Who paid to treat gun assaults
The halls outside Johns Hopkins Hospital’s emergency department were crowded with police, worried family members, doctors and nurses. Eight people had been shot in one incident the last Saturday in September in East Baltimore. Among them: 3-year-old Kendall Brockenbrough, Missouri’s daughter.
Missouri spotted a hospital social worker walking toward her and immediately thought, “No, no, no!”
Her mind flashed back to June 2011, the last time a hospital social worker had approached her. Back then, the staff member told her that her husband, Henry Mills, had been shot in the back of the head and killed. Missouri had to identify her husband as he lay on a gurney, his chest and legs covered by a white sheet. She asked hospital workers to wipe up the blood pooling under his head.
Mills had been shot by David Hunter, a member of the Black Guerrilla Family, Baltimore’s most powerful gang. Hunter, who is serving two life sentences plus 40 years for the crime, is considered a hit man by Baltimore police. This class of shooters, who take murder-for-hire contracts issued on the streets, are responsible for an outsized share of city homicides, police say.
This time the social worker escorted Missouri to a trauma bay. Kendall was alive. Her father hovered over her, singing “Five Little Monkeys Jumping on the Bed” to distract her from the pain of a broken left femur and a ruptured artery. She had taken a shotgun blast.
“Mommy, mommy,” Kendall sobbed when she saw her.
Kendall had been outside with her father when three gunmen approached from different directions and fired on the crowd, according to police. The father had also been hit, in his foot, and it was bleeding. He had refused treatment until he knew his daughter would survive.
Missouri jumped in and sang the nursery rhyme with him. Later, as doctors sedated Kendall for surgery, her mother told her how much she loved her. During an eight-hour operation that included two blood transfusions, doctors removed a section of artery from her right leg and spliced it into her left leg.
Three surgeries later — to remove bone fragments and scar tissue and close wounds — Kendall is on her third week in the hospital. One day last week, she lay under a pink blanket depicting Disney’s “Frozen” movie, her left leg held together by a heavy external fixator that resembled metal scaffolding. She alternated between grimaces, uttering “ow,” and the unsinkable amiability of a toddler.
She had been a girl who was gaining independence: She had finished potty training, started picking out her own clothes and could tell her right shoe from her left. Now, Missouri said, she would have to relearn to walk in a rehabilitation hospital, where she is scheduled to stay for up to two months after she’s discharged.
Kendall wasn’t “just shot,” Missouri, 37, said. “It was a life-changing event.”
Will Kendall have full feeling in her foot? Will her leg grow properly? Will the scars on her skin make her suffer teenage humiliation?
These are her mother’s worries, and they go on. How long will Kendall need counseling? How long will she need painkillers? And for today, how long will we be able to entertain her by blowing bubbles or playing with an iPhone? When will the violence end?
Missouri, who lives in White Marsh, is at a loss to understand why gun violence has hit home twice. She recently bought a
Bible looking for answers — or at least a different future.
“My kids have suffered. I have suffered,” Missouri said. “Now my youngest daughter suffers.”
A nurse walked in with a vial of Valium, and Kendall started crying. “She’s not gonna touch my feet. No, I don’t want her to hurt me,” the girl said.
Last week, a doctor removed his white lab coat in an attempt to put Kendall at ease after she asked, “Are you going to hurt my leg again?” This time the nurse promised to stand by the door as Missouri tried to get her daughter to drink the Valium from a syringe through gritted teeth.
The girl turned her head, smacked her mother’s hand, hid her face.
Eventually, Kendall swallowed the medicine. Missouri heaved and hid her face in her hands as she cried. She tells herself she can’t be upset at her daughter’s lashing out. Missouri says she is grateful.
“She’s here,” the mother said. “She’s here.”
It’s the fear and anxiety that hospital staff also need to tend to, with the help of social workers and pastoral care. And sometimes, they need extra security, as was the case in the shooting that wounded Kendall. A shootout can bring victims, perpetrators and their families to the hospital, and Verrillo has to ensure they remain on opposite ends of the hall.
“We have to have very clear boundaries,” she said.
It can be difficult to remain at a clinical distance. Dr. Rodney Omron, an emergency physician and associate program director of emergency medicine at Johns Hopkins Hospital, recalls the “executionstyle” shooting of an apparently homeless man he often saw on his way into work.
Like law enforcement officials, Omron notes a more brazen cold-bloodedness among shooters. That’s hard to quantify, but over the past two years, Baltimore, among a number of cities, has seen a steep rise in homicides.
In recent months, it seems as if almost every Friday night he has to tell family members a loved one is dead.
