probably true. But in a smaller area, smaller city, or maybe a rural area, there. course if it's very rural the response may not be very fast but at least establishing a link letting someone know that something is is happening and if nothing else calling getting the doctor, it's probably going to be somebody in the business office or maybe the office manager that greets somebody coming in the front door. And so letting the doctor or letting other team members know to be on the alert, to know what to do. The bottom line is that everyone should have an emergency action plan. The Department of Homeland Security, again, and the FBI have all this training. There's great free training videos that you can access for active shooter incident response. So if somebody did come in with a gun, do you run, do you hide, or do you fight back? And those are things that have to be discussed ahead of time to know, do you have a place to run to? Do you have a place to hide, to be safe? And do you have the ability to fight back? a few years ago there was a dental assistant in tennessee who was shot and killed by her estranged husband who came into the workplace and shot and killed her and this gunman probably would have shot more people in the office as he was there but he was shot and taken down not killed but just taken down by a patient who happened to be in the chair who had a gun so You know, whether you feel it's necessary to have weapons on site to protect yourself. I don't know. I think that's sort of a personal decision that everyone has to make and follow gun rules and all that in your area. But at least understanding that these are now becoming more the rule rather than the exception. What state was the occurrence where the dental assistant was shot? That was in Tennessee. Okay, so the gun laws there allowed license to carry, they call it an LTC or something. So it does depend on the state. And California, where that horrific murder of that young dentist occurred, the gun laws are very strict there. And it's difficult, you can buy a gun. In fact, the person who committed the perpetrator who committed the crime actually bought a gun legally two weeks prior to that incident in California. no and you know you you hear the news reports all the time that some of the school shooters or people that go into a workplace and kill some of their former co-workers in many cases they have purchased weapons not long before they committed their violent acts so you know there's a lot of things that come into play that we working in a dental practice can't control but what we can do is learn as much as we can about how to protect ourselves what kinds of things to look for and then even doing simple things like having Security cameras. If you have a private entrance to the office, that door should be locked at all times. Have a security camera there so you could see who might be at that door. If it's a delivery person, you can even install like the camera doorbells that somebody can ring the bell. You can see who it is. And if you have to go and let the UPS or FedEx delivery driver come in. with packages, just those types of things that use technology to help make us safer. We'll be right back with Mary in a second. But first, if you're looking for a state-of-the-art denture system, then you need to check out Ivotion from Ivoclar. The Ivotion denture system is a fast and predictable process that delivers a finished denture out of a single disc for increased efficiency with attractive aesthetics. Your impressions are quickly and easily digitized in the lab, and the intuitive software allows the denture to be individually designed and customized with high accuracy. And here's the amazing part. In only one uninterrupted milling cycle, without bonding, the Ivotion disc is transformed into a denture with both base and teeth material. And when the milling process is done, all you need to do is polish. The Ivotion denture system is truly a game changer in denture fabrication. The dream of finishing a denture out of one single disc with unparalleled efficiency and quality is now a reality. To learn more, visit ivachlor.com. Talking about workplace violence, there's different kinds of workplace violence, different types. And this is kind of defined on many state sites that talk about workplace violence. So out of those four types, type one is usually considered someone with no legitimate business at the work site. So they, you know, that's someone who nobody's ever seen before comes in and commits a crime. The second one, what I've been reading is visitors that are employees or customers. And the third is violence against an employee by a present or former employee. So that's like a disgruntled employee. And then the last one is a personal relationship one. And that's the one you described with the estranged husband of that dental assistant who was shot and tragically killed. So out of those four types, I would think that the most common one I would think would be the personal relationship. Is that true? Or do you think it's a disgruntled employee? common to me would be someone who has no legitimate business at the workplace. You're exactly right. We don't see as many of those types of incidents of someone who's just randomly going in and shooting people in a dental practice. It is very, very common that is some kind of a domestic situation that spills over into the workplace, whether the perpetrator feels like they have them in a captive situation, wants to either embarrass or humiliate them or whatever the motivation is. But that is the most common that happens. And then disgruntled former employees. and or disgruntled patients who get upset about fees or treatment or anything perceived um that they were wronged um in seeking some kind of of revenge so osha talks about you talk about different types of workplace violence osha defines it as any act or threat of physical violence harassment intimidation or other threatening or disruptive behavior that occurs on the worksite that's the those kind of behaviors could happen anywhere but it's workplace violence when those things happen in the worksite and it ranges from threats to verbal abuse physical assaults and even homicide as we saw in in california and it can not only affect but involve employees patients, visitors, just as you said, total strangers. And some other kind of interesting information, the Association of American Medical