Hospitals Work to Prevent Patient Violence
December 1, 2023 7 minutes read
By Greg Freeman
A series of violent attacks on personnel has prompted hospitals in San Diego to create a task force to address this serious problem familiar to hospital leaders across the country. The task force works with local law enforcement to develop tactics to keep healthcare workers safe.
The task force first met in June and heard from healthcare workers telling of their experiences with violence in the workplace. Interest in the task force grew quickly, and it now includes leaders from every health system and law enforcement agency in the San Diego area, says Chris Van Gorder, EMT, MPA, FACHE, CEO of Scripps Health in San Diego, and a former police officer.
The Scripps health system’s tracking data indicate violence against employees increased 28% in the previous 12 months. “The task force came out of a little bit of frustration on my part in the sense that the volume of incidents, attacks on our people, continue to rise. We seem unable to get control of this or lower the incidence, and we need help from others,” Van Gorder explains. “We’ve tried to take this on as a healthcare industry or as a hospital industry, but the reality is that this is a community issue, and the community needs to take some responsibility in helping us with this.”
Van Gorder, who spent 20 years with the San Diego County Sheriff’s Department, contacted local law enforcement leaders to participate on the task force. A recently retired sheriff of San Diego County, who also is a former FBI agent, joined the effort.
“I was talking with [the former sheriff] about my frustration with the incidents. He suggested that I go to all the chiefs of police and the sheriffs. There’s an association [of police chiefs and sheriffs] in town and all of the heads of the law enforcement agencies in the community belong to that,” Van Gorder says. “I asked for permission to come down and make a presentation. I was given 15 minutes on their agenda to make a case and an idea, so I went down and gave them the statistics.”
Reports from the U.S. Bureau of Labor Statistics show 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 2020.1 Forty percent of healthcare workers say they have been involved in workplace violence in the past two years, according to a recent survey by Premier.2
“I shared with them the statistics and I said, ‘We’ve got a real big problem here in this community, and it goes from everything from the incidents themselves to the failure to prosecute and handle those incidents and failure to get appropriate legislation to make these attacks more serious so that it acts as a deterrent to the continued attacks,’” Van Gorder explains. “I said, ‘Frankly, we need law enforcement advice on how we can secure our facilities better.’”
Van Gorder used the example of an active shooter in a healthcare facility and how current teaching for the public is not sufficient for healthcare employees. Citizens are taught to “run, hide, fight” when facing a shooter, but Van Gorder pointed out how that approach does not always work in a hospital or clinic. How are patients going to run if they cannot walk? What if they are in the operating room? How can employees run or hide if that means abandoning their patients?
“We need to think about hospitals and healthcare very differently,” Van Gorder says. “We think of a school, or we think of an office building in these scenarios, but we are not the same.”
Healthcare facilities are different and pose challenges in violent situations, Van Gorder notes. Compared to a school or office building, a hospital can be like an elaborate maze, with many areas inaccessible.
“You can’t run and hide in the pharmacy if that’s the closest refuge. Even I can’t get in the pharmacy,” Van Gorder says.
Van Gorder also explained healthcare employees sometimes need more cooperation and understanding from law enforcement. He recalls a recent incident at a Scripps hospital in which police brought a man to the ED and insisted he was a 5150, which in California is the Welfare and Institutions Code for a person who is gravely disabled, harmful to themselves, or harmful to others. If the patient is declared 5150, he or she can be held for 72 hours.
“The supervising law enforcement [officer] insisted that this was a 5150, but the psychiatrist checked the patient out and said, ‘No, he doesn’t qualify for 5150.’ There was an argument between the police sergeant and a psychiatrist. Finally, the doctor had to say, ‘Look, let’s just agree to disagree, but I am the physician here,’” Van Gorder explains.
Not long after, the police brought in another patient who had been violent. Usually, the officers would accompany the patient during treatment to ensure he does not become violent again, but this time, they dropped him off at the front door.
