How Gun Violence Looks in Hospitals

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Brian Lehrer: It's The Brian Lehrer Show on WNYC. Good morning again, everyone. The recent series of shootings that have made the news in New York City continued yesterday when somebody walked into the emergency room at Jacobi Hospital in the Bronx and shot somebody right there. Walked into the ER and shot a patient who was there being treated for something else. News reports say the victim was shot in the arm, was immediately treated in that emergency room, and will survive. We will talk to a doctor who works at Jacobi in just a minute.

That actually is a coincidence. We had already booked Jacobi Hospital doctor Noé Romo for today's show because he is featured in a documentary called GSW Gun Shot Wound, which shows some of what it's actually like when someone comes in after being a victim of gun violence and how doctors there don't just treat the victims. They're getting involved in New York City's hospital-based violence intervention program. In Monday's gun violence prevention blueprint speech, Mayor Adams said this is exactly one of the things he plans to expand. Here's the mayor.

Mayor Eric Adams: Our existing hospital-based violent intervention programs are an important frontline response to these individuals and individuals who enter our hospital system with criminal or behavioral issues. These programs bring together hospital staff and law enforcement and community partners to provide support to violently injured people. Engaging patients in the hospitals during their recovery is a real opportunity to improve lives and reduce retaliation and recidivism. The Health Department will expand this intervention program to 10 additional hospitals in the communities experiencing high rates of gun violence.

Brian Lehrer: Mayor Eric Adams on Monday referring to the program at Jacobi and other public hospitals. Here's 30 seconds from the documentary that takes place there.

Speaker 3: Jacobi Medical Center emergency department. Go ahead.

Speaker 4: This is [unintelligible 00:02:18] EMS. I got a 34-year-old male, multiple GSWs, 90 over 12, respiration is at 35. ETA is 4 minutes out.

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Speaker 3: This is the adult ED. We have a level one trauma coming in. We have a 34-year-old male with multiple gunshot wounds. Blood pressure is 80 over 40.

Brian Lehrer: 30 seconds from near the beginning of the documentary film GSW Gun Shot Wound. We'll hear more from it as we go. The film premiered last year at the Hamptons Doc Fest on Long Island and has been selected to be screened at the 2022Docs Without Borders Film Festival. Joining me now, Dr. Noé Romo, medical director of Jacobi Hospital's Stand Up to Violence Program and director of pediatric inpatient services at the Jacobi Medical Center.

If you think a pediatrician is outside the realm of gun violence, by the way, remember that the other headline shooting from the Bronx this year was of 11-month-old Catherine Gomez, who has now undergone brain surgery after being hit by a stray bullet while sitting in a car seat inside a car. We have the director of the documentary GSW, Jody Schiliro. Jody and Dr. Romo, thanks so much for some time today. Welcome to WNYC.

Dr. Noé Romo: Thank you very much for having us.

Jody Schiliro: Thanks for having us.

Dr. Noé Romo: Thank you for having us, Brian. I'm glad of being here.

Brian Lehrer: To begin on the news, Dr. Ramo, I don't know how much you're at liberty to say about a specific incident, but were you there at the hospital when the shooting in the ER took place yesterday?

Dr. Noé Romo: Yes, I was in the hospital.

Brian Lehrer: What happens in a situation like that? Did the whole hospital go into some kind of lockdown, or what can you say happened once the shooting took place?

Dr. Noé Romo: What I can say is that yes, the whole hospital went into lockdown and there was a swift response from both our hospital police and the local 49th Precinct here to try and calm the situation as well as a prompt response from our ER staff in terms of ensuring that all the other patients in the ER were safe, putting everybody in a room, ensuring the other patients and families were safe in there, as well as attending to the patient himself who was injured in the waiting room and taking him back to the emergency room promptly to give him life-saving treatment.

Brian Lehrer: I read a quote from the union that represents many Jacobi Hospital workers saying this was the fourth gun incident there in the last 14 months. Do you know that to be true?

Dr. Noé Romo: I cannot confirm that, I'm not privy to that information, but us being a trauma center, obviously, it's not unlikely for there to be some firearm-related issues here in terms of people at least saying that they have weapons.

Brian Lehrer: Continuing their disputes, which may be what happened in this case yesterday. The target seemed to be not random, but an individual who the shooter apparently was going after. Is that what you mean by being a trauma center that treats gun wounds, gun incidents might happen?

