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DHMC Reflects on Response, Repercussions in Wake of Fatal Shooting

  • Technician Halla Sampito and her co-workers disassemble surgical case carts to clean the instruments in the central sterile reprocessing unit at Dartmouth Hitchcock Medical Center in Lebanon, N.H., on Sept. 13, 2017. The day before, Sampito was on her way in to work the 3-11 p.m. shift and was delayed when the hospital was locked down due to an active shooter incident. (Valley News - Geoff Hansen) Copyright Valley News. May not be reprinted or used online without permission. Send requests to permission@vnews.com.

  • Ed Merrens, chief clinical officer at Dartmouth-Hitchcock, speaks about the level of care patients received during and after an active shooter incident at the hospital the day before. Merrens and other hospital officials spoke during a news conference off-site in the Centerra business park in Lebanon, N.H., on Sept. 13, 2017. (Valley News - Geoff Hansen) Copyright Valley News. May not be reprinted or used online without permission. Send requests to permission@vnews.com.

  • Amanda Steele, a biomedical electronics technician, rebuilds an infusion pump in the engineering unit at Dartmouth Hitchcock Medical Center in Lebanon, N.H., on Sept. 13, 2017. Steele said while an active shooter incident was ongoing in the Intensive Care Unit two floors above them the day before, about a dozen engineering technicians were locked in the room, with the lights off, for about four hours. (Valley News - Geoff Hansen) Copyright Valley News. May not be reprinted or used online without permission. Send requests to permission@vnews.com.

  • Roger Bickford, who has worked in Dartmouth Hitchcock Medical Center's physical plant for 36 years, checks the readings on a natural gas burner in Lebanon, N.H., on Sept. 13, 2017. Bickford was on his way in to work the 3-11 p.m. shift the day before when he was stuck in stopped traffic due to the active shooter incident at the hospital. The boiler room's other operator was locked into the room during the afternoon. (Valley News - Geoff Hansen) Copyright Valley News. May not be reprinted or used online without permission. Send requests to permission@vnews.com.



Valley News Staff Writer
Thursday, September 14, 2017

Lebanon — Dartmouth-Hitchcock Medical Center returned to relative normalcy on Wednesday following the shooting death of a patient in the intensive care unit on Tuesday.

“This is a resilient organization,” said John Kacavas, D-H’s chief legal officer and general counsel, in a news conference outside a D-H office building on Wednesday afternoon in Lebanon. “Patient care was always the top priority. Patient care remains the top priority. Patient care will be the top priority. Doctors and nurses are caring for patients. Food preparers are preparing food. Housekeepers are keeping house.”

At the time of the shooting and subsequent “code silver” alert, some providers evacuated from the medical center — where approximately 6,600 people work — while others sheltered in place until the shooter was apprehended and law enforcement allowed people to return to the hospital, D-H Chief Clinical Officer Ed Merrens said on Wednesday.

The shooting took place on a normal Tuesday, when the hospital’s nearly 400 inpatient beds were mostly full and the operating rooms were busy, Merrens said.

D-H officials still are taking stock of the incident’s full effect on patient care, he said. For example, officials did not yet know how many people were affected by the evacuation and lockdown. Ambulatory patients and providers were evacuated from the hospital, while those in the midst of surgery or other procedures — such as interventional radiology and endoscopies and women in labor — stayed in place.

DHMC’s emergency room did stop accepting transfers for a couple of hours, Merrens said. During that time, for example, the Dartmouth-Hitchcock Advanced Response Team helicopter could not land, he said.

Alice Peck Day Memorial Hospital, the D-H affiliate that also serves Lebanon, received three diverted patients in its emergency department on Tuesday as a result of the shooting, APD spokesman Peter Glenshaw said. APD also received about eight patients in other departments, he said.

APD had a “code purple” in place from about 2 p.m. to 6:30 p.m. on Tuesday, which meant the hospital had additional people working in the emergency department to be ready for additional patients, Glenshaw said.

“We felt as though we were able to respond quickly and efficiently and in a very organized manner to what was a pretty stressful day throughout the Upper Valley,” he said.

