CNN
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The gunman arrived at UPMC Memorial Hospital in Pennsylvania carrying a bag with a handgun and zip ties, authorities said. He went straight to the Intensive Care Unit, where he held staff members hostage until he was killed in a shootout with police.
A responding police officer was killed, an intensive care unit doctor, a nurse and a custodian suffered gunshot wounds and a fourth employee was injured in a fall, according to authorities.
The York County District Attorney’s Office has not released a motive, but a law enforcement official briefed on the investigation told CNN that Diogenes Archangel-Ortiz, 49, believed that more could have been done to save his wife, who was on life support at the hospital for a terminal illness.
The February 22 attack at the hospital is among an alarming number of incidents of violence against health care workers in recent years, illustrating the need for more to be done to keep patients and staff safe, experts say.
“Workplace violence is a longstanding and unresolved issue in health care,” Jennifer S. Mensik Kennedy, president of the American Nurses Association, said in a statement after the shooting, calling on the federal government to strengthen prevention and reporting requirements. “It is a growing public health crisis that demands urgent attention.”
Health care workers are five times more likely to experience workplace violence than employees in all other industries, government surveys have found.
Health care and social assistance workers accounted for 72.8% of all cases of private industry workplace violence from 2021-2022, more than any other sector, according to the latest data available from the US Bureau of Labor Statistics. And while health care workers make up 10% of the workforce, “they experience 48% of the nonfatal injuries due to workplace violence,” the Centers for Disease Control and Prevention said in 2024.
A 2023 Survey of Registered Nurses from AMN Healthcare, a nurse staffing company, found what AMN Chief Clinical Officer Cole Edmonson called a “perfect storm” of problems in the industry.
“We’re just trying to take care of people, and they’re lashing out at us,” Terry Foster, a critical-care nurse and past president of the Emergency Nurses Association, told CNN. “It’s patients who don’t want to wait, or they act out or are very dramatic or violent. And sometimes our patients are fine, but their families will lash out at us and threaten us.”
The International Association for Healthcare Security and Safety’s 2023 Healthcare Crime Survey showed that simple assault on health care facility staff rose over three years from 10 incidents per 100 beds to 22 incidents.
“Anyone you talk to in health care is going to tell you that since Covid we’ve definitely seen a significant rise in workplace violence for a variety of reasons,” said Eric Clay, vice president of security services, Memorial Hermann Health System in Houston, and past president of the International Association for Healthcare Security and Safety.
Many health care settings are stressful and emotions can run high for patients and providers, especially in emergency departments.
“We see people typically on their worst day, right when they’re going through some sort of trauma, emotional trauma, physical trauma, and to be honest, there can be significant wait times in ED,” Clay said.
Often, active shooter situations covered by the media are mass shooters with seemingly random victims, but violence at hospitals is typically targeted, according to Clay.
“There’s a perceived wrong that either the physician has not given the treatment or the outcome has not been what was expected, or a domestic violence situation,” Clay said.
Last year, a Nashville man seeking mental health assistance but unsatisfied with his treatment allegedly assaulted a security guard and threatened to take the lives of hospital employees before being arrested.
In August 2024, a primary care and emergency physician in Woodland Hills, California, was walking to his car from his medical practice when he was shot and killed in what the Los Angeles Police Department called a targeted attack.
A man police said was seeking new treatment after being dissatisfied with the care he was receiving from the Department of Veterans Affairs went to Northside Medical Midtown in Atlanta in May 2023 and opened fire, killing a 38-year-old woman and wounding four others.
A security guard working at a Concord, New Hampshire, psychiatric hospital was fatally shot in November 2023.
A gunman killed two doctors and two others at Tulsa, Oklahoma’s Saint Francis Hospital in 2022 after he blamed one of the physicians for causing him pain from a recent back surgery, police said.
In 2022, a man killed two employees of Methodist Dallas Medical Center in Dallas inside the “mother/baby” unit.
‘I relive it when my eyes are opened and closed’
Hospital officials and law enforcement have not provided information about security measures in place at UPMC Memorial at the time of the February 22 attack, but in a statement the day after the shooting the hospital said, “UPMC Police and Security have enhanced their presence.”
