It was a typical Saturday morning: Angeline Perla, a member of the Oregon Nurses Association (ONA), was working as the charge nurse at the OHSU Knight Cancer Institute on the Legacy Good Samaritan campus in Northwest Portland. 

Around 11 a.m., the clinic stopped taking new patients for around an hour. Some of the nurses left the clinic to have lunch, while Perla and the rest of the nurses remained in the clinic taking care of the morning’s patients. 

The first indication that something was going awry came minutes later. Perla had signed up for Legacy’s emergency alert system, and she got an alert on her phone that there was a Code Silver in the hospital for an active shooter. 

As she was processing that message, Perla got a call from her director confirming they were in the midst of an emergency. But not all of the OHSU nurses at the clinic were signed up for Legacy’s emergency alerts, and there was no overhead page system or intercom in the clinic to inform all the nurses and patients that there was an active shooter on the premises. 

That left Perla scrambling to gather fellow workers and patients and lock the doors to the clinic, which she discovered could only be locked from the outside. In the subsequent lockdown, Perla waited—trying to glean information through a variety of sources including the staff’s Microsoft Teams page about where exactly the shooter was and how the staff should proceed. 

“It just took hours,” Perla said. “It took hours to find out what exactly was going on.”

The situation was ultimately resolved, but not before a security guard, Bobby Smallwood, was shot and killed.

Perla said the experience of not knowing what was happening on the day of the shooting was jarring not just to the nurses working at the Legacy campus, but also to nurses working at the other four OHSU clinics in the Portland area. 

“The other clinics have had lockdowns too, where they’ve been like, ‘We had no idea what to do. We couldn’t lock our doors. We didn’t know that we could call OHSU and have them remotely lock,’” Perla said. “It just kind of dawned on everybody, we have no idea what in the world we’re supposed to do in these situations—and it’s nothing that’s ever been reviewed with us.”

The Monday morning after the shooting, a nurse at the OHSU clinic in Beaverton walked around their facility evaluating its security systems. What they found was disconcerting. 

“The building that is open seven days a week has no metal detectors, no security on site,” the nurse, who declined to give their name out of concerns about retaliation, said. “I counted visibly three surveillance cameras, [but] I was informed by staff that works in the area where the cameras are that those surveillance cameras are not running 24/7.”

The nurse said the Beaverton facility lacks an intercom system as well as a wall or a locking door separating the department from the rest of the building, leaving nurses and patients exposed in the case of a violent threat. 

Employees have raised concerns about the lack of a wall or door to their department multiple times over the years, but OHSU has declined to make changes due to the associated costs. That has particularly rankled nurses because, unlike a number of other OHSU clinics, the Beaverton clinic is not located within another hospital. 

“Beaverton is unique in the sense that Beaverton is owned and operated by OHSU,” the nurse said. “So they have full control over how the door accesses work, how security works, and they have control over putting a door up or putting a wall up and providing safety for their employees—or not.”

The renewed concerns about nurse safety come at a time when the rate of violence against healthcare workers across the country is increasing at an alarming rate. There have been multiple shootings at healthcare facilities in the U.S. in the last two years, with healthcare workers accounting for 73 percent of all nonfatal workplace violence injuries in 2018. 

The incidence rate of nonfatal workplace violence against healthcare workers nearly doubled between 2011 and 2018, the last year the U.S. Bureau of Labor Statistics has data for—and that was before healthcare workers were thrust into the middle of heated debates about lockdowns, vaccines, and gender in the wake of the COVID-19 pandemic. 

Healthcare workers in the region are dealing with a variety of threats. Last Friday, for instance, a bomb threat made in response to a story alleging that OHSU’s Richmond Family Health Center had dropped a cancer patient for making bigoted remarks about the LGBTQ+ community shut the clinic down for the entire day. 

ONA spokesperson Kevin Mealy that OHSU has been receptive to enhancing its security measures in recent contract negotiations, and that OHSU is far from the only hospital system that has not adequately addressed safety concerns—but that the clinics, which are largely located on the campuses of other hospitals, have in some ways been “lost in the shuffle.” 

Mealy said ONA would like to see all patients and visitors to healthcare facilities screened by metal detectors, ensure that all facilities have sufficient security staff, improve incident reporting protocols, provide de-escalation and safe gun handling training to healthcare workers, and more.

Perla agreed that there needs to be new, industry-wide standards for safety at hospitals. 

“It’s all the hospitals,” It’s not just Legacy. It’s not just OHSU. And it’s all staff—it’s not just nursing, obviously.” 

Legacy, for its part, has said that it will install metal detectors and bag searches at the entrance to each of its hospitals and lock down other access points in the aftermath of the shooting. 

OHSU staff had the opportunity to voice some of their concerns on a call for Community Hematology/Oncology (CHO) staff in the days following the shooting. On July 28, OHSU CHO Senior Director Michelle Corn wrote to staff members that the hospital had developed its own security response framework “to enhance safety and security measures” at its facilities and would conduct an “initial risk assessment at each site.” 

According to a document obtained by the Mercury, the areas of focus in the safety and security response plan include risk assessment, collaboration with public safety, physical security, lighting and physical environment, emergency preparedness, secure medications and supplies, staff training, and regular assessments and improvements. 

In a statement provided to the Mercury, an OHSU spokesperson said the organization is “doing everything possible to support our colleagues at Legacy Health.”

“OHSU’s Department of Public Safety is closely monitoring the incident at Good Samaritan and remains committed to supporting and protecting OHSU health care professionals, patients and staff,” the statement continued. “The department regularly assesses our policies and procedures to ensure the safety of all who seek and provide care at OHSU.”

The nurse at Beaverton said they’re appreciative that OHSU has been responsive to concerns in the aftermath of the shooting, but wants to see the organization commit significant financial resources to enhance safety at its facilities. 

“We want action,” the nurse said. “I don't want one of my fellow workers or myself to be injured at work because of a violent person, then get counseling after that. I want somebody to prevent it from happening to begin with.”