Dangerous employees: How to deal with a potential threat

Not every disgruntled employee is ready to lash out, but there are signs to watch for to make sure someone with violent tendencies doesn't act out in your practice.

By — Posted June 25, 2007

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About once a year or so, an employee or student somewhere wreaks havoc at his company or school, killing, injuring, and often committing suicide. In the aftermath, the media are filled with experts offering advice on how to anticipate and prevent violent attacks.

The truth is that, like lightning strikes or plane crashes, homicidal attacks in the workplace are, while horrific, extremely rare.

But that doesn't mean medical practices can ignore the potential danger of employee attacks. Even non-lethal aggression -- hysterical yelling, pushing, stalking, "poison pen" letters, unwelcome sharing of pornography -- can have a devastating effect on employees, patients or vendors. And if a practice fails to take reasonable actions to identify volatile workers and protect people in the office from them, the outcome could bring declining employee morale, or a lawsuit.

Every physician-employer should have procedures in place to help identify people likely to explode in violence. But, most medical consultants say, forget the advice from TV's talking head profilers. Loners, people fixated on video games, people who can't make eye contact and people with emotional problems aren't necessarily violence-prone people. If you single out employees based on personality type, you may be asking for legal trouble.

"We never advise administrators or doctors to try to profile people who may cause violence. They're not trained for that, and even professionals often get it wrong," says Robert Levy, president of Corporate Counseling Associates, a workplace training and consulting company in New York.

While personality type is not a good indicator, behaviors are more indicative of potential problems. Sheila Dunn, a medical practice employee consultant, says there are "red flags" that everyone in the office should be aware of. "The most serious red flag is when there is a major change in behavior," says Dunn, CEO of Asheville, N.C.-based Quality America, which advises medical groups on compliance with health and safety regulations.

"We all have bad days," she says. "But if someone begins to regularly show up at work badly groomed, or if they break down in tears often, or if their attendance suddenly drops, or they begin to look at every suggestion as a personal attack, the situation should be investigated."

Dunn suggests speaking to the person privately, asking if there is a problem with which the practice may be able to help. There are also community resources the employee can be made aware of.

But Dunn warns that unless the red-flag behavior interferes with the office's effectiveness, administrators or doctors should not take forceful actions. "You can suggest that an employee seek professional help. But if it's a personal matter, you can't require it."

A more difficult situation for the practice arises when someone actually makes a threat or takes some aggressive action, even relatively minor, against another worker. "I can't tell you how many times I've had to defend clients who had experienced a violent act in the workplace where there were previous acts of violence from that same employee and nothing had been done about it," says Jon Kane, chair of the labor and employment department at legal firm Pepper Hamilton in Berwyn, Pa.

Dunn goes further, "In my experience, most of the time before someone commits an act of violence, they tell someone they're going to do it. Too often the person they tell doesn't believe them."

Attorneys say ignoring overly aggressive or violent acts or threats puts groups at extreme peril. "The legal liability issue is based on whether a reasonable person should have recognized the signs that a worker could cause problems," says Jon Zimring, an attorney with Duane Morris in Chicago, who works on the management side in labor-management issues. Of course, warning signs, when viewed by juries with the benefit of hindsight, often seem much more obvious than they did at the time.

Eyes and ears on the ground

Because doctors and group administrators can't be everywhere and see everything, they have to depend on co-workers to report events to them. Experts stress that the most important thing groups can do to prevent violence in the workplace is to create an atmosphere in which employees are willing -- and even feel it is their responsibility -- to report any threat or threatening behavior no matter how minor. "I tell people, if for one second you think 'I wonder if I should report this,' then you should," Kane says.

It may not be significant that an employee, after getting a dressing down from a supervisor, says with a gentle smile "Someday, I'm going to put arsenic in her tea." But it's not up to co-workers to evaluate the threat, Kane says, just report it.

Groups may encourage employees to come forward by keeping their names out of it. But Kane says you can't promise total anonymity; if an event escalates to a police or civil action, the employee witness may have to testify.

Once abnormal behavior is noticed or reported to an administrator or a doctor, something must be done. "It can't go to a higher level and then be dismissed without some sort of investigation," says Zimring.

While most investigations can be handled by the practice administrator, Zimring and others suggest that, because the group is ultimately responsible, one doctor be assigned to oversee issues of workplace violence. The administrator should report any investigations to that doctor, who should make sure that the appropriate process continues until the matter is resolved.

The way an investigation progresses depends on many factors, including whether more than one person witnessed the incident, whether the employee had been reported before, and whether red flags (such as sudden personality changes) have also been noticed. In general, the administrator should simply state the facts and ask the worker for an explanation.