Omron had to put a breathing tube in his own father and watched his mother, who succumbed to cancer, die in his arms. He served as a physician for the Marines in Iraq. “I thought I had seen everything,” he said.
Then he came to Hopkins. He said he has seen mothers suffer heart attacks from grief. He’s also tried to comfort patients, sharing with one gunshot victim what his mother often said when she was fighting cancer: “Every day is a different gift from God.”
The patient disagreed. He’d watched his mother commit suicide and was a victim of abuse growing up. He had just gotten out of jail and, because of his injuries, was facing a life with a colostomy bag. Now he worried his son will never respect him. So he wanted to die. Omron felt powerless. “I have to bear witness to somebody else’s sins that I have no control over,” Omron said. “It’s like a disease I have no cure for.”
‘Stop the Bleed’
More and more, the wounds of urban gunshot patients look like those from war. Studies have shown that many of these victims have died from three potentially preventable injuries often seen in battle — massive bleeding, obstructed airways and open chest wounds. A gunshot victim struck in an artery can bleed to death in five minutes. Certain victims, depending on the location of their wounds, could be saved if they receive prompt care.
Those parallels have sparked the health field to institute life-saving practices borrowed from the battlefield. Emergency rooms are stocked with Velcro tourniquets to stop bleeding, something that trauma surgeons and federal officials believe will become commonplace in stores, malls and workplaces in the near future.
Even school districts are looking at acquiring tourniquet kits, said Dr. Richard Alcorta, state medical director for the Maryland Institute for Emergency Medical Services Systems.
Haut, the Hopkins surgeon, carries a tourniquet with him at all times and compares the coming changes to how CPR became more commonplace.
“When it first came out, they said, ‘Oh, it’s just for doctors.’ Now it’s for everyone. There are defibrillators everywhere. This is the same thing,” said Haut.
The American College of Surgeons and Homeland Security officials are teaming up to make tourniquets widely available and train the public in using them. The national push comes after mass shootings and mass casualty events, such as the Boston Marathon bombing. Homeland Security began the “Stop the Bleed” campaign late last year.
In Baltimore, everyday violence warrants the same preparation. The Police Department started issuing tourniquets in 2015, and officers carry them on their belts. Already this year, at least two officers have saved lives using them, and just Wednesday night, a tourniquet was used to clamp the wounded wrist of an officer who accidentally shot himself while approaching a carjacked vehicle.
Other cities have already expanded their efforts. In Philadelphia, Temple University Hospital is teaching residents in high-crime neighborhoods how to give life-saving care to gunshot victims, including how to use tourniquets.
Also in Philadelphia, police have long practiced “scoop and run” with seriously injured victims. This allows officers to take trauma victims from scenes to hospitals in their patrol cars, bypassing ambulances because speed could save a life. Last year, Philadelphia police took more than 2,250 people, including gunshot victims, to area hospitals.
“There have been a lot of lives saved over here because of that practice,” said police spokesman Lt. John Stanford. “We can’t just sit here and let this person bleed out, so we throw them in a car and go.”
Still, most people killed by gunfire die where they are shot, said Dr. Garen Wintemute, director of the Violence Prevention Research Program at the UC Davis Health System in California. “Trauma people don’t have a crack at these people. They’re just dead,” he said.
Even if they make it to the emergency room where trauma medicine has improved dramatically, their odds of survival are getting worse, according to a number of hospital studies across the country, including in Baltimore.
In most U.S. trauma centers, even though firearm injuries account for a fraction of injured patients, they result in the same number of deaths as motor vehicle accidents — the most common reason people land in emergency rooms, according to a recent report in the Journal of Trauma and Acute Care Surgery.
Researchers say gun violence has become a public-health crisis and needs to be studied like an epidemic. About 11,000 Americans die a year in gun homicides.
“It’s complex and it requires a broad investigation much like you would do with any disease,” said Dr. Stephen Hargarten, chair of emergency medicine and director of the Injury Research Center at the Medical College of Wisconsin. “We did this with HIV.”
But there is a lack of data on what’s happening at crime scenes. For instance, many police departments don’t track how many people get shot and survive. So researchers can’t determine how lethal gun violence has become.
“We centralize data on cancer, we centralize data on vaccinations, things that are important. Let’s put more money into it and start a national intervention on this,” said Sauaia, from the University of Colorado Anschutz Medical Campus, which undertook one of the latest studies on gunshot patients based on a Denver trauma hospital’s data.
By collecting the data available from the nation’s largest cities, The Sun found that gunshot victims in at least 10 cities were more likely to die last year compared to the previous year. But half of the 30 biggest cities don’t keep statistics on non-fatal shootings.
