The fatal shooting at a medical clinic in Buffalo last week is reigniting anxiety about hospital safety and raising new concerns about how best to deal with irate patients vowing violence.

At Hennepin Healthcare's Whittier Clinic in south Minneapolis, a group of staffers convened the day after the shooting to share their concerns about safety from outside threats.

"It's stressful," said Ursula Reynoso, program supervisor of Aqui Para Ti, an office within the clinic for Latino youths and their families. "Anything that happens anywhere with any type of violence, we think something else could never happen in Whittier."

Authorities allege Gregory Ulrich walked into the Allina Health Clinic in Buffalo, about 50 miles northwest of Minneapolis, with a handgun and pipe bombs. In about six minutes, he detonated three explosive devices and shot five people, killing one, a 37-year-old medical assistant. He surrendered to police when they arrived.

Two years before, Dr. Andrew Burgdorf obtained a restraining order against Ulrich after Ulrich told him he intended to kill people and commit the kind of mass violence that would get the public's attention. Even after the order was filed, Ulrich continued to visit the clinic and terrorize employees, sometimes being escorted away or arrested by police.

The incident underscored a grim reality for clinics — that restraining orders work best on people least likely to violate them.

Ulrich, a 67-year-old Buffalo man, had a long record of mental health and substance abuse problems. He also harbored intense and violent feelings toward medical practitioners he believed wronged him.

Violent gun attacks such as the one last week where a legal restraining order had been obtained against a patient are rare, but health care workers face a constant challenge of assessing patients for threats.

"Violence in health care settings happens every day, on every shift, in all units of the hospital," Minnesota Nurses Association (MNA) spokesman Rick Fuentes said.

On the day of the shooting, the nurses' union sent a news release, citing its own 2019 survey showing that 95% of its nurses say they do not feel safe from violence at work. "We want to start people working on: What's the solution to this? But there's so many things that went wrong with this Buffalo situation, it's like where do you start?" he said. Evidence about the use of harassment restraining orders at Minnesota clinics is mostly anecdotal in part because they are obtained by individuals, not the clinics.

Liz Richards, executive director of Violence Free Minnesota, emphasized that restraining orders are designed to be a part of the process of protection — but not the whole process.

"When there is a tragic situation, we go back to see whether there was information that could have been acted on that wasn't," she said. "In each system, how do you assess whether every case is potentially lethal? That's what we're doing all the time."

In her 14 years as the CEO of NorthPoint Health & Wellness Center, a medical and behavioral health clinic in north Minneapolis, Stella Whitney-West recalled only one restraining order obtained by an employee who heard from police that a person had made threats against her in a session with a therapist elsewhere.

Whitney-West, however, said violence is always a wake-up call. "It's important that people not shrug it off and say, 'It can't happen here.' "

Hennepin Healthcare CEO Jennifer DeCubellis, who oversees HCMC in downtown Minneapolis, said restraining orders are relatively rare. "Challenging situations can also be handled via a trespass order versus restraining order — or can be as simple as alerts attached to patient records," she said.

What is also happening at NorthPoint and elsewhere is risk and threat assessment, both with formal questionnaires and discussions with patients. They also have "duress" buttons they can push to call internal security.

Paul Sarnese, president of the International Association for Healthcare Security & Safety, said gun violence incidents are rare for most health care organizations, but physical assaults are common. He cited Occupational Safety and Health Administrations statistics indicating that health care is second only to social services in terms of workplace assaults.

"We are experiencing what seems to be an increasing number of violent acts in society, and I do not believe health care spaces are immune from that," he said.

The national average across professions is 1.8 assaults per 100 workers. The national average for health care is five times higher — 9 assaults per 100 workers — he said.

At the Native American Community Clinic on East Franklin, CEO Antony Stately said providers work hard to understand why a patient is disgruntled. "The best way to mitigate these things is to work up front to prevent them," he said. "We take a trauma-informed approach and try to be as respectful as possible of our patients. There's all kinds of reasons patients get upset."

Still, "We've had situations where we've had to 'fire' a patient," Stately said, but the critical step is finding them the care they need.

But broader issues are troubling as well, especially access to guns and lack of access to mental health care.

At the State Capitol, the tragedy renewed debate over gun restrictions. Some DFL legislators and gun control advocates revived their push for background checks and red-flag laws. Despite a restraining order and an arrest for violating it, Ulrich still managed to acquire a permit from local police to purchase the handgun he later turned on medical staff.

"He clearly was posing a threat," said Rashmi Seneviratne, executive director of Protect Minnesota, a nonprofit that advocates for gun-safety measures. The organization backs efforts to establish a red flag law or Extreme Risk Protection Order, which would allow courts to temporarily remove someone's guns if they are found to be a danger to themselves or others.

Although DFL lawmakers vow to request hearings on the bill again this year, many expect the measure to ultimately stall again in the Republican-controlled Senate.

Said Whitney-West, "At the end of the day, the unfortunate scenario is we have far too many guns and we have far too many people struggling with mental illness and addiction that have guns."

Staff writer Alex Chhith contributed to this report.

Rochelle Olson • 612-673-1747