Report Warned of Hospital Violence : Shootings: Supervisor Molina attacks health officials for being unaware of recommendations in 1991 study. Officials say some proposals have been implemented but many are too costly.

More than a year before three doctors were shot at County-USC Medical Center, an official report warned the Department of Health Services about dangerous lapses in hospital security and offered an eerie premonition of last week’s emergency room violence.

The June, 1991, study was made public Tuesday by Supervisor Gloria Molina, who lambasted health department officials because they were unaware of its recommendations. The Board of Supervisors ordered the study, which was carried out by an independent security firm, after a panhandler stabbed a nurse in the neck with a pair of scissors.

Health department Director Robert C. Gates admitted that he had not read the report before Molina presented it to him Tuesday morning. Many of its recommendations have not been implemented, he said, in part because of the county’s anemic budget.

“The actual report I never saw,” Gates said in an interview. “Clearly, in hindsight, that would have been the smart thing to do, to read it. Whether that would have changed the outcome (of the emergency room shooting), I don’t know. It may have. . . . Everyone involved is doing a lot of soul-searching these days.”

The study by Donald J. Halloran, a security operations consultant, called for strictly controlled access to the hospital and outlined a variety of problems in the sprawling facility.

The report recommended greater security in the hospital’s parking facility, and Molina noted that if the plan had been implemented it might have been possible to prevent the armed assault and rape of a student nurse that occurred just hours after the Feb. 8 emergency room shooting.

“We do these reports and nobody follows up on them,” Molina said. “If these things had been in place, we wouldn’t need (to be adding) security officers.”

Although Gates did not read the report when it was first issued, a health department task force acted on some of its recommendations, including the hiring of additional security personnel, known as Safety Police.

Still, many other recommendations were not implemented. The 1991 report vividly described the overcrowded conditions in the emergency room waiting room and in the triage and pre-admittance areas, but in two years officials did little to relieve the crowding.

“These conditions are the breeding grounds of disturbances, which are generated by long waiting periods, frayed tempers and exasperation,” the study said. “No efforts to console or placate these waiting persons is made by hospital personnel. The inevitable result is a hostile outbreak resulting in Safety Police officers involvement.”

The assailant in last week’s attack, Damacio Ybarra Torres, complained of long waits and poor treatment in the hospital’s emergency room. In the wake of the shooting, health department officials say they are considering whether to use trailers to alleviate the overcrowding.

The security consultant’s report also refers to problems with the Safety Police assigned to the emergency room area.

“Safety Police personnel stationed at the entrance area are frequently called away for various assignments,” the consultant wrote. “It was stated that Safety Police officers are slow in responding when not stationed in the emergency area.”

County officials have said that although one Safety Police officer was assigned to the interior of the emergency room at the time of the shooting, his post was far from the triage area where the wounded doctors were working. The officer was in another area of the emergency room when the shooting took place.

The department implemented some of the 1991 report’s recommendations. Additional security officers were placed in the emergency room, the hospital developed an electronic surveillance system and metal detectors were installed in the psychiatric ward.

But the health department could not implement other recommendations, including stricter enforcement of rules requiring personnel to wear security badges. Recommendations to restrict entry to the hospital were not fully implemented at the time of the shooting.

The report also recommends that all visitors to the building be registered and issued passes.

“They didn’t have the resources to get around to everything,” Gates said. “No one is coming forward with the funds to solve the problems.”

Last year, the Board of Supervisors failed to grant a health department request for 143 additional officers throughout the hospital system. About a dozen budgeted positions for Safety Police at County-USC were not filled before last week’s violence.

Since the shooting, officials have increased the security staffing at the hospital, placing 35 additional officers in the facility. The temporary measure will cost the county $1.9 million annually. The county is studying more cost-effective solutions to the security problems.