Funding for gun violence research has dried up in the past two decades, since Congress restricted spending by the Centers for Disease Control and Prevention on studies that could be construed as promoting gun control. Gun rights advocates, including the National Rifle Association, argued that guns are not a disease.
Dan Blasberg, president of Maryland Shall Issue, which advocates for gun owners’ rights, said researchers should approach their work comprehensively, rather than ideologically. Instead of focusing on suicide by firearm, he said, they should explore the root causes.
Part of the fallout from the void in research money is the disappearance of gun researchers. Wintemute determined that there are no more than a dozen active, experienced researchers in the country who have focused primarily on firearm violence. To do his work, Wintemute eventually decided to self-fund the research.
“Firearms and the impact that they have on public health gets a very little piece of the pie,” said Dr. Cassandra Crifasi, an assistant professor in the Johns Hopkins Center for Gun Policy and Research.
In June, in response to the Orlando nightclub mass shooting, five of the nation’s medical associations representing more than 420,000 doctors called on Congress to provide the CDC with funding for gun violence research.
Another approach
In lieu of scientific study, many medical professionals are intervening in other ways. Many hospitals, like Baltimore’s Shock Trauma Center, have noted the “frequent flier” phenomenon, in which victims of violence show up two or more times as patients. Studies have found that these people are much more likely to die in a violent crime once they’ve been shot or stabbed and survived.
Shock Trauma, under Cooper, created the Violence Intervention Program in 1998.
The effort connects patients with resources, monitoring and counseling to steer them away from violence. Cooper studied outcomes of the program and found it had a profound effect on participants who reformed and got jobs. About 900 patients have enrolled in the program.
Last month, the city health department received a $500,000 grant from the U.S. Department of Justice to start a program like Shock Trauma’s. The planned program, called the Baltimore City Thriving Communities Project, will use Safe Streets intervention workers, ex-felons who try to interrupt violence by helping to mediate disputes, in hospital emergency rooms.
In Philadelphia, Temple University Hospital’s anti-violence program Turning Point does similar work, but goes even further, showing gunshot victims who have recovered a video of their actual resuscitation in the emergency room. It helps victims understand how hard it was to keep them alive, and how many people cared enough to help.
The hospital has another program, Cradle 2 Grave, which takes middleschool children through a simulation of what actually happened to a 16-year-old, Lamont Adams, shot 12 times in 2004. The students lie down on gurneys, while hospital workers put red stickers on their bodies to mark where the bullet holes were on Lamont.
These programs, along with police efforts to “scoop and run” with gunshot victims, have been underway for years, in some cases decades. Philadelphia’s lethality rate has remained largely unchanged for years while lethality rates have risen in other cities.
Meanwhile, researchers such as Dr. Daniel Webster, director of the Center for Gun Policy and Research at the Johns Hopkins Bloomberg School of Public Health, are increasingly examining the networks of the victims and the perpetrators. Much of the violence is concentrated in poor, segregated neighborhoods.
In the 92 square miles of Baltimore, a Sun analysis found, 80 percent of homicides by shooting in the past five years took place in about one-quarter of the neighborhoods.
Webster describes urban gun violence as mimicking the outbreak of an infectious disease.
“It’s person-to-person exposure and social contacts,” he said.
To investigate this idea, the Baltimore City Health Department is exploring the launch of a survey of residents to determine how many people have been shot or victimized and look for patterns. Health officials want to map where homicide victims lived — not where they were killed — to see if trends can be extrapolated as to how gun violence might spread.
One man is going directly to the shooters to look for answers.
James Evans is the CEO of Illume Communications, a Baltimore advertising firm that has worked for CVS Pharmacy, Timberland boots and Chase Brexton Health Care. He was hired by the city health department to figure out how to the reach the men doing the shooting, to convince them to put their guns down.
It’s a challenge that has vexed researchers from Hopkins to Harvard University, as well as police departments, trauma surgeons and grieving families.
So far he has discovered that shooters are more likely to listen to the women in their lives — mothers, sisters — and that they aren’t afraid to die. So he’s found another angle that does resonate with them, asking: What if you survive a shooting?
What if you’re paralyzed? What if you’re in a wheelchair for the rest of your life and called “knees down” — a street nickname for these victims. What if you’ll need a colostomy bag?
Evans, who grew up in Park Heights and lost two family members to violence and more than 10 to drugs, also learned a big reason some of these young men are carrying handguns — not to be aggressors, but to protect themselves.
“Those who don’t live here, don’t understand . ... Like the Wild Wild West, real men — John Wayne kind of men — are expected to carry a gun,” Evans said.
“If there was a way for people in those neighborhoods to feel less afraid, there would be less impetus to carry a weapon.”
In the end, some shooters may be just as scared as everyone else.