April 24, 2024

In harm’s way: San Diego County hospitals join forces to reduce patient-on-worker violence

A year ago, an inmate being treated at Scripps Mercy Hospital in San Diego threw the gun of a sheriff’s deputy who was guarding him and fired three rounds before a nursing assistant helped disarm him.

Internal documents show the incident left carers scrambling for cover. Fortunately, no one was injured. But even today, there are many who suddenly found in a harmful way relive the moments.

“Anytime there’s an incident across the country, I hear from the 10th floor at Mercy, because they’re worried it’s going to happen again,” said Chris Van Gorder, CEO of Scripps Health.

Although there are plenty of stories to illustrate the point, such as last week’s killer shooting hand surgeon from Tennessee or the 2022 murder A Tulsa surgeon at a patient angry with the result of his back surgery, the numbers also document a growing trend.

According to the US Bureau of Labor Statistics, the number of intentional injuries to health care workers and technicians has increased from 6.7 to 12.9 per 10,000 workers from 2011 to 2020. survey of health care workers across the country conducted in early 2023 found that 40 percent reported being directly involved in workplace violence in the past two years.

Van Gorder, a former police officer turned health care executive, said Scripps’ own tracking systems show violence against its workers was up 28 percent in the previous 12 months. In two other recent cases, he said, patients in the custody of Border Patrol agents attempted to brandish weapons.

The executive said something has to change.

“This one is done for me; I’m in charge of all these people, these are my people,” Van Gorder said. “They are hurt.”

That sentiment appears to be widely shared.

After pitching the task force idea to a narrow group of San Diego County health and law enforcement leaders, the idea has grown quickly, drawing in leaders from all hospital-operated health systems across the region as well as the law enforcement agencies that respond to emergency medical facilities.

An inaugural meeting of the entire task force in late June featured three medical personnel sharing stories of instances where violence had personally affected them in their workplaces. Meeting minutes detail instances where patients have choked, punched and dragged their caregivers to the ground by their coats, even engaging in hand-to-hand combat with officers in the middle of busy emergency rooms.

Dr. attended. Asia Takeuchi, an emergency medicine specialist at Sharp Memorial Hospital, at the meeting and said her facility is calling “code lock” more often than it used to. That’s the phrase that goes out over the facility’s announcement system when a medical provider needs urgent assistance from security personnel.

From January to May 2023, she said, the fewest number of code lock calls Memorial experienced in a month was 34. The most 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 where a patient cannot be calmed down with words or medication. One incident, she said, involved a very upset patient who picked up a metal medicine stand and threw it into the light fixture of his room.

“Unfortunately, it just kept rising and rising; he needed restraints and, unfortunately, he had to be Tased,” Takeuchi said. The hospital also recently added metal detectors, she said.

Other local examples are not difficult to find.

Last week, Van Gorder said, a patient admitted at Scripps La Jolla Memorial Hospital, which still doesn’t scan every patient in with metal detectors like it does at Scripps Mercy in Hillcrest, was found to be carrying two weapons.

“When they were getting his belongings they discovered a six-inch Bowie knife and a silver-plated revolver,” Van Gorder said. “We confiscated as we always do when we find weapons … when the man was released and found that his gun and knife were no longer there, he threatened our security officers.

“Of course, you know, carrying a concealed Bowie knife and a gun without a permit are 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 that takes place, between hospitals with violent incidents and between health providers and law enforcement.

Better communication, he said, is especially necessary in common situations such as picking up patients on “5150” when incidents in the community cause officers to suspect that someone may be a danger to themselves or others or that they are seriously disabled and cannot take care of themselves. Different officers from different departments may handle such a case differently, with frequent disagreements about what constitutes valid involuntary possession and what does not.

“We’re very supportive of law enforcement, and generally they’re very supportive of hospitals, but there are issues and sometimes, when it comes down to managing these cases, it’s really important that we have a relationship that we can reach literally 24/7 to be able to discuss issues that come up like threats against hospital staff,” Van Gorder said.

San Diego County District Attorney Summer Stephan is part of the task force and said this week that the stories of health care workers who were harmed by patients during treatment showed that more should be done.

She said her office is on the lookout for reported incidents of assault, but few of those that occur are forwarded to her office for review.

“Nationally, we can see an increase in violence in hospitals against doctors, against nurses, against hospital staff,” she said. “I think what’s happening is that it’s not being reported enough.

“I think, sometimes, hospital staff think that because they are in the business of caring for people, they have to accept the abuse, accept it.”

The DA said she has assigned a special prosecutor and investigator to work on hospital violence reports. Hospitals are different, however, to almost any other setting, not least because they deal with people whose medical conditions may cause them to behave violently.

Many health care workers may refuse to cooperate with law enforcement, regardless of the extent of personal injury.

Stephan said she believes there is a lot of discretion in handling such cases.

“In my mind, it’s important that these incidents be investigated and prosecuted if appropriate because, you know, you send a clear message that the hospital workforce is valued and we’re going to take care of them,” Stephan said. “But, within the justice system, there are different, very humane ways to deal with people who have, for example, mental health (issues), through behavioral health court, collaborative courts, mental health referral.”

Takeuchi, the Sharp emergency physician, said she agrees that hospital personnel could benefit from incident reporting and changes to current criminal laws that make an assault inside a hospital less of a crime than an equivalent violation out in the community. A bill proposed in 2018 that would have increased penalties for assault on health care workers failed.

“Those modest attacks that you ignore because you accept that they’re just part of the job, they add up in the end,” Takeuchi said. “Eventually they lead to more attacks if they’re ignored, so by bringing them up and bringing them to light more often, hopefully, people will understand what’s going on, and that’s how change can happen.”

Van Gorder noted that hospitals face particular security challenges in that they have to screen everyone who comes into their emergency departments and that, in most cases, patient rooms cannot be locked.

Part of the task force’s early work, he said, is to ask local police departments to make visits and recommendations on how to increase the physical security of workers and patients 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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