Colleges published some research that said that 60% of the healthcare workforce prior to the pandemic had experienced some type of verbal or physical abuse from a patient. um that's a pretty big number of of people that say that they were harassed by a patient um the human resources organization sherm society for human resource management says that one in seven employees in u.s workplaces feels unsafe in their workplace that's again another sort of scary statistic that um we would think of necessarily a health care setting as a safe place but apparently not so much in our current climate in this country. Yeah, I'm not sure there's any place where you can feel completely safe anymore in this world. But when we talk about the personal relationship part, which is one of the types of violence that could occur at a workplace, the personal relationship, do you think that it's the responsibility, for instance, of a dental assistant to say that I have a restraining order on my estranged husband and he's kind of gone off the edge. And if he walks into this office, please let me know and or call the police or whatever. Is it the responsibility of that employee to alert the office of that kind of scenario? I believe so. Because they could be the only person to give people a clue that there is a potential threat. Now, sometimes that's not something that we want to admit to other people that maybe we have a failing relationship, or maybe we're being stalked by someone. But yes, I think that everyone has it could be the employer, maybe it's a disgruntled, you know, spouse and an employer relationship, you have to let someone or everyone know that there is that potential threat so you can be prepared a number of years ago i worked with a practice in a small town and they did have a team member who was going through a very contentious divorce she did have a restraining order against her soon-to -be ex-husband and he kept threatening her coming into the office and just causing a bus he'd walk into the reception area and throw magazines around or just make a mess nothing terribly violent but it still was frightening and threatening and so what they finally did was have the police come out and meet with them and they reinforced the team reinforced with the police department that this person did have a restraining order and they kept a log of how many times that they'd showed up they did install some security cameras so they could actually see the footage of this person coming in and then they developed a code if you will um so rather than you know dialing 911 from the front desk where that again might alarm someone what they did was they dialed the main number for the police station and everyone because small town small police department everyone knew if they said the next patient is here that was the code for this guy is here you better get up here quickly so there's lots of different I guess creative for lack of better description things that you can do but preparation is everything know what to do because when Something like that happens panic will set in and then we just don't necessarily think logically Right and to get that information on what to do, especially if there's an active shooter I know there's a lot of resources out there. The fbi has it There's different community safety organizations that issue that information in the form, you know, they have PDFs and so forth. But I mean, situational awareness is number one. So you have to be aware if something looks like it's not right, or somebody looks very nervous, or they're coming in with a trench coat, and it's 85 degrees out, you know, you know, something's wrong, right? So situational awareness is number one. And then, of course, being prepared to do something. And you mentioned run. Hide and fight and I think those are the three things that are very important in these kinds of situations But they're in that order. So the last resort is fighting because your life is at stake You know, the first thing you want to do is get out of there if you can just leave and get away And then of course if you can't you hide and then if you're approached and there's a deadly threat you fight So what are some of the things that need to be documented in an office? How much I mean we have so much documentation infection control, OSHA, HIPAA, this stuff never ends. And if you have a surprise inspection by an OSHA inspector and you don't have good documentation, you're in real trouble. So you have to document this stuff. What do we need for this kind of situation? You need what OSHA would call an emergency action plan. And there's really two components to it. One would be an evacuation plan. There's a fire. There's some, you know, you spill the chemical, not very likely for that to happen, but maybe a fire in the dental office. And how are you going to get out? You identify your exits and make sure that. Everyone knows where the closest exit is, how to get out. What if that exits blocked? What's my next alternative? Those types of things. And then the other part in emergency action plan is more situational than just I have to get out of the office. I have an active shooter or I have someone who's called in a bomb threat or any number of things. And OSHA. has a terrific e-tool on their website we'll we'll have the link accompanying this podcast for that that practices can go and they can use this template to create their emergency action plan and then you have to practice it so that you know what to do if something happens just like practices should make sure that they do that drill of, you know, we have a medical emergency. What are we going to do? How are we going to take care of this patient? Or maybe it's even an employee who has collapsed at work. So we need to have a plan, have it documented. We need to practice it so that we know what to do if the situation arises. Yeah. And we all hope the situation never arises. But like we said at the top of this podcast, you have to be prepared. That's just the way life is right now. And those that are prepared in the long run are going to be safer. and endure less casualties if something, God forbid, does happen that's really bad. Thank you very much, Mary. We're going to be talking on future podcasts about workplace violence and how to handle some of these issues and what to do to be prepared. And we look forward to talking to you about that in the future. Great. Thanks for having me.