Dr. Noé Romo: Right. Yes. We are the level one trauma center in the Bronx so we do see a significant amount of both pediatric and adult violent trauma here. In terms of the exact circumstances around the incident yesterday, they have yet to become confirmed.

Brian Lehrer: Jody Schiliro, why'd you make this film?

Jody Schiliro: Our executive producer, Jennifer Goodman, read an article a couple of years ago called What Bullets Do to Bodies by Jason Fagone, thought it would be a good idea for a film to look at the everyday gun violence in many of our large cities that doesn't get a lot of attention. We wanted to look at the issue of gun violence through a different lens, through a public health lens, and show viewers behind the scenes what really happens at a level one trauma center with gunshot patients. Try and show the true impact.

Brian Lehrer: I watched the film last night. One of the points of the film seems to be like the clip we played of somebody being rushed with gunshot wounds into Jacobi Hospital, to have emergency room doctors talking about what it's really like when someone comes in with a gunshot wound. For example, like that so often, people aren't shot once. They're shot multiple times if they're shot at all.

Describing in some detail how removing the bullet or bullets is what many think the main job of a doctor is, but it's so much more than that. One of Dr. Romo's colleagues describes all these organs that are getting damaged in patients. She talks about there's one guy who the bullet lands in his tongue. Pretty gross to imagine. Thank you for not showing it. Are you going for a driver's ed horror film effect movies like The Last Prom about teenage car crashes but about guns?

Jody Schiliro: That's a good question. No. We're just trying to show the reality which is really invisible except to the trauma surgeons and the nurses and other healthcare providers and the victim's families. We're just trying to show what really happens because when people see it, when young people especially see it in video games or in movies, someone gets shot and it's almost glamorized. We wanted to show what really happens from the trauma surgeon's perspective.

Brian Lehrer: Is it your intent to have this film used in any of the violence intervention programs run by people like Dr. Romo?

Jody Schiliro: Yes. We're working on distribution now, but we're planning to retain the educational rights to the film so that we can offer it to violence intervention programs. Actually, we've had a lot of interest from medical schools.

Brian Lehrer: Dr. Romo, as director of pediatric inpatient services at Jacobi, do you ever deal with gunshot wounds in minors?

Dr. Noé Romo: Yes, absolutely. Unfortunately, Brian, yes. Us being a level one trauma center for adults and level two pediatric trauma center, we do see a fair number of gunshot wounds in patients under 21 years of age, which is a pediatric age range.

Brian Lehrer: To borrow a page from the film to do a little bit of a radio version, what's it like treating a minor with a gunshot wound? What's involved medically?

Dr. Noé Romo: Medically, obviously, acutely the patient comes in, they're in the emergency room, the number one goal is to stabilize a patient and to try to address very quickly the degree of life-saving care that they may need. Sometimes that could be as simple from just placing an IV, getting a couple of X-rays if the patients are stable and you have time to figure out exactly where the damage is. However, we don't always have that luxury.

There are times when patients are what we call unstable, meaning their blood pressure may be really low or their heart rate is really low and there are at risk of having cardiac arrest. In that instance, there really is no time to get things like X-rays or CAT scans. You just immediately rush patients to the operating room where our trauma surgeons initiate. They're really curriculating efforts to try to save somebody's life.

If they're able to do so, then they come to our inpatient pediatrics ICU or our pediatrics ward where I am, where I work closely with the trauma surgeons to manage these patients and try to continue to stabilize them and save their lives and figure out what else may be going wrong that we can address. It is quite traumatizing as you can imagine for anybody, adults, more so for a child, which is why we have instituted means here of screening for things like posttraumatic stress disorder or provide some additional resources, including our SUV program to try to really redefine how we treat violent trauma in both children and adults.

Brian Lehrer: Listeners, we can take a few phone calls for Dr. Noé Romo, director of pediatric inpatient services at Jacobi Medical Center in the Bronx, and Jody Schiliro, director of the documentary GSW Gun Shot Wound. Anyone else who works treating gunshot wound victims want to call up and describe your work to help make the point, or discuss how you're getting politically involved, because we're going to get to that part, in anti-gun violence activities, 212433-WNYC, 2124339692, or tweet @BrianLehrer. Dr. Romo, tell us about the group that you're the medical director of called Jacobi Stands Up to Violence. What is it and what does it do?

