On Nov. 22, 2015, James Boyd, a physician working at a Planned Parenthood clinic in Colorado Springs, wrote an email to officials at the group's regional office.

"I wanted to follow up regarding some issues that were raised on the provider conference call from several weeks ago regarding security," the email began. "...Resources for the providers and staff regarding overall security (at work, home, other locations), identity protection, emergency resources, are some of the major areas..."

"Hope you are well and are able to enjoy the holidays."

While Planned Parenthood had an active shooter policy on its books, Boyd said training on how to carry it out was never conducted at the clinic.

Five days after sending the email, a gunman entered the facility; more than five hours later three people — a wife and mother, a military veteran, and a University of Colorado-Colorado Springs police officer — had been killed. Nine others were wounded.

Boyd was in the clinic during the shooting; in the years since he said he and other survivors have been subjected to numerous stresses. Not only the memories of what happened that day, but also the frustration of the lack of a resolution in the courts.

Courtesy of James Boyd

In May of 2016, the gunman, Robert Lewis Dear Jr., was ruled incompetent to stand trial. Since then, his mental health status has been reviewed every 90 days.

Each time, the ruling has been the same.

"Not only have these folks survived one of the longest shooting ever, they also have to go through this protracted legal process," Boyd said. "Every 90 days we get a notification, and it's stressful for a lot of folks — is this the time we're going to get to start moving forward with a trial, or not?"

"We're just waiting. We're waiting. We're waiting."

But just as troubling to Boyd is what he calls a lack of support from Planned Parenthood -- either before or after the incident.

Boyd said he was fired from Planned Parenthood after speaking out against how the survivors were being treated by the organization. He and Lindsey Raymond, another former employee who was in the clinic during the shooting, recently spoke to Colorado Matters as the fourth anniversary of the attack neared.

"The anniversary is just an extra and added weight," said Raymond, who was working as a medical assistant at the time. "I carry PTSD of gunfire. Loud noises. I carry the idea of not being heard. I mean, I have nightmares every night. It doesn't matter what medication I've been given. I literally toss and turn every night. So, that's what I carry with me every day..."

Raymond said that an attack like this can happen to any organization or business. "What are the plans so that victims after shootings get the proper care that they need, and it's not just swept under the rug and pushed aside," she said.

Colorado Public Radio reached out to Planned Parenthood of the Rocky Mountains, as well as the national headquarters, Planned Parenthood Federation of America. Citing active litigation, officials at PPRM said they were limited in how they could respond to claims made by Boyd and Raymond.

As an example, PPRM said Boyd's claim that no active shooter training was conducted prior to the shooting was "false," but did not provide documentation to definitively refute him.

Similarly, Raymond said when the clinic reopened about a month after the shooting, staff struggled with how to answer questions from patients about the attack. She said it took about two weeks for PPRM to forward information on how to discuss the incident.

PPRM said that portrayal is again false, adding that resources and guidance was sent "within days."

In a statement, PPRM vice-president of communications Whitney Phillips said, "This month, we remember the attack on our Colorado Springs Health Center four years ago. Despite the passage of time, the memories of November 27, 2015, remain all too fresh for many of us, and our hearts go out to all whose lives were forever changed by the actions of the gunman. We particularly remember those law enforcement officers who were injured, and the family of Officer Garrett Swasey, who was killed coming to our aid. We will never forget his valor.

"In the immediate aftermath of that horrible day, meeting the needs of our Colorado Springs staff was our paramount concern. And that concern continues today. We stand with our staff — those who remain at Planned Parenthood, and those who have moved on — as they each heal from the attack in their own way.

"When Dr. Boyd left our medical staff, he made his harsh feelings toward our organization known, and he has continued to share those feelings in private conversations and in public statements. While Planned Parenthood acknowledges Dr. Boyd’s right to speak freely, we also need to set the record straight. Our organization is, and always has been, committed to assuring the safety and security of all those who visit, and who work in, our health centers. The violence unleashed by the gunman that November day was beyond anything we could have prepared for or stopped. Dr. Boyd’s statements to the contrary are both inaccurate and hurtful.

"In the wake of among the worst days in our Planned Parenthood family’s century long history, we continue to come together as an organization to recover and to thrive."

Boyd said it's important that the people who provide abortion care are protected, "because, undoubtedly, we're going to be having these events happen in the future and we need to make sure that those folks are supported going forward.

"Knowing how poorly they treated us. I doubt they have the pieces in place to support people that may go through this in the future."

David Zalubowski/AP Police investigate at a Planned Parenthood clinic and area around the building north of a strip mall early Saturday, Nov. 28, 2015, in northwest Colorado Springs, Colo.

Almost six months after the 2015 shooting, an attorney for Boyd received a letter from lawyers for PPRM.

"After careful and deliberate consideration, Planned Parenthood of the Rocky Mountains’ Chief Medical Officer has determined that it would not be appropriate for Dr. Boyd to return to the organization’s medical staff," it began, then continued, "...this determination is not based upon Dr. Boyd’s professional competence or his compliance with any law governing his practice. Rather, it is clear that Dr. Boyd is substantially dissatisfied with, and lacks trust in, both the organization’s management and its operational policies and procedures. As a consequence of these circumstances, Dr. Boyd is no longer a good fit for the organization’s medical staff and his membership must conclude at this time."

Boyd doesn't disagree that he lacked trust in Planned Parenthood, pointing out that not long after the shooting, he and other survivors received an email from PPRM noting that security in the 18 months preceding the incident was "verifiably solid."

Later, Raymond recalled "being re-traumatized" when co-workers attended an active shooter drill, featuring someone slamming a notebook being opened and closed to simulate gunshots.

"I find it just appalling that the leadership thought that this was appropriate and it highlights how worried I am about them not having the guidance and leadership that they need," Boyd said.

Boyd denied that his feelings may be a case of sour grapes that stem from his dismissal. Neither he or Raymond are involved in any litigation against Planned Parenthood.

"I got into providing abortion care out of the importance of doing this work; we don't have enough providers and it's incredibly fulfilling work," he said. "The reason that I'm speaking up is to try and make sure that we have the resources in place. So should this happen again, that people can be protected and supported regardless of what clinic it is and make sure that we can do this better in the future."

Editor's Note: Planned Parenthood of the Rocky Mountains is a financial sponsor of Colorado Public Radio.