UPMC Memorial in York County is a hospital. A hospital is a place where life or death struggles take place every day.

It is usually a cardiac arrest or a stroke or an anaphylactic allergic reaction. It can be a traumatic injury. It might be a gunshot wound.

It is not every day that the gunshot wound is inflicted in the hospital. That is what happened Feb. 22.

Diogenes Archangel-Ortiz did not go to UPMC Memorial with an illness or a wound. He went with zip ties and a handgun. He took hospital employees hostage. He wounded five people. He killed West York Borough police Officer Andrew Duarte.

It was not a normal day working in a place of healing, but violence in a hospital is not that unusual.

“What happened at UPMC York is an extreme example but, unfortunately, not a unique example,” said state Rep. Arvind Venkat, D-McCandless.

Venkat is also an emergency physician who described patients who have tried to assault him, who have threatened him and who have become violent with nurses.

“It’s scary. What should be a therapeutic environment becomes challenging,” he said.

How can this be counteracted? It isn’t like a hospital can separate patients and providers between bulletproof glass.

UPMC has been here before. In 2012, therapist Michael Schaab, 25, of Regent Square was killed at Western Psychiatric Institute and Clinic in Oakland.

Much like the York incident, five other people were injured and the gunman was shot by police. Afterward, UPMC put $10 million into upgrades to counter such attacks.

But nothing is completely effective.

The needs of a city hospital and a more rural one are different. The security requirements of a trauma center and a pediatric facility are different.

Addressing these demands must be done thoughtfully, creatively and with an eye toward safety of patients and employees.

The patients are an important part of this because they can be the variable in the equation. One person in the waiting room could be a threat to other sick people and providers. But they can’t simply be shut out.

People in a hospital setting could be there for mental health reasons. They could have physical conditions that are altering their behavior. They could have injuries related to questionable activity.

They may be dealing with stress and anxiety from their own or someone else’s health problems.

Much like school shootings bring up the competing solutions of gun control and mental health care, hospital violence needs to include hard responses like locks, metal detectors and officers on the scene. But it also should include review of what care is being provided and how changes might better serve and protect.

“It’s part of the job,” said Elizabeth Barrall Werley, president-elect of the Pennsylvania College of Emergency Physicians.

It is. But it shouldn’t be.

— Pittsburgh Tribune-Review