Dr. Noé Romo: Jacobi Stand Up to Violence is a hospital-based community violence prevention initiative that has been in existence here since August of 2014. It was initially established as a means of trying to really revamp the way we treat violent trauma here at our hospital. Try to think beyond the realm of just the medical care we are providing, but looking at violence like the disease that it is, and trying to engage in means of primary, secondary, tertiary prevention. What exactly that means is that when you look at that public health model, it means that you engage in means of trying to prevent the violence from ever even happening, which is primary prevention.

Then secondary and tertiary prevention is addressing the violence from getting worse once it's already happened. The way we engage in primary prevention is we have a strong community component consisting of a network of community outreach workers who live in areas and neighborhoods of a high incidence of violent trauma, and who can essentially act as conflict mediators in the community, but also community mentors to try to identify individuals in the community who are at high risk for either being the proprietors of that violence or being victimized by that violence.

Try to essentially mentor them to prevent them from engaging in violent activity or being victimized themselves, along with identifying conflicts that may be leading to some of the violent traumas we are seeing in our hospital. They're also overseen by a network of community outreach supervisors along with a strong community outreach director, Pastor Gooding, who helps us create these community links. The whole program itself is overseen by Carjah Dawkins-Hamilton, who's a licensed social worker.

At the hospital component piece, it consists of myself, a designated social worker who sees every single patient who's a victim of violent trauma. Her name is Caitlin Bea. Then followed by our designated hospital responder, Kadeem Nicholas, who's an individual who sees patients from the community. His main job is to literally see patients alongside me and the social worker who are either shot stabbed or assaulted.

At the hospital level, our main goal is to try to identify perhaps the circumstances that led to their injury, try to mediate potentially that dispute, prevent retaliation to try to prevent re-injury in these patients, and mostly to try to engage them and provide them with any services they may need to help them prevent from getting re-injured and revamp their lives.

Brian Lehrer: Prevent retaliation is such a key part of it, Jody. At least that's a key part that's highlighted in the film. I'm thinking of a moment in the mayoral campaign where there was some pushback from the right against Eric Adams saying that he would meet with former gang members if elected mayor, or that he was meeting with former gang members. I think there's pretty wide consensus that that's exactly one of the things that a mayor should be doing.

It seemed to really be exemplified in the documentary in terms of when somebody comes in with a gunshot wound who may be in a gang, that's exactly the moment when they are vulnerable enough to maybe hear a different message like don't retaliate for what somebody just did to you to try to break that cycle in the neighborhood. Am I getting that right? Did I see that right in the film?

Jody Schiliro: Yes. I think what's so powerful is that it's not an MD coming in to tell them don't retaliate, it's someone from their neighborhood who they may or may not even know. It just carries more weight for them. It's interesting too that this hospital-based SUV program is based on the Cure Violence model that started in Chicago. Jacobi's program is a little bit different in that it's hospital-based, not community-based so the violence interrupters are employed by the hospital.

There's about 69 established and emerging hospital-based violence intervention programs in the US now. Some of the research coming out of them suggests that they've been able to cut the number of gun violence re-injuries in half, which is pretty incredible.

Brian Lehrer: The clip we played at the top of Mayor Adams before I played a clip from your film, the mayor talking on Monday about expanding these hospital-based violence interrupter programs. I can imagine that if you heard that part of the speech, you were like, "Wow, wait, there's the mayor. He's talking about the thing in my movie."

Jody Schiliro: Yes. [laughs] Right. Exactly. I hope they're able to expand and give more dollars to these programs.

Brian Lehrer: I want to talk about the political end of this because doctors who treat gun wounds sometimes get involved politically as your film demonstrates. I want to play another clip from the film. This is a trauma specialist at a hospital in Baltimore, Dr. Joseph Sakran if I'm saying his name right, who mentions the political pushback that, believe it or not, doctors who treat gunshot wounds get when they take a stand for reducing gunshot wounds. Here he is.

Dr. Joseph Sakran: In November of 2018, the NRA came out with a community that essentially said that doctors have no business being part of the solution of firearm-related injury and death in America. They essentially used the phrase that we should stay in our lane. I was just incensed that an individual, an organization would think that we as healthcare professionals, the people that are literally on the frontlines of caring for these patients day in and day out have no business in being part of the solution.

Brian Lehrer: Dr. Joseph Sakran at Johns Hopkins University Medical Center. Jody, is that something you can take us further into, the politics of the doctors you profiled? I should say for our listeners who are mostly in the New York area, it's not just the Jacobi Hospital. You were in Philadelphia, you were in Baltimore. The politics of doctors you profiled getting involved politically, and the NRA trying to discredit them.