CNN has reached out to the hospital for details.
Archangel-Ortiz was removed from the hospital by security the previous night after becoming irate and emotionally overwrought following a diagnosis that there was no other treatment available for his wife, the official briefed on the investigation said. It is not clear whether she has died.
York County District Attorney Tim Barker said at a news conference the day of the attack that Archangel-Ortiz had “contact previously in the week in the ICU for a medical purpose involving another individual,” but his office has declined to provide additional information.
Archangel-Ortiz returned to the hospital last Saturday morning, carrying a backpack with a firearm, zip ties and duct tape, and held staff members hostage before being killed in a shootout with police, officials said.
Nurse Tosha Trostle said in a Facebook post she was one of those hostages. Trostle said she was drawing blood from a patient when she heard a commotion and went to see if she could help, not knowing there was an active shooter.
When she went into the corridor, she saw Archangel-Ortiz holding her coworker at gunpoint. The coworker “was forced to zip tie my hands behind my back,” and Trostle then “heard the shots fired into her” colleague, the post said.
Trostle said the attacker then grabbed her and “pushed the gun against my neck and spine,” holding her against him as a shield when they encountered “a wall of armed officers.”
“The sound of gunshots rang out and the smell of smoke, the sound of empty shells echoing as the(y) hit the floor,” Trostle wrote. “I eventually fell into the floor under the weight of the shooter’s body.”
As she got to her feet, an officer ushered her into another room.
“Sadly, the experience doesn’t end there… I relive it when my eyes are opened and closed,” she said.
Hospitals are particularly challenging to secure because of the way they are set up, Clay said.
“By their very design, hospitals are built to be warm, welcoming, easy to access places of healing. Which makes them difficult to secure and monitor,” Clay said.
But that doesn’t mean they can’t also be secure. Good security starts with hospital leadership, who should communicate to their employees a commitment to preventing workplace violence, Clay said.
“Employees need to know they are supported from the top down,” he said. “This should include medical and psychological support for both victims and witnesses of violence.”
By training staff to recognize early warning signs and triggers of violence, the focus can be on early interventions before situations escalate, as well as techniques to deescalate patients and visitors, Clay said.
Technology also has a significant role to play, such as controlled access to different parts of a hospital campus, wearable duress alarms for staff and concealed weapons detection.
In fact, Clay believes that within the next three to five years concealed weapons detection technology will be a staple of most hospital security management plans. These devices are more precise and subtle than old fashioned metal detectors, using specific sensitivity settings and artificial intelligence to detect hidden weapons as opposed to harmless items such as keys and phones, allowing people to enter facilities with very little delay.
In some cases, hospitals have formed their own police departments or decided to arm their security guards.
“I think it’s up to each health care facility to conduct a risk assessment and determine if there is a need to arm their security officers,” Clay said. “If they use an outside consultant, I would stress that they use someone with actual, confirmed health care security experience.”
There is no one solution to secure everything, Clay said.
“At the end of the day everything that we are implementing, which includes the concealed weapons detection, the armed security officers and a lot of other things that we’re doing, are part of a layered plan that is designed to ensure the safety and security of our patients and of our employees and of our visitors.”
Ultimately, security in health care settings is about more than safety. Clay said a good security management plan strengthens employee retention and reduces the anxiety of caregivers, which allows them to focus on care.
“Not having to worry about their safety, they’re able to provide that quality care which translates, in my opinion, to allowing the patients to really focus on healing,” he said. “And it keeps nurses and caregivers in our facilities.”
A 2024 State of US Nursing Report found that a shocking 88% of nurses surveyed think staffing shortages are having a detrimental impact on patient care. Furthermore, half of nurses have been “verbally and/or physically assaulted by a patient or a member of a patient’s family within the past year,” and 26% of nurses indicated they are likely to leave their current role as a result of these incidents, according to the report, issued by nurse hiring platform Incredible Health.
“It’s important to remember that workplace violence is not solely a health care issue. It’s a community issue,” Clay said. “In order to ensure our communities have access to quality, affordable health care, we must support our caregivers… Failure to do so will have a detrimental and long lasting effect on health care and patient outcomes.”