A disgruntled patient brandishing a .357-magnum revolver opened fire in the emergency room of Los Angeles County-USC Medical Center on Monday, critically wounding three doctors and taking two women hostage before he surrendered five hours later, authorities said.
The gunfire, which forced the evacuation of dozens of hospital employees and sent hundreds of patients running for their lives, erupted about 12:20 p.m. in a walk-in area of the emergency room, officials said.
Witnesses said the 45-year-old man, whom police would not identify, had been pacing for about 10 minutes in a first-floor waiting room that was jammed with patients when he lost control.
"Goddamn, give me something for my pain! Can't you give me something for my pain?" one woman said he cried.
Witnesses said the man--wearing dark glasses and a military jacket--strode into the emergency room and opened fire on a group of doctors who were charged with screening patients for care.
"He came in very calm," said Celsa Chavez, who had been waiting to see a doctor for a pinched nerve. "He stopped in front of the desk and started shooting. I jumped to the floor and everybody started running."
Ralph Jimenez, another patient, said the man seemed to be aiming only for the three physicians, who were seated at a desk near the door.
"He could have shot anybody he wanted," Jimenez said. "He wanted to shoot those doctors."
Hospital officials identified the wounded men as Glen Roger, 41; Paul Kazubowski, 44, and Richard May, 47. All three were listed late Monday in critical condition in the hospital's intensive care unit, although May reportedly was near death, having been shot point-blank in the head and chest.
After the shooting, police said, the gunman fled to a first-floor X-ray room, where he barricaded himself with two female hostages. At 5:20 p.m., after negotiating for most of the afternoon by telephone with a police special weapons and tactics team, he surrendered without incident, leaving the hostages unharmed.
The barrage of gunfire disrupted the nation's busiest emergency room and interrupted care for thousands of the county's neediest patients. The 2,045-bed institution, which serves as many as 15,000 patients a day, is the largest of the county's six public hospitals and the cornerstone of the county's trauma care network.
Health care workers noted, however, that the incident is only the most recent example of the rising tide of violence that has spilled over into the nation's urban emergency rooms.
"We are an open front door to whatever society has to offer, and some of these patients are not the best people," said Dr. Marshall Morgan, chief of emergency medicine at UCLA University Hospital.
"The really scary people are the ones who are angry and sober and probably a little bit crazy."
In recent years, assailants have killed people at hospitals from San Diego to New York. A 1988 University of Louisville survey of 127 emergency rooms found that 41 reported at least one verbal threat a day, 23 received at least one armed threat a month and 55 recorded at least one physical attack a month.
Another study of crime, done in 1989 at 25 hospitals, found that 1,435 assaults had occurred, a sharp upswing from the prior year. Half the attacks took place in emergency rooms and one in five involved weapons.
County-USC has been no exception. During the first six months of 1991, for example, security guards at the hospital responded to 1,400 reports of threats or attacks, six of which led to arrests. Among the assailants was a panhandler who approached four nurses in the cafeteria and plunged a pair of suture-removal scissors deep into one nurse's neck.
Officials at County-USC said metal detectors had been installed in the hospital's psychiatric wing but not in the emergency room, which instead is monitored by security guards.
Hospital spokesman Harvey Kern said such precautions never had been proposed because the emergency room had "never had anything like this happen."
"I don't know if you could have prevented something like this," said LAPD spokesman Lt. John Dunkin.
But patients and hospital employees disagreed.
Bob McCloskey, an official of the county nurses' union, said inadequate security at County-USC was a major issue in strikes by nurses in 1989 and 1991. The county has since beefed up security budgets at all of its hospitals by $1.1 million annually, but the union, Local 660 of the Service Employees International Union, considers the measures inadequate. At County-USC in particular, there are many unguarded doors and routes to the emergency area, McCloskey said.
"They have a lot of unruly patients in those emergency rooms," he said. "They cuss, they spit. Some are high on drugs or drunk and they are hard to control."
Nurses, he said, have been shoved, hit and verbally abused by patients and family members upset by long waits for care at County-USC, which has suffered in recent years from chronic overcrowding.
"People get mad when they wait 16 hours and are still not seen," McCloskey said.
Witnesses to the shooting also said they could understand the gunman's frustration.
"They treated him with no respect," said a man who was in the emergency room with his wife and baby when the shooting occurred.
"They should have addressed him a little bit better. Everybody's human and he was sick. They should have spoke to him with a little more respect."
Times staff writers Andrea Ford, Melissa McCoy, Douglas P. Shuit, Edward J. Boyer, Scott Harris, Claire Spiegel, Irene Wielawski and Hector Tobar contributed to this story.