Clinicians at Mt. Ascutney Hospital and Health Center in Windsor were not able to send patients to DHMC for specialty care on Tuesday afternoon, “but this did not affect patient outcomes in any way,” Dr. Joseph Perras, Mt. Ascutney’s chief executive, said in an email on Wednesday.

DHMC also was unable to send patients to Mt. Ascutney’s rehabilitation units until late afternoon and into the evening, Perras said, noting that some transfers occurred after 8 p.m.

During the news conference, Merrens characterized the effect of the shooting as “a stutter step for us from a clinical standpoint, but everyone got great care.”

Meals were delivered a little later than usual and the operating room also ran late, he said. Merrens, a hospitalist, was making rounds as late as 11:30 p.m., he said.

DHMC patient and Plainfield resident Nancy Liston, a cancer survivor, was in the middle of a radiology test as part of ongoing surveillance for a recurrence of the disease on Tuesday when she heard there was an active shooter in the ICU.

Even without a code silver, “these are always really stressful days,” she said.

But, she said, her provider was calm during the emergency. Liston, wearing a hospital robe, exited the building and made her way to D-H’s administrative offices at Colburn Hill, across Mount Support Road from the medical center.

“I was quite the scene,” Liston said of her appearance. “You had to keep your sense of humor and had to recognize that everybody was doing the best they could.”

While it seemed to Liston that providers could have had more training on what to do in such a situation, “overall, it was wonderful.”

She recalled that one D-H employee dropped $25 in $1 bills on a table in the room she was in at one point so patients could use the vending machines.

Eventually Liston, still in her gown, walked to the gas station at the corner of Medical Center Drive and Route 120, where her daughter, who is a graduate student at Dartmouth College, picked her up. She left her car and clothes behind, but was glad to be home, she said.

On Wednesday, she was waiting for a ride to retrieve her belongings. She already had rescheduled her appointments for next week. For her, the worst part of the experience was the delay in finding out whether her cancer has returned.

“I never got to my doctor to hear the results of the test,” she said.

DHMC patient Lynnford Henry, of Randolph, ended up having a much longer doctor’s visit than he originally had planned. He evacuated with his doctor in the middle of his appointment and they walked together to the Colburn Hill complex.

As they waited for several hours, “We talked about his son and my grandson,” Henry said.

Though he was concerned about the unfolding situation, Henry felt he was out of harm’s way and that the professionals had it under control.

“The hospital staff kept everybody very calm,” Henry said. “I was impressed.”

After people were allowed to leave, Henry’s doctor, who was concerned by Henry’s recent bout with pneumonia, walked him to the parking garage.

“He was excellent,” Henry said.

During Tuesday’s incident at DHMC, anxiety was high across the Upper Valley.

At Mt. Ascutney, “the biggest concern here was with our employees that had family members and friends that were working at DHMC,” Perras said. “As in any event like this, it was challenging to get detailed information early on, but once we knew there was a code silver at DHMC, we increased our campus security posture, with security posted at the driveway entrance and in the emergency room. We also shared information with our staff as we received it from DHMC.”

Valley Regional Hospital in Claremont also ramped up security while the situation unfolded at DHMC.

“Our team stood up on (our) incident command system and locked down the facility,” Valley Regional’s chief executive Peter Wright said. “Given we had what we believed to be an accurate description of the suspect, patients and families were allowed continuous access to the facility, albeit through a limited number of access points and with enhanced presence at each.”

D-H officials still are taking stock of security systems, the health care system’s emergency management coordinator, Jim Alexander, said during Wednesday’s news conference. No immediate changes are planned, he said.

“We really want to not be reactionary in thinking we want people in the hospital with weapons,” said Alexander, a former Lebanon police chief.

To help those affected navigate the emotional toll of an incident like this, D-H is providing employees with support from trained counselors and chaplains in the wake of the shooting, Merrens said.

“That’s not just something that’s going to happen today or tomorrow, but that’s something that’s ongoing,” he said.

Nora Doyle-Burr can be reached at ndoyleburr@vnews.com or 603-727-3213.