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Medical centers deal with danger every day

QUINCY — The emergency department at Quincy Medical Center can be a tense environment. From bed to bed, the patients can include agitated drug addicts, drunks, and people hearing voices.

A hostile mix at times.

“I don’t think there’s a day that goes by that a nurse or another staff member isn’t at the very least threatened or spit on,” said Stacey McEachern, a 35-year-old nurse in the ER.

Three attacks at Boston medical facilities in recent days made it clear that staff members and patients face more than just medical risks when they walk through the doors of hospitals, clinics and doctors’ offices.

On Tuesday, a patient at a Massachusetts General Hospital bipolar clinic was shot to death by an off-duty security guard after the patient stabbed his psychiatrist during an afternoon treatment session.

On Sunday, a man was stabbed in the neck when a fight broke out in a waiting room at Boston Medical Center.

On Oct. 22, a sex offender allegedly tried to rape a woman in a bathroom at Massachusetts General Hospital.

Medical professionals in Massachusetts have pushed for laws to force hospitals to take security more seriously and to strengthen criminal penalties against those who attack health-care workers.

Last week on Beacon Hill, lawmakers heard testimony on the need for health-care employers to create plans to prevent workplace violence.

“Hospitals don’t want a lot of security, because they want a welcoming environment, but hospitals aren’t hotels,” said David Schildmeier, spokesman for the Massachusetts Nurses Association.

Financial pressures have led some hospitals to cut back on security and other support staffing, Schildmeier said.

A lack of legislation does not mean hospitals do not take steps to prevent and prepare for violence, however.

At South Shore Hospital, for example, security personnel regularly train health-care workers in crisis intervention and to recognize and react to patients showing signs of turning hostile, hospital spokeswoman Sarah Darcy said.

“We’re taking care of people during the worst time in their life,” she said. In a high-stress environment, she said, “early intervention is key.”

Paramedics and police will often call ahead if they suspect that an incoming patient might turn violent, Darcy said, giving security guards a chance to prepare.

The rate of assault against health-care workers is four times higher than other industries. For nurses, it is 12 times higher, according to the Massachusetts Nurses Association. Half of Massachusetts nurses indicated in a 2004 survey that they had been punched at least once in the previous two years.

The administration at Quincy Medical Center trains staff in “de-escalation” techniques, which McEachern defines as “talking someone out of hurting you.”

Effective? McEachern laughs, saying, “What we find most helpful is calling 911.”

The medical center stopped paying for a police detail several years ago, she said, but installed a security lock at the emergency department’s ambulance bay and agreed to a 24-hour security guard for a psychiatric section.

That six-bed section is the most dangerous, McEachern said, noting it can be overcrowded while patients wait for a bed to open in a psychiatric hospital.

There are times when patients need to be sedated and restrained.

“You could be talking about a 25-year-old, 200-pound male on extensive mind-altering drugs who wants to get out of there,” McEachern said. “Picture four women trying to hold him against his will.”

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John P. Kelly may be reached at