What Happens When Victims of Community Violence Leave the Hospital?

Often, they face the same dangers as they did before. In high-crime areas, hospital responders work to keep patients safe after they're discharged back into the neighborhood.

Thirty boys stood outside waiting for him.

A 16-year-old boy had just finished his meal at a Chinese restaurant in the East New York neighborhood of Brooklyn. When he walked outside, he was knocked to the ground in a flurry of punches. He woke up and the boys were gone. He dragged himself around the corner to a friend’s apartment and she called an ambulance.

“He is not going back out there.” His mother was defiant in the middle of the hospital. The boy could not speak. The severe facial lacerations and heavy anesthetics left his face practically immobile. The doctors treated his wounds and were prepared to discharge him that night.

This is when a “hospital responder,” Abena Amory-Powell, who told me this story, stepped in. She came to the boy’s bedside to listen to his mother’s worries. The victim, his face wrapped in bandages, had been incarcerated for the past year, his mother told Amory-Powell. He used to run with a local gang, the same boys who greeted him outside of the Chinese restaurant. Now that he was out of prison, he was trying to get a job and go back to school. His mother said they were punishing him for trying to leave the gang.

Amory-Powell referred the boy’s mother to a lawyer with the organization Safe Horizon. They worked to set up a safe house for him in Queens, get him out of East New York. She checks in on him from time to time.

Amory-Powell does what doctors and surgeons have neither the expertise nor the time for. They are paid to concern themselves with patients’ physical health. She assesses the social aspect of violence. As a hospital responder with Kings Against Violence Initiative (KAVI), Amory-Powell is stationed at King’s County Hospital and is informed of any shooting or stabbing victim who enters the hospital. She visits the victims and tries to figure out how they were injured.

A hospital responder is someone who follows up with a victim of a gunshot wound, a stabbing, or any kind of assault. The responder is there to make sure that when a person leaves the hospital, they are not going back to a dangerous environment. (They also try to keep one incident of violence from leading to more. Tislam Milliner, a hospital responder from Man Up! Inc., tells stories of scouting out emergency waiting rooms, looking for friends of victims who might be antsy for revenge.) The responder coordinates with the police if they think that the situation could breed further violence. But most importantly, they connect the victims and their families with resources and services they may not know how to find. They set the victims up with counseling, refer them to jobs, and help them fill out the applications. They try to get them IDs, if they have none. If the victim has no place to sleep, they try to find them a shelter.

“We can give them options,” Amory-Powell said.

But, what is really important is that a responder can talk to victims on their level. This is why hospital responder organizations hire people who have grown up in the high-crime areas they serve.

Amory-Powell grew up in East Flatbush, a self-described truant, running with a tough group of girls. She said her boyfriend when she was a teenager went to jail for holding up cab drivers at gunpoint. She herself has been robbed at gunpoint.

“You live at Flatbush back then, walking down certain streets, you never knew,” she said. “It could come at any time.”

But, Amory-Powell said, her greatest strength as a hospital responder is her ability to empathize with the family members of a victim. She sees herself as more equipped to understand what they need than a doctor or therapist who has never been in their shoes.

“[Hospital responders] are not coming in unfamiliar with what goes on here,” said Linnea Ashley, the manager of the National Network of Hospital-Based Violence Intervention Programs (HVIPs). There are currently 28 nationwide, with three currently in New York and two more opening soon (one at Lincoln Medical Center in the Bronx and the other at Coney Island Hospital in Brooklyn, according to the NYC Health and Hospitals Corporation).* These are publicly funded programs, overseen by the cities they’re in.

“These are people who, in the mess of medical jargon, worried parents, and friends looking for revenge, will look a patient in the eyes and say, ‘Let's make sure that you are safe,’” Ashley said. Surprisingly, according to Ashley, community violence is tough to rally empathy for.

“If you talk about domestic violence, people have a lot of emotions,” she said. “When you talk about community violence, that stuff is harder.” People may see victims of gang, crime, or drug-related violence as perpetrators by association. However, a lot of the time, circumstances and a lack of options throw victims back into the cycle of violence. One estimate says that 45 percent of victims of violent crime will end up back in the hospital because of a similar injury.

This is where HVIPs can make a difference. Hospitals with HVIPs showed a 60 percent reduction in the rate of re-hospitalization of victims of violent crimes compared with hospitals without the program, according to a 2014 study in The American Journal of Surgery. They were also linked to a 25 percent drop in the total amount of violence in their neighborhoods.

HVIPs are also proven money savers. A small hospital adopting an HVIP could save its city up to $4 million over five years, according to researchers writing in the American Journal of Preventive Medicine who did a cost-benefit analysis of the programs. The number was based on the downturn in violence, decline in re-hospitalization, and the productivity lost when someone is injured and unable to work. (New York City’s public-hospital system is in a $702 million hole, which is expected to increase to $1.7 billion by 2018, according to a November 2014 report by the Citizens Budget Commission.) And these hypothetical savings could be on the low end. The cost-savings report only factors in people going to the same hospital for each visit. And according to an earlier study, only 42 percent of people return to the same hospital if they are involved in another incident. But the psychological cost of violence is harder to quantify.

Willis Young, the only other hospital responder at KAVI besides Amory-Powell, had a client last year who stopped being able to fall asleep at night.

According to Young, at midnight, one night last summer, Young’s client was standing outside of her apartment building in Flatbush when she heard gunshots. Her group of friends scattered and she ran inside and into her first-floor apartment. Bullets flew through her windows. Her door was shredded. It not until she was inside that she realized her shoulder had been grazed.

She arrived at the hospital in a taxi. They treated her and sent her home. Then Young came to visit her.

“She thought I was crazy,” Young said. “Coming into that neighborhood. She said it’s bad. But I’m from the neighborhood. I know it.”

Young said that the woman was shocked to see a young man walk through the door. She seemed surprised that the hospital responder dressed and talked like her friends did.

Young, who started out doing this work on a volunteer basis, says the victim spoke to him for a few hours the first day he visited her. She told him that since the shooting she could not sleep. After drifting off for an hour, she would go, bleary-eyed, to work, come back home and begin another night of fighting off the sound of gunshots ringing in her head. She started calling Young in the middle of the night.

“She didn’t know if there was someone after her,” Young said. “I’d stay on the phone for like 10 or 20 minutes and then I would be like ‘Alright, you think you can fall asleep now?’” Sometimes she would call back in 10 minutes, sometimes they would both nod off.

Young would ask about her day and whatever she was thinking about at that moment. He said he was trying to “entertain her mind away from what had happened.”

After a while, she stopped calling. She texted him now and then, “I tried, I couldn’t fall asleep.” Young would text her until she fell asleep. As the texts became less frequent, he knew she was sleeping more. The texts stopped a few months ago. Young hasn’t talked to her since.

* This article originally misidentified Lincoln Medical Center as Lincoln Memorial Hospital. We regret the error.