COLUMN ONE : Hospitals Caught in Cross-Fire : Violence is escalating at medical centers, especially inner-city facilities. Officials have turned to such security measures as police dogs, stun guns and metal detectors.

Hospitals--sanctuaries for the sick, injured and dying--have fallen victim to America’s violent ways.

In medical facilities across the country--but particularly in the emergency rooms of large, public, inner-city hospitals--tensions have been heightened by an unnerving number of shootings, assaults, rapes, robberies, thefts and bomb threats.

The gang gunfire that last month ripped through the windows of White Memorial Hospital in Boyle Heights, striking a pregnant woman in the face with shotgun pellets, dramatically illustrated how vulnerable hospitals are to attack.

But hospital employees in Los Angeles and other urban centers say they face less-publicized dangers daily--the reality, they explain, of providing care to the growing ranks of aggressive, addicted and deranged people for whom the emergency room is the last resort.

“In the emergency room, we see the failures and successes of our social policies,” said Dr. Charlotte Yeh, a former UCLA Medical Center resident who now oversees emergency medicine at two Boston hospitals. “Here, we put our finger on the pulse of America.”

A doctor at Martin Luther King Jr./Drew Medical Center said a visitor pressed a knife against his throat, warning that the physician would be next if his patient died. Several nurses at County-USC Medical Center said they or their colleagues have been assaulted in hallways and parking lots. Security officers say they have intercepted gang members who were hoping to find a wounded rival and finish him off.

“Even in wartime, everyone lets the Red Cross go by,” said Steve Valdivia, executive director of Community Youth Gang Services. “What we’re seeing is the equivalent of blowing up the Red Cross.”

Administrators, in the prickly dilemma of having to ensure safety without violating the legal right of every patient to emergency treatment, have turned to such security measures as police dogs, stun guns and metal detectors.

Wounded gang members are listed as “John Doe” on patient lists at several local hospitals to keep rivals at bay. In other parts of the country, nurses have taken to putting only their first names on name tags. At Dominican Santa Cruz Hospital in Northern California, officials have devised a special help call so as not to alert belligerent patients that reinforcements are on the way: “Mr. Dominican” over the P.A. system means all able-bodied employees in the vicinity are needed right away.

During the first six months of 1991, security guards at County-USC’s General Hospital responded to 1,400 reports of threats or attacks, six of which led to arrests, officials said. At Martin Luther King Jr./Drew Medical Center, there were 430 “safety incidents” and 17 arrests during the first three months of the year, according to an internal quality-assurance report. Harbor-UCLA Medical Center counted 3,000 disturbances in 1990, resulting in 19 arrests.

“It’s a little bit like going to war,” said Dr. Robert Hockberger, director of Harbor-UCLA’s emergency room. “You may not have any casualties at first. But it’s escalating and we’re expecting them.”

In recent years, assailants have killed people at hospitals in Los Angeles, San Diego, New York, Washington, Sandy, Utah, and Danville, Pa. The Journal of Emergency Nursing, which devoted its October issue entirely to hospital violence, reports that emergency departments in Philadelphia last year confiscated loaded guns, knives, box cutters, piano wire, brass knuckles, razors and hand grenades.

In a 1988 survey of 127 emergency rooms, University of Louisville researchers found that 41 reported at least one verbal threat a day, 23 received at least one armed threat a month, and 55 sustained at least one physical attack a month.

A study of crime at 25 hospitals in 1989 found 1,435 assaults had occurred--a sharp upswing from the previous year. Weapons were used in roughly one in five assaults. Half of the assaults took place in hospital emergency rooms, and about a quarter of them occurred in psychiatric wards.

Officials at Henry Ford Hospital in Detroit launched a highly touted project several years ago aimed at screening weapons at the emergency room entrance. A sign warned visitors that they would be passing through a metal detector, and lockers were installed for belongings to be checked. Even with those admonitions, guards in the first six months seized 33 handguns, 1,324 knives and 97 cans of Mace-type spray, according to the Annals of Emergency Medicine.

“The emergency room is where the rubber hits the road in medicine,” said Frank S. Waller, director of security at the 600-bed Anderson Memorial Hospital in South Carolina.

Violence is not an entirely new challenge for emergency room personnel, who endured in the 1970s a wave of extremely aggressive patients high on phencyclidine, or PCP.

But emergency departments have come to be known in the 1990s as the Knife and Gun Club among practitioners who classify their hostile encounters in three general categories: drug abusers and the mentally ill, gang attacks, and lashing out by those who face increasingly long waits.

The most common and longstanding threat, they say, is posed by mentally unstable and drug-addicted patients who can become unpredictably combative or emotionally distraught:

* In a notorious New York case, a 23-year-old homeless man with a history of psychiatric problems was charged with the 1989 rape and strangulation murder of a female doctor in her office at Bellevue Hospital Center. Police said the suspect told them that he had been living for weeks in a storage closet and had been roaming the hallways disguised in a stolen lab coat and stethoscope.

* In September, a 39-year-old Utah man was accused of storming a hospital in a Salt Lake City suburb while armed with dynamite and two guns, killing a nurse and holding eight people hostage before surrendering 17 hours later. A hospital spokesman said the suspect was apparently angry because doctors had tied his wife’s Fallopian tubes.

