Who paid to treat gun as­saults

Baltimore Sun Sunday - - NATION & WORLD - Bal­ti­more Sun re­porter Mered­ith Cohn and in­tern Wy­att Massey con­trib­uted to this ar­ti­cle. jge­[email protected]­sun.com Twit­ter.com/justin­ge­orge

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.

ALGERINA PERNA/BAL­TI­MORE SUN

At Johns Hop­kins Hospi­tal, Lekya Mis­souri, 37, pre­pares to give her daugh­ter, Ken­dall Brock­en­brough, 3, Val­ium and ap­ple juice, as the child re­cov­ers from shot­gun wounds.

ALGERINA PERNA/BAL­TI­MORE SUN

JEN RYNDA/BAL­TI­MORE SUN

James Evans, CEO of Il­lume Com­mu­ni­ca­tions, is work­ing with the city health de­part­ment to reach men who are po­ten­tial per­pe­tra­tors or vic­tims of vi­o­lence.

AMY DAVIS/BAL­TI­MORE SUN

Dr. El­liott R. Haut, a trauma sur­geon at Johns Hop­kins Hospi­tal, demon­strates the use of tourni­quets on hospi­tal em­ployee Chanapa Tan­tiban­chachai.

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