Stuart ShowalterI’ve read and heard numerous stories about the "incomprehensible" school shootings in Newtown, CT, and I wonder whether “incomprehensible” is the correct adjective. Horrific, unconscionable, despicable, shocking, appalling, frightening, dreadful, horrendous, ghastly...all these seem more apt to me. Given the number of random shootings in recent times—Virginia Tech, Tucson, the Oregon shopping mall, the Aurora movie theater—it seems the events are common enough that they are not "incapable of being understood" (the definition of incomprehensible).

There are and always will be psychopaths in the world: people who lack empathy or remorse and whose personality disorders manifest in aggressive criminal or amoral behavior. And there are and always will be insane people in the world: individuals who labor "under such a defect of reason, from disease of the mind, as not to know the nature and quality of the act [they are] doing; or [do not know what they were] doing was wrong.” Rule in M’Naughton’s Case, House of Lords Decisions, May 26, 1843. Given that it is comprehensible that evil and insanity are afoot, we should not dismiss such acts as merely random and incomprehensible. We should recognize that they can and will occur from time to time.

That being so, there are some issues for compliance officers and healthcare executives to ponder. How can we be alert to prevent such atrocities from occurring on our premises? Are these kinds of scenarios part of the HEICS training? Are our social work and chaplaincy personnel equipped to deal with the psychological aftermath for staff, patients, and visitors? Do all employees know how to deal with such a situation as it occurs? Is our organization well “networked” in the community so we can call for assistance or be able to assist others if the need arises?

In other words, do we as individuals know how to react, and are our hospitals well prepared? Have we provided training for this kind of scenario? I suspect that the answer is: kinda, sorta. We all do some kind of emergency planning -- using the HEICS concept or some other -- but does it include how to recognize and react to a madman armed with semi-automatic weapons?

Hospitals are big, prominent institutions. Lots of people are present at all times of the day and night. There are plenty of disgruntled former employees, distraught family members, disaffected former patients, and others who might go crazy and cause havoc.

The expression used to be that somebody would "go postal" when they snapped like the young man in Connecticut did. It's an unfortunate expression because it makes light of a serious situation, and we don't want that expression someday to become "go hospital."

Stuart is a contributing editor to HFMA’s Legal & Regulatory Forum and author of The Law of Healthcare Administration.