Jody Schiliro: Honestly, in my experience, the majority of the trauma surgeons that we spoke with aren't really coming at this issue politically, they're looking at it as a public health crisis and trying to raise awareness, and help create programs to prevent these injuries from ever happening in the first place. They're on the front lines, as Joe Sakran said, of this crisis day in and day out. I think it was infuriating to a lot of healthcare providers when the NRA came out with that tweet saying stay in your lane. Joe Sakran tweeted, it actually went viral. Healthcare providers, not just trauma surgeons but nurses and other healthcare providers were very angry with the NRA when they came out with that.

Brian Lehrer: Dr. Romo, I don't know if you get political at all yourself, but the NRA saying to trauma care surgeons who treat people with gunshot wounds, "Stay in your lane," is that a little like when Lebron James as a Black man in America was speaking out after George Floyd was murdered and a Fox News host said, "Shut up and dribble."? This is like NRA to gunshot wound specialists, "Shut up and operate."

Dr. Noé Romo: Yes. I think it is quite interesting to make that comparison, but as healthcare providers, as Dr. Sakran said, we are on the front lines and we treat these injuries firsthand. We see it firsthand. Like Jody said, this is indeed a public health crisis and it's been as such for quite some time. I think just now it's starting to come to light. Thanks to Jody for making this film and bringing this even more to light. Hopefully, it can become even more aware. Now I think the talk around it is changing. You just mentioned Mayor Adams's talk about expanding hospital-based violence intervention programs.

I never thought when we started this program eight years ago that we would have the mayor of New York City wanting to expand these programs. I'm now part of a executive committee with all the public hospitals in New York to try to implement our program throughout the city. You mentioned the rates of re-injury. For us in our program, we've been able to decrease the rates of re-injury by 59% in patients that we have seen compared to patients that we have not seen. We are indeed successful but we are by no means saying that we are the only solution. I do think that this being a public health crisis is going to require a village, and is going to require interventions on multiple fronts.

I do think that, as physicians and as healthcare centers, we are part of the solution and we can help bridge the gap between communities and hospitals to try to prevent these gunshot wound victims from ever presenting to our hospital. What I tell people where they try to give us accolades as a program, "Wow, you've done so well. You've increased your funding and you decreased your rates of re-injury and you're expanding," I wish we didn't have to expand, and I wish we didn't need more funding because that would mean that there wasn't a need. We are expanding and we are getting more funding because there is indeed a need. It's a little bit of mixed feelings there.

Brian Lehrer: We're out of time except to say, Jody, how can our listeners see this film if they're interested in seeing it?

Jody Schiliro: We're working on distribution right now, but we do have a website which is www.gswthefilm.com. When--

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Brian Lehrer: Did we lose Jody? Dr. Romo, are you still there?

Dr. Noé Romo: Yes, I'm still here.

Brian Lehrer: I guess we lost Jody's line. What do you think of the film? Did you see it?

Dr. Noé Romo: Yes, I did. Actually, I was at the Hamptons Doc Fest when it was screened. It's very interesting to see yourself on film, but I think it was very powerful. I think it did a great job at highlighting the real effects of violent trauma and highlighting how it affects patients both short-term and long-term, and how it affects communities. I'm glad they were able to go out to the community where we did the shooting responses where, unfortunately, young men were killed to see the effects that it has on mothers, grandmothers, and families.

I think that's what is often not seen. I think before anybody fires a firearm weapon or fires a gun, they need to think about what the effects that can have. Oftentimes, when I go to these community responses, I often say, "If you're having thoughts or thinking about killing somebody because of a dispute that has no other solution, do me a favor and go tell the mother of that person yourself first. Tell her, 'I'm sorry, ma'am. There's nothing else I could have done for your son,'" because frankly, as physicians, we are tired of doing that.

Brian Lehrer: The film does have a website, by the way, gswthefilm.com. Gswthefilm.com. Dr. Noé Romo who now can say he played himself in the movies is medical director of Jacobi Hospital's Stand Up to Violence Program and director of pediatric inpatient services at the Jacobi Medical Center, and the director of the documentary GSW, Jody Schiliro, who's back on the line but only with enough time for me to say thank you very much for putting this in front of us. We really appreciate it.

Jody Schiliro: Thank you for having us. We really appreciate you shining the light on this issue.

 

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