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LA hospital uses unique approach to manage gang violence


In 1991, gang members opened fire into White Memorial Hospital’s ED. Years later, the hospital hired a reformed gang member to help manage violence.

LA hospital uses unique approach to manage gang violence

In 1991, gang members opened fire into White Memorial Hospital’s ED. Years later, the hospital hired a reformed gang member to help manage violence.

In the early morning hours of October 12, 1991, a 19-year-old gang member was being treated at White Memorial Medical Center in Los Angeles. Street violence had erupted hours earlier in Boyle Heights, an East LA neighborhood that surrounds the hospital, and Richard Ortiz had been shot in the head by rival gang members, according to the Los Angeles Times.

Approximately 30-35 gang members gathered in the emergency department entrance waiting for news on Ortiz’s condition. At 1:30 a.m. the rival gang returned, but this time they walked up to the entrance of the hospital and opened fire on the group standing in the ED waiting room.

A woman who was five-months pregnant and standing with the gang members was hit in the face with pellets from a shotgun blast, but she was treated and sent home. Police told the newspaper that it was miraculous no one was hurt considering bullets from a 12-guage shotgun and a .30-caliber rifle penetrated three walls.

“We have a lot of gang violence but this is unusual,” Los Angeles police detective Robert Suter told the Times. “How often do you get a hospital shot up?”

The answer was, and still is, “almost never,” but the incident left an indelible mark on the facility and served as a harsh reminder the violence in the surrounding community was a pervasive threat to the hospital.

“That was obviously a wakeup call for us—we needed to do something about that,” says Brian Johnston, MD, chair of the Department of Emergency Medicine at White Memorial.

Johnston has held that position since 1975. During the 1980s and early 90s, the ED would see two-three gunshot victims a day, he says. Since then, the violence has calmed, but Boyle Heights and surrounding neighborhoods are still statistically among the most deadly in Los Angeles.

According to the Los Angeles Police Department, the city and county are the “gang capital of the nation,” home to more than 450 gangs that have been in existence for more than 50 years. Johnston estimates that White Memorial’s service area has approximately 65 active gangs.

The hospital learned a lot from the 1991 incident, Johnston says, and the reforms it made, including the unorthodox decision to hire a reformed gang member, have continued to help prevent gang violence in the hospital and in the community nearly 25 years later.

An unusual hire

After the 1991 shooting, Johnston says the hospital considered the usual security modifications: Installing metal detectors, arming security officers, and implementing a police dog program. In the end, they decided against all of those options and focused instead on personnel and equipment, adding uniformed security to the ED and installing cameras throughout the hospital.

“We had some [cameras] previously, but we made fetish of looking for blind spots and making sure everything was covered,” Johnston says. “It’s very hard to get on this campus without being recorded at some point.”

Johnston also collaborated with Father Greg Boyle, founder of Homeboy Industries, a company that began in the Boyle Heights community and has grown to be the largest gang intervention program in the country. Boyle says the 1991 ED shooting “altered everything, forever”

White Memorial’s collaboration with Boyle led the hospital to Mike Garcia, a “retired” Boyle Heights gang member that had spent much of his younger years in prison. Garcia was eventually hired with the official title of director of gang intervention at White Memorial, but Johnston says his responsibilities range from reading graffiti on campus to talking with patients affiliated with local gangs.

“The hiring of Mike Garcia came after a lot of conversations about trying to keep a high degree of reverence for how complex the gang issue is so that we can somehow get underneath it and address the undergirding issues,” Boyle says.

For the hospital, Garcia’s street smarts have been undeniably valuable.

“Because of his prior gang affiliations and his time in incarceration, he knows almost everyone in the community,” Johnston says. “He knows who is in what gang, who is arguing with whom and what it’s all about. He spends a great deal of time on the street and he also spends a great deal of time the ED and in maternity.”

Garcia serves as a liaison between the hospital and the gangs that inhabit the surrounding community. Because he spends much of his time on the streets, interacting with gang members, he’s able to keep pace with gang interactions, or the significance of graffiti or a particular tattoo, which helps him prevent violence from entering the hospital campus.

“If he sees someone come in who is at risk, that is to say, someone who is out of his or her territory and the hospital is unsafe for him or her, [Garcia] will get that person out of the waiting room and into a safe room in the hospital,” Johnston says.

Garcia is respected by gang members even though he is no longer affiliated with a gang himself, Johnston adds, and gang members trust him because he does not work with the police.

“He’s honest, he’s sincere, he’s 100%,” he says. “He’s turned his life around and people respect that.”

A neutral site

One of the biggest things that the hospital took away from the 1991 shooting incident was that the hospital was almost unanimously considered neutral territory by the surrounding area. Members of the community willingly reported the shooters to police who arrested the perpetrators shortly after the shooting.

Even gang members disapproved of the shooting. At the time, Johnston says, that particular gang had been deprived of its leadership because police had arrested all the senior members of the gang. The younger, inexperienced members were trying to make a statement.

“It taught us something about the community and their values and the fact that there are norms that you can reinforce,” he says.

Since then, White Memorial has pushed a message to the community that the hospital should be viewed as neutral territory. They may not be able to prevent violence from occurring in the surrounding areas, but the message has made it clear to gang members that the hospital is off limits when it comes to exacting revenge.

Garcia has played a key role in pushing that message to various gangs, Johnston says.

“Whatever disagreements people have with one another or actions that occur outside the hospital, none of that matters when they are in the hospital,” Johnston says. “That reinforces, I think, a societal norm, even for gang members.”

One of the ways that the hospital has made that message clear is by treating gang members and their families with “dignity and respect,” Johnston says. Gang members often expect to be treated poorly, he adds, but clinicians aren’t there to take sides or make judgments; they are just there to help patients get better, regardless of their background. Garcia’s presence in the hospital, and in the streets, helps strengthen that message.

“We’ve never reached out to gangs directly because that legitimizes them,” Johnston says. “We don’t negotiate. We don’t make deals. We just treat everyone the same.”

An unusual approach

Johnston says he hasn’t seen any other hospitals utilize reformed gang members the way White Memorial has used Garcia. He says St. Francis Medical Center, located not far from White Memorial, has implemented a similar program, but no other hospitals have followed in their footsteps. (St. Francis declined to participate in this story and would not confirm that such a program existed).

Still, Johnston acknowledges that it takes the right kind of person to be effective. Prior to Garcia, White Memorial hired a different reformed gang member, but because he was too close to one gang, he wasn’t seen as a neutral party. 

The key to managing gang violence in a surrounding community is being able to identify gang members and having an intimate understanding of how each gang operates. Most importantly, hospitals that care for a lot of gang members need to prepare for their presence in the hospital.

“We all have certain stereotypes about gang members, but not all gangs are the same and not all gang members are the same,” Johnston says. “I think you have to find out who you’re dealing with in your neighborhood, what their story is, and why they do what they do. The sooner you know that and the better you know that, the better you’ll be able to deal with them.”


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