For example if someone is being investigated for threatening another worker, a common (and usually truthful) response will be "I was just venting" or "I was joking." The administrator will then have to use the reasonableness test to determine if the employee should be believed. "If the threat was said with clenched jaw with the face red with rage, you'll take it more seriously than if the worker was pretty calm and was quickly able to return to regular duties," says Timothy A. Dimoff, president and CEO of SACS Consulting, a workplace security consulting company in Ohio.

The result of the investigation may range from exoneration to a warning to firing.

The practice can guard against being sued for unjust termination by having written policies against any kind of threats, cursing in the office, or physical or verbal abuse, says Mike Carrouth, a Columbia, S.C. attorney with the labor law firm of Fisher & Phillips. Initially, the policy, which should be distributed to everyone, can be just a few sentences. But over time, groups should expand it to detail specific prohibited activities. Some lawyers advise groups to specify which words cannot be used in the office.

While zero-tolerance policies have gained media exposure, many lawyers and consultants discourage that approach. "It's better for the administrator to have some leeway," Carrouth says. In addition, a zero-tolerance policy will make it less likely that co-workers will report seemingly minor incidents because they know that will cause someone to be fired.

Groups should maintain careful records of every incident, including a detailed summary of every interview and what actions have been taken. That documentation will provide some protection against lawsuits from someone injured by an employee, and also from employees who claim they were unjustly terminated.

While experts advise groups to find remedies short of termination, there are definitely times when firing is the best option. "Doctors have to walk a tightrope," Zimring says. "But if I had a choice, I'd much rather defend a medical practice against an employee suing for unjustified termination than from a victim of violence."

In the end, though, experts say the best way to reduce employee violence issues is to hire the right people. Most medical practices don't go beyond contacting previous employers, even though they're generally reluctant to give poor references. "At the very least, do a credit and criminal record check," Dimoff advises. For important employees, such as business managers, consider contracting with an investigation company for a more detailed background check.

Violence in the workplace can strike anywhere at any time. And sometimes there is no warning. But physician-employers should be able to say to themselves, and to juries if necessary, that they did their best to protect employees, patients and visitors.

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Effects of workplace violence

[download pdf]

A Bureau of Labor Statistics survey details the number of businesses that reported an incident of workplace violence and the type of effect on employees.

All industries Education and health services Health care and social assistance
Total incidents 389,380 61,540 59,770
Any effect 35.5% 42.9% 43.0%
Absenteeism 7.5% 11.4% 11.4%
2.7% 0.6% 0.6%
Turnover 5.3% 4.4% 4.3%
Fear levels 20.9% 25.1% 25.1%
Productivity 8.7% 6.6% 6.7%
Morale 20.6% 23.5% 23.6%
Other effect 0.7% 1.4% 1.5%
No effect 64.2% 55.7% 55.7%

Note: Multiple responses were allowed.

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Outside threats

Health care is one of the professions most affected by workplace violence, with patients or outsiders most likely to be the source.

48% Health care and social service's share of all nonfatal injuries from workplace violence
69 Homicides in health services (1996-2000)
12.6 Average annual rate for nonfatal violent crime for all occupations, per 1,000 workers
16.2 Per 1,000 physicians
21.9 Per 1,000 nurses
68.2 Per 1,000 mental health professionals

Most likely settings: Hospitals, nursing and personal care facilities, residential care services.

Most likely victims: Nurses, orderlies, attendants

Source: Occupational Health and Safety Administration, Bureau of Labor Statistics, Dept. of Justice's National Crime Victimization Survey

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When domestic abuse comes to the workplace

Sometimes people outside the practice bring in violence, most often when domestic abuse spills over into the office.

These situations can take many forms. In an extreme case, the abuser may enter the office and physically attack not only the spouse but also anyone else in the way. Or the abuser may stand off-premises at closing time, frightening the staff. Some abusers try to call their spouses or partners multiple times a day and, when they can't get through, verbally abuse the receptionist.

The first response should be to deal directly with the abused person. "Call her into the office and explain to her the community resources that are available," says Sheila Dunn, CEO of Quality America, which advises medical groups on compliance with Occupational Safety and Health Administration regulations.

If the abuse continues to affect the office, the office administrator or physician can try to create procedures to maintain a level of comfort and safety. Teresa Tracy, partner in the law office of Baker and Hostetler, says workers can be trained to send the abuser's calls to voice mail. And if the abuser stands off-premises at closing time, don't hesitate to call the police.

Eventually, a group may have to take the abuser to court. "This is a situation where it would seem pretty easy to get some form of injunctive relief," Tracy says.

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