Earlier this summer, when the Faculty Senate at the Medical University of South Carolina said they were "dismayed" the university hadn't yet taken a stand on gun violence, they took matters into their own hands and set their own stake in the ground.
The group approved an official resolution to "affirm that gun violence is a public health problem of the highest priority."
At the same meeting, one faculty member questioned why metal detectors hadn't been installed at each of the hospital system's entrances.
The answer came down to cost. MUSC briefly considered installing permanent metal detectors, Department of Public Safety Chief Kevin Kerley said during a panel discussion on gun violence in late July. But they canned the idea when they found out it would cost $980,000 to staff the detectors every year.
There are about two dozen entrances to MUSC's hospital buildings. Each detector would need to be manned by three people, Kerley said.
"We looked into the cost, and that's where it ended," Kerley said.
The dilemma Kerley described has played out at other hospitals, too, where leaders are considering how best to protect their facilities as mass shootings become more common. Many find hospital complexes are difficult to protect.
Schipp Ames, spokesman for the South Carolina Hospital Association, said in an email hospitals can be difficult to protect because they are so accessible.
"Hospitals are the institutions we rely on to keep their doors open to everyone, which makes them more difficult to secure," he said. "Because healthcare campuses have become more vast, hospitals now have more access and entry points to monitor and protect."
By his observation, some South Carolina hospitals are actively considering security options. But they have to balance a desire to seem open to the community with making their buildings safe.
"It’s difficult to be welcoming with metal detectors and armed guards, but hospitals are having to consider that," Ames said.
Regional hospitals have found some compromises.
Carl Lindquist, spokesman for Georgetown-based Tidelands Health, said the hospital's security team has handheld metal detectors. The entire staff recently went through training on what to do in the event of an active shooter.
The security director and the hospital's leadership meet regularly, Lindquist said.
Atrium Health in Charlotte announced in late August they would be installing metal detectors at their facilities, the Charlotte Observer reported.
The North Carolina hospital system also said they would be increasing the number of armed guards. There had been a couple of concerning incidents in their area in recent years.
Representatives for Greenville Health System and Palmetto Health, two of the largest systems in South Carolina, did not respond to questions about gun safety for this article.
Back in Charleston, MUSC spokeswoman Heather Woolwine said part of the hospital's security strategy involves protecting victims of gun violence who arrive in the emergency department. It can be hard to predict how an attacker might react when he finds out an effort to kill someone failed.
"We think this is a worthwhile precaution to protect that victim," as well as their families and hospital employees, she said.
To protect these patients, Kerley, who has served as chief of MUSC's security force since 2014, said his team set up temporary metal detectors to protect victims of gun violence 148 times in 2017.
The number of times this has happened has increased somewhat over the years. The Department of Public Safety at MUSC "assisted" a gun violence victim 124 times in 2010 and 178 times in 2014. As the area's population has grown, so has MUSC's patient base.
Even so, there hasn't been an security incident involving a firearm on the hospital campus as far as Kerley remembers. He said MUSC's police force has begun to "open up lines of communication" with the leadership to push prevention possibilities.
Still, shootings at hospitals are rare. A study done by Johns Hopkins researchers in 2012 found 154 "hospital-related shootings" across the country.
The researchers reviewed newspaper clips. Information about these kinds of incidents are scarce, they said. No South Carolina agency seems to track them.
Nineteen health care workers died of violence in 2016 in United States, according to the Bureau of Labor Statistics. Studies have shown that while deaths are rare, violence against health care workers happens on a daily basis.
When violence does happen on hospital grounds, the motives are often complex and difficult to predict, the Johns Hopkins researchers wrote.
At Grand Strand Hospital in Myrtle Beach, for instance, a family argument broke out in front of the hospital in 2015, The Sun News reported. A 27-year-old man was shot but not seriously injured.
In Chester, a 20-year-old was shot to death in the early morning hours at the area hospital in 2010. Gang disputes caused the violence, WIS-TV reported.
Conversations about gun violence at MUSC have been active in recent months. A campaign began in July that encourages pediatricians to ask parents questions about guns in their patients' homes. And a panel at the end of that month brought experts together to address gun violence prevention.
Not everyone agrees that doctors should ask patients about gun safety. Some South Carolina lawmakers introduced a bill in 2013 that would have banned physicians from discussing firearms with patients. It did not become law.