Trying to break a cycle where nearly half of hospital trauma admissions in U.S. involve repeat victims of violence

In an effort to break the common cycle of violence that can spin out from a single shooting, one New Jersey lawmaker hopes to expand access to counseling and other support services at facilities all too familiar to the victims: hospital emergency rooms.

Assemblyman Louis Greenwald has introduced a package of legislation that would require Level 1 and Level 2 Trauma Center hospitals that serve communities with high violence rates to provide additional mental healthcare services and other assistance to victims of shootings and stabbings; the aim is to reduce the chance they will be reinjured through additional violence, or cause harm to others. It would also expand funding options and Medicaid coverage for these services, which Greenwald said are showing positive results in several other states.

According to the Camden County Democrat, up to 45 percent of hospital trauma admissions nationwide involve repeat victims of violence; at least four in 10 of these patients will be reinjured and one in five will be killed in the five years that follow an incident. In most U.S. cities, less than 0.5 percent of the population is responsible for the vast majority of violence, the bills note.

“Many hospitals see a ‘revolving door’ of gunshot injuries, as patients who have been shot are at a very high risk of being violently reinjured and committing violent acts themselves,” said Greenwald, who has made gun violence a top issue on his agenda. “Making counseling a critical part of the services a patient receives may be just the prescription needed to save lives and discourage recidivism and the use of retaliatory violence.”

Costs and funding mechanisms to be determined

The six-bill package — due for a hearing in the Assembly health committee at some point in the future — would also require the state Department of Health and other agencies to oversee and coordinate with these hospital-based initiatives. One measure would create a grant program within the Office of the Attorney General to fund local anti-violence initiatives.

There are no estimated costs or funding mechanisms attached to the proposals and it would be up to lawmakers to appropriate resources as they saw fit.

Diana Trasatti, a mental-health professional from Collingswood with the state chapter of Moms Demand Action for Gun Sense in America, said hospital-based programs have been shown to reduce the chance that someone will be revictimized, while also improving victims’ chances of succeeding at work or school.

“These bills will ensure that all those who have been impacted by gun violence are provided with the essential support required to process and work through their traumatic experience and will provide disproportionately impacted communities with much-needed resources to advance proven and community-led gun violence prevention strategies,” she said.

New Jersey, with some of the nation’s strongest gun control laws, has one of the lowest rates of firearm deaths: at 5.5 per 100,000 people, it is less than half the national average, according to Kaiser Family Foundation data from 2016.

A big problem for NJ cities

Even so, there are more than 1,000 shootings annually in the Garden State and some 485 residents still lost their lives to gun violence in 2016.

Credit: Amanda Brown Credit: Amanda Brown According to one of Greenwald’s bills, up to 90 percent of the victims of gun violence in New Jersey are black and Latino men and many of the crimes are concentrated in just five cities: Camden, Jersey City, Newark, Paterson and Trenton. Violence can be traced to a lack of educational and economic opportunity, unstable housing and job situations, behavioral health and medical issues that remain unaddressed, and high rates of violence, the legislation notes.

“This violence results in enormous trauma, lifelong health impairments, immeasurable human suffering and significant economic costs,” one bill reads. It notes that firearm violence alone costs the state some $1.2 billion annually in costs related to healthcare, law enforcement, criminal justice, and lost productivity. The impact skyrockets to $3.3 billion if the victims’ pain and suffering and quality-of-life losses are included.

As mass shootings continue to rock the country, Garden State leaders have looked to reduce these numbers — and to take a wider view of gun violence, one that also takes into account the public-health impact. Gov. Phil Murphy, also a Democrat, has joined with the leaders of four other states to share data on gun violence, something experts insist has been missing from the debate, and committed $2 million to launch a research program in New Jersey; lawmakers have called for Rutgers University to host the initiative, modeled on a similar effort in California.

Hospital programs a growing national trend

Greenwald said the next step is to engage doctors and others in healthcare to help reduce the impact of cyclical gun violence. Hospital-based violence intervention programs are part of a growing trend nationwide, he said, and studies have shown they can be effective in stemming the bloodshed. And reducing the likelihood that individuals will be reinjured and rehospitalized also cuts costs, the bills note.

“This legislation is intended to assist in breaking the cycles of street violence and retaliation by providing counseling to patients recovering from gunshot or stab wounds. Multiple case studies and controlled trials have shown that this type of counseling can be effective at reducing patients’ rates of violence and re-injury,” one bill reads.

The legislation seeks to build on a program at Newark’s University Hospital, a Level 1 Trauma Center that Greenwald said has the state’s only fully operating community-based violence intervention program. (University Hospital has been the focus of intense scrutiny lately for leadership and financial problems.)

Dr. Stephanie Bonne, a trauma surgeon at University Hospital, was criticized on Twitter by the National Rifle Association for weighing in on gun violence, after posting a photo of the waiting room where she tells parents their children have been killed in a shooting. Bonne wrote an Op-Ed about gun violence as a public health threat and the role providers must play in addressing the cyclical problem.

So, a lot of folks have asked me about this photo: the chair. Why? Well, I have a chair for all the things I ROUTINELY do: my dinner chair, my reading chair, the chair where I rock my kids to sleep. And the chair where I tell parents their kids are dead. #ThisisOurLane pic.twitter.com/MNDutybXwC — Stephanie Bonne (@scrubbedin) November 17, 2018

Details of the legislation

Greenwald’s package of bills includes a measure (A-4801) that requires the Attorney General to launch a violence intervention grant program to provide funding to municipalities, law enforcement agencies, nonprofits and other organizations focused on reducing gun violence among at-risk individuals in communities disproportionately affected by shootings. Similar efforts in New York City have helped reduce violence in target areas by more than 60 percent, the bill notes.

Another proposal (A-4802) would require hospitals licensed as Level 1 or Level 2 Trauma Centers that serve communities with “disproportionately high” levels of gun violence to provide such hospital-based violence intervention programs to victims of violence; services would need to include counseling, case management and social services. The DOH would provide a definition for “disproportionately high” and the nine other Trauma Centers now in existence would have a year to create programs or lose their designation.

Under a third measure, (A-4803), mental-health and other providers who treat victims of violence through hospital-based programs could submit the bill for the cost of treatment to the state’s Victims of Crime Compensation Office, for reimbursement up to $1,000. The office already provides up to $25,000 to victims of a wide range of crimes for counseling, medical bills, lost wages and other expenses. Another, (A-4804), would expand Medicaid coverage for these services.

The remaining bills, A-4805 and A-4806, would call on the crime-compensation office and the DOH to establish programs and infrastructure to support the new initiatives, including a registry of providers. In addition to funding provided through the Legislature, the agencies could seek federal or foundation funding for these causes.