Calif. county hospitals work to reduce patient-on-staff violence
San Diego County health and law enforcement leaders are looking at violent patients, restraints and TASER protocols to reduce violence in hospitals
By Paul Sisson
The San Diego Union-Tribune
SAN DIEGO — One year ago, a prisoner receiving treatment at Scripps Mercy Hospital in San Diego wrested away the gun of the deputy sheriff who was guarding him and fired three rounds before a nursing assistant helped disarm him.
Internal documents reveal that the incident sent caregivers scrambling for cover. Fortunately, no one was hurt. But even today, many who suddenly found themselves in harm’s way relive those moments.
“Any time there’s an incident across the country, I hear from the 10th floor at Mercy, because they’re concerned that it’s going to happen again,” said Chris Van Gorder, CEO of Scripps Health.
While there are plenty of anecdotes to illustrate the point, such as last week’s fatal shooting of a Tennessee hand surgeon or the 2022 murder of a Tulsa surgeon by a patient angry with the outcome of his back surgery, the numbers also document a growing trend.
According to the U.S. Bureau of Labor Statistics, the number of intentional injuries against healthcare workers and technicians has increased from 6.7 to 12.9 per 10,000 workers from 2011 to 2020. A survey of healthcare workers nationwide conducted in early 2023 found that 40 percent reported that they were directly involved in workplace violence in the previous two years.
Van Gorder, a former police officer turned health care executive, said Scripps’ own tracking systems show that violence against its workers was up 28 percent in the previous 12 months. In two other recent cases, he said, patients in custody of Border Patrol agents tried to take sidearms.
The executive said something has to change.
“I get worked up on this one; I’m in charge of all of these people, these are my people,” Van Gorder said. “They’re getting hurt.”
That feeling seems to be widely shared.
After pitching the idea of a task force to a narrow group of San Diego County health and law enforcement leaders, the idea has quickly grown, now pulling in leaders from every health system operating a hospital across the region as well as the law enforcement agencies that respond to medical facilities in an emergency.
An inaugural meeting of the full task force in late June included three medical personnel sharing stories of instances where they had been personally affected by violence in their workplaces. The meeting’s minutes detail cases where patients have choked, punched and pulled their caregivers to the ground by their coats, even doing hand-to-hand combat with officers in the middle of busy emergency rooms.
Dr. Asia Takeuchi, an emergency medicine specialist at Sharp Memorial Hospital, attended the meeting and shared that her facility has been calling “code green” more often than used to be the case. That’s the phrase that goes out over the facility’s announcement system when a medical provider urgently needs assistance from security personnel.
From January through May of 2023, she said, the smallest number of code green calls that Memorial experienced in a month were 34. The largest was 64. That’s between one and two incidents of significant violence per day.
Recently, she said, the hospital instituted a Taser protocol in its emergency department for situations when a patient can’t be calmed down with words or medications. One incident, she said, involved a severely agitated patient who picked up a metal medical stand and threw it into the light fixture of his room.
“Unfortunately, he just continued to escalate and escalate; he required restraints and, unfortunately, ended up having to be Tased,” Takeuchi said. The hospital also has recently added metal detectors, she said.
It’s not hard to find other local examples.
Last week, Van Gorder said, a patient admitted at Scripps Memorial Hospital La Jolla, which is not yet scanning all incoming patients with metal detectors as is the case at Scripps Mercy in Hillcrest, was found to be carrying two weapons.
“While they were securing his belongings they discovered a six-inch Bowie knife and a silver-plated revolver,” Van Gorder said. “We ended up confiscating that as we always do when we find weapons ... when the guy was discharged and he found out his gun and knife wasn’t there anymore, he threatened our security officers.
“Of course, you know, carrying a concealed Bowie knife and a gun without a permit are both felonies in the State of California.”
Both weapons, he said, were turned over to the San Diego Police Department.
The task force, Van Gorder said, is designed to increase the amount of communication going on, both among hospitals experiencing violent incidents and between health providers and law enforcement.
Better communication, he said, is especially necessary in common situations such as bringing patients picked up on “5150" holds when incidents in the community cause officers to suspect someone may be a danger to themselves or others or gravely disabled and unable to take care of themselves. Different officers from different departments may handle such a situation differently, with regular disagreement on what constitutes a valid involuntary hold and what does not.
“We are extraordinarily supportive of law enforcement, and they’re generally very supportive of hospitals, but there are issues and sometimes, when it comes down to managing these situations, it’s really important for us to have a liaison that we can contact literally 24/7 to be able to discuss issues that come up like threats made against hospital staff,” Van Gorder said.
San Diego County District Attorney Summer Stephan is part of the task force and said this week that hearing the stories of healthcare workers who have been harmed by patients during treatment made it clear that more should be done.
She said her office does pursue reported incidents of assault, but few of those that occur are forwarded to her office for review.
“Nationally, we can see that there has been an increase in violence in hospitals against doctors, against nurses, against hospital staff,” she said. “I think what’s happening is that it’s under-reported.
“I think that, sometimes, the hospital staff thinks that, because they’re in the business of caring for people, that they have to take, take the abuse.”
The DA said that she has allocated a special prosecutor and an investigator to work on hospital violence reports. Hospitals, though, are different from almost any other kind of venue, especially because they treat people whose medical conditions may cause them to behave violently.
Many healthcare workers may refuse to cooperate with law enforcement, regardless of how much they were personally harmed.
Stephan said she believes that there is enough discretion available to handle such situations.
“In my mind, it’s important that these incidents are investigated and prosecuted if appropriate because, you know, then you send a clear message that the hospital workforce is something we value and we’re going to take care of,” Stephan said. “But, within the justice system, there are different, very humane ways to deal with people with, for example, mental health (issues), through behavioral health court, collaborative courts, mental health diversion.”
Takeuchi, the Sharp emergency physician, said she agrees that hospital personnel could benefit from reporting incidents and from changes to current criminal laws that make assault inside a hospital a lesser legal infraction than it is for an identical infraction out in the community. A bill proposed in 2018 that would have equalized penalties for assault on healthcare workers did not pass.
“Those moderate aggressions that you just kind of ignore because you kind of assume that they’re just part of the job, eventually those add up,” Takeuchi said. “They just eventually lead to bigger aggressions if they’re ignored, and so bringing them up and bringing them to light more often, hopefully, will make people realize what’s happening, and that’s how change can happen.”
Hospitals, Van Gorder noted, face particular challenges around security in that they must take all comers in their emergency departments and patient rooms, in most cases, cannot be locked.
Part of the task force’s early work, he said, is asking local police departments to make visits and recommendations on how the physical security of workers and patients can be increased without violating rules and regulations.
“We’re different than any other industry, we’re not a normal business with normal clients that come here,” Van Gorder said. “
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