* In San Diego last year, a man distraught over the death of his father at Mission Bay Memorial Hospital walked into the emergency room and fired a barrage of bullets that killed a nurse and a hospital trainee while wounding a doctor and a visitor.

* In March, a panhandler approached four nurses as they ate breakfast in the cafeteria of County-USC and plunged a pair of suture-removal scissors deep into one nurse’s neck.

“You don’t forget something like that,” said one of the nurses, Petra Palma-Appel, whose friend recovered from the stabbing but has been too traumatized to return to work.

Doctors say they have grown accustomed to diffusing the anger of distraught patients, but have few defenses when their quarters become an extension of the gang battlefield.

That happens most frequently when rival gangs arrive at the same time, each carrying wounded members from the same shootout. According to security guards and gang experts in Los Angeles, groups of 15 or 20 rivals have been known to square off, exchanging threats and, on at least two occasions, bullets.

After witnessing a gang fracas in August at King/Drew Medical Center, an Army doctor on loan to the emergency department asked to be recalled to his base in Texas.

“I do not feel that it is part of my training to come out here and potentially get shot and killed in this institution,” said Maj. Earl Scott, before returning to Wm. Beaumont Army Medical Center in El Paso.

A year ago at County-USC, 18-year-old Jose Llamas and several of his fellow gang members went to visit an ailing friend. They bumped into a group of rivals in the hallway who had come to visit a wounded homeboy of their own.

“Let’s take this outside,” one of Llamas’ friends said, according to court records.

But as the two gangs descended the winding stairwell, someone in Llamas’ group slipped and stumbled down a few steps. The rivals howled in derisive laughter. And Llamas, protecting his honor in the twisted logic of the gang world, pulled a .22-caliber handgun and fired a single shot into the face of 18-year-old Toribio Sanchez.

He pleaded guilty and is serving 12 years in prison for attempted murder.

“When you have two rival gangs on the same floor, it’s like two locomotives heading on a collision course,” said Father Gregory Boyle, pastor of Dolores Mission Church in Boyle Heights. “There’s like this little ritual dance out there. You’re obliged to hit somebody up and ‘dis’ their neighborhood and then, as the kids say, ‘It’s on.’ ”

The third area of tension, though it rarely produces the same level of carnage, stems from the exasperation of patients.

Increasingly, inner-city emergency departments are overwhelmed by patients who have no other access to health care--including the working poor who have no medical insurance. Many of them are forced to wait for hours, and sometimes entire days, while doctors treat the most severely injured.

“Fuses are short. Fear brings out the worst in people,” said Yeh.

A confidential report prepared this spring by hospital trouble-shooters at King/Drew Medical Center blamed many of the verbal and physical assaults there on patient “anxieties and frustrations regarding accommodations, length of waiting time (and) suspicions . . . regarding lack of staff concern for timely patient care.”

“You’re sitting bait out there,” said a nurse at the Harbor emergency room, where she sits alone in an unprotected booth. “Just recently, a patient went berserk. He yelled: ‘I’m not going to wait any longer!’ and started grabbing the patient charts and tearing them up.”

To guard against violence, administrators are increasingly devoting scarce resources to beefed-up security. Recognizing a need for tighter security at public hospitals, Los Angeles County health officials recently made an urgent request to the supervisors for an additional $1.7 million to hire more security officers.

Among the most extreme measures taken by private hospitals was the addition several years ago of three highly trained police dogs--Dario, Toro and Barry--at Pomona Valley Hospital Medical Center.

Charles Eddinger, chief of security, said a nurse recently called for a K-9 team when an unruly crowd of about 40 people gathered in the hallway outside the intensive care unit, blocking gurneys.

“The elevator door opened and the officer and his dog walked out,” said Eddinger. “Not one word was spoken and the whole group dispersed.” He said the dogs have never bitten anyone.

At Primary Children’s Medical Center in Salt Lake City, hospital officials have armed their security force with one stun gun and have ordered three more. The Texas firm that manufactures them said about a dozen hospitals are using stun guns “as a less than lethal device” to control unruly patients and visitors.

White Memorial, after the Oct. 12 drive-by attack, moved its emergency department waiting room out of street view and posted a uniformed guard there. Officials plan to install bulletproof sliding glass doors and a concrete wall in front of the entrance.

In Los Angeles, most public hospitals have resorted to metal detectors, closed-circuit surveillance cameras, electronic doors with coded access and “panic buttons” that set off alarms in safety police offices.

“People who cause trouble are gone in a second,” said a third-year resident in King/Drew’s emergency room.

At County-USC’s General Hospital, which has 22 entrances, officials have purchased the hardware for a key-card locking system on all doors, but fire officials for the last two years have blocked implementation for fear of impeding escape during a blaze.

At King, metal detectors have been installed only at the hospital’s mental health center and the pediatrics ward, which treats many juveniles. A third metal detector was promised for the emergency room, but officials say the area will have to be remodeled to accommodate it. Harbor-UCLA has ordered metal detectors but administrators say there are no guards to staff them.

To be “danger-proof,” said Carl Stevens, an emergency room physician at Harbor-UCLA, “the security would have to be impossibly high. It would have to be akin to an armed camp, which is incompatible with our mission as caretakers.”