“They basically said, ‘This guy is going to be a real problem for you guys,’” Van Gorder recalls. “Nursing staff asked if they would please come back and accompany them, but they said, ‘No, no, no, we’re out of here.’”
The patient became violent after the officers left, forcing hospital employees to call 911 for help. Van Gorder recalls seeing all the law enforcement leaders drop their heads, hoping it was not their officers who refused to help the first time.
Van Gorder also notes an incident from his own law enforcement days in which an ex-convict was involved in a domestic dispute at a hospital and threated to return to shoot up the facility. When Van Gorder was called to the hospital, employees asked if he could stay until the man returned. Van Gorder’s supervisor said no.
Van Gorder was frustrated by the order, and the undersheriff admitted policies were inconsistent. If somebody threatened a school, the police would send dozens of police cars to manage it, but the same threat to a hospital receives far less response, the undersheriff admitted. Van Gorder called on the task force to change that.
Van Gorder asked for a liaison from every law enforcement department with a hospital with a trauma center or an ED in their jurisdiction, with the aim of reviewing cases to evaluate the performance of both the hospital and law enforcement. He also advocated for investigating violent healthcare incidents downstream to see if there was prosecution.
The district attorney immediately said, “‘We’ve got to do something about this. I had no idea.’ She said, ‘You know, with these numbers and these percentages, I agree with you. This is a community problem we have to address together,’” Van Gorder recalls.
The district attorney followed up with research showing more than 3,000 violent incidents occurred at Scripps hospitals alone in the previous year. The data indicated that of those incidents, there were 67 prosecutions. The district attorney expressed dismay at the small number of prosecutions and realized most cases were not even referred to her office after a police report was made.
After the initial meeting with law enforcement, Van Gorder expanded the task force to include local trauma hospitals and then others. The task force will continue to meet quarterly.
Law enforcement members were tasked with visiting all the hospitals within their jurisdiction to meet with their security directors. “The hospital administrators were told to talk specifically about the security issues that they’re having, and any case issues that they’d like to discuss,” Van Gorder says. “We wanted them to start getting into the issues around active shooter and be prepared to come back the next meeting to review our findings, and then start to chart a course of action.”
In the meantime, an incident occurred at Scripps Mercy Hospital during which a patient was escorted out after care. The patient had been violent and uncooperative. The patient stopped at the metal detector and punched one of the attendant security officers there, knocking him down. Other security officers detained and handcuffed the individual, who was then arrested.
“For the first time, I actually reached out to the district attorney and said, ‘We would like to see this individual prosecuted since it was a misdemeanor battery case,’” Van Gorder recalls. “She contacted the city attorney, who filed charges against this individual. Before this, nothing would have been done. We would have had a workers’ comp incident, somebody assaulted and injured. And nothing would happen.”
The district attorney did point out that some cases will not be prosecuted when there is a psychiatric issue that prevented the person from knowing what they were doing, but that there are other remedies, such as psychiatric holds.
The task force also is looking at legislative changes. “In the state of California, if you hit a nurse who’s working in the EMS system, it’s a felony. You hit that same nurse working in a hospital, it’s a misdemeanor,” Van Gorder says. “We’ve tried to get legislation passed that would equalize the crime.”
Plus, in California and many other states, Van Gorder says if the crime is a misdemeanor that does not occur in the presence of the police officer, the employee has to make a citizen’s arrest.
“Not only do they get battered, now they have to make the citizen’s arrest, and be the person that kind of follows up almost as the prosecutor,” Van Gorder says. “These cases just don’t get prosecuted because even the employees don’t want to get that much more involved. The only way we are going to be able to address this is by making it a community issue, not just a hospital issue.”
REFERENCES
- U.S. Bureau of Labor Statistics. Workplace violence in healthcare, 2018. April 2020.
- Premier. Premier survey reveals key insights on workplace violence incidents in healthcare. June 1, 2023.
A series of violent attacks on personnel has prompted hospitals in San Diego to create a task force to address this serious problem familiar to hospital leaders across the country. The task force works with local law enforcement to develop tactics to keep healthcare workers safe.
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