Letters: Taking the Lead on Safety

I read with great interest the article published in the December 2010 issue of ENT Today, “Safety Net: With violence on the rise, otolaryngologists implement prevention strategies” (p. 1). Physician safety in the workplace is still largely ignored and your article serves to further awareness of the problem. I thank you for providing this forum.

It has been well over a decade that I experienced events similar to what you address. As chief resident, I treated a patient with radioresistant oral cavity squamous cell carcinoma who subsequently underwent curative surgery. From the time of his initial presentation to when I was last involved with his treatment, he expressed anger and frustration about the failure of radiotherapy to cure his disease and the swallowing and speech disabilities that followed. Following his curative surgery, he brought legal action against the treating physicians, alleging improper and inhumane treatment.

For over the following decade in multiple court appearances and voluminous written documents, the patient threatened the judges who heard his case, the president and vice president of the United States of America, members of the United States Congress and the governor of Illinois. He invoked complex mathematical calculations about how much his disability cost him in lost wages and time and described suffering that was akin to what was experienced in Nazi concentration camps. During some of his court appearances, he became belligerent and after making a death threat to the judge, was escorted out of the court room by law enforcement officials. Particularly important, however, were the threats against myself and the other treating physicians.

Despite my repeated written warnings to our representing attorney, my grave concern for his threats was not acknowledged, and neither by the judges and lawyers who heard his case. In at least one communication to our legal representative where I expressed my concern, I was told that this type of patient would just go away and that there was nothing else that could be done. I found it difficult continue my warnings and had little other recourse, especially in light of my ongoing status as plaintiff.

Following years of multiple court appearances, the patient finally broke into the house of the last presiding judge, with the intent of murder. Instead, he found her husband and mother in law and shot and killed them both. Days afterward, following a routine traffic stop he committed suicide. In the van where he had been living not only was a suicide note (also sent to local media outlets) found, but also a “hit list”, containing the names of the physicians who had treated him. He apparently was on his way to completing this objective.