More hospitals rely on police to keep health workers safe, but there are downsides

KFF Health News

Hearing the screams, Destiny rushed to her room, where she witnessed a patient assaulting a caregiver. As the nurse in charge of her Northeast Georgia Health system, she was trained to defuse violent situations.

But that day in the spring of 2021, Destiny stepped in and the patient punched, kicked, and bit her for several minutes. And by the time a team of security guards and other nurses freed her, the patient had torn out clumps of Destiny’s hair.

“We’re not guarded on the floor,” she said later that year, reflecting on the story during testimony before the Georgia Senate Commission of Inquiry on Violence Against Health Care Workers. Destiny said she used only her first name at her hearings because she feared retribution for her remarks about the patient who assaulted her.

Republican Governor Brian Kemp signed a bill in May that strengthens criminal penalties for assaults on hospital staff and allows medical facilities across the state to create independent police forces. The legislation is a response not only to that testimony, but also to data documenting an increase in hospital lobbying and violence against health care workers. In enacting the law, Georgia joins other states in trying to reverse the increase in violence over the past few years through tougher criminal penalties and stronger law enforcement.

According to the American Nursing Association, nearly 40 states have enacted laws that create or increase penalties for assaults on health care workers. And legislators in 29 states have approved or are working to enact similar laws or laws allowing the creation of hospital police. Members of these units can carry firearms and make arrests. Additionally, they have higher training requirements than non-certified personnel such as security guards, according to the International Medical Safety Association.

Organizations representing nurses and hospitals argue that such laws address the everyday reality of patients becoming aggressive, agitated, and sometimes violent. Still, such interventions are relatively new. Critics fear the creation of a hospital police could escalate violence in medical settings and have downstream repercussions.

“I worry about all the reasons patients don’t trust me and don’t trust the health care system,” said Elinor Kaufman, a trauma surgeon at the University of Pennsylvania.

Health care workers are five times more likely to experience violence than employees in other industries, according to federal data. A day after Kemp signed the Safer Hospitals Act, a gunman opened fire at a Midtown Atlanta clinic, killing a woman and injuring four, including a medical worker.

Matt Caseman, CEO of the Georgia Nursing Association, said increased verbal and physical intimidation during the pandemic is exacerbating the acute shortage of nurses. Destiny testified that one of her colleagues quit nursing after a patient smashed a caregiver’s face against a wall and floor in 2021. Destiny also said that for months she suffered from post-concussion headaches.

The Centers for Medicare and Medicaid Services noted an alarming increase in violence in health care settings last November. Federal agencies have recommended that hospitals implement patient risk assessment strategies, increase staffing, and improve staff training and education. There was no mention of increasing the presence of law enforcement agencies.

Mike Hodges, secretary of the Georgia chapter of the International Medical Safety Association, said health centers argued that if they could reduce the number of violent incidents, they could keep staff employed and improve patient care. State laws vary on how hospitals can respond to violence.

In Georgia, a new law increases criminal penalties for aggravated assault against all health care workers on hospital premises, not just emergency room health care workers, which were already regulated. And hospitals could set up law enforcement agencies like those on college campuses. Police officers must be certified by the Georgia Peace Police Officer Standards and Training Council and must maintain publicly available law enforcement records.

Republican Rep. Matt Reeves, a co-sponsor of the Georgia bill, said a dedicated police presence would allow hospitals to better train police officers who work in the medical field. Police officers can learn about staff members and regular patients, as well as hospital campus layouts and protocols. “Having a dedicated police station would be more responsive to the needs of the facility,” he says.

The same is true for Atrium Health Navicent, which operates hospitals in central Georgia, said company president Delvecchio Finley. The health care system was one of the few agencies to have certified personnel in law enforcement before the new law was enacted.

Atrium Health employs staff that reflect the diversity of its community, conducts training to combat implicit bias, and holds debriefing sessions after incidents, Finley said. Police officers are trained to respond if someone is violent at one of the facilities.

“The biggest thing we want to tell our officers is that they are in an environment that provides a safe environment that cares about everyone,” he said.

Atlanta emergency nurse Terry Sullivan said hospitals, unlike other companies, can’t simply throw out misbehaving patients. One patient once punched her in the chest and broke two of her ribs, then ran out of her room and tried to punch her doctor. In Sullivan’s experience, the presence of hospital security guards can prevent patients from acting violently, she said.

Yet little data exists on whether such forces are effective in preventing violence in hospitals. Ji Song Song, a law professor at the University of California, Irvine who studies policing in health care, worries about “unintended consequences” of laws that increase the presence of law enforcement where people receive medical care. are doing.

“I can see where there are a lot of problems,” she said. “Especially if the patient is African American or undocumented Latino, they are more likely to be criminalized.”

A ProPublica investigation found that private police at the Cleveland Clinic falsely accused and cited black people. And in March, a video was released showing Virginia police and hospital workers pining down a mentally ill patient to death. A Johns Hopkins University study found that in 23% of emergency department shootings between 2000 and 2011, the gunman snatched a gun from a security guard. A CMS memo described several incidents at hospitals involving police, which the agency cited as failing to provide a safe environment.

Georgia law does not require hospital police officers to arrest patients with outstanding warrants for offenses such as probation violations that occur off hospital premises. But Maisie Lynn Gertin, executive director of the Georgia Association of Criminal Defense Lawyers, said those powers are not limited.

“Unless discretion is restricted, it will someday be exercised by someone,” she says.

Trauma surgeon Kaufman argued that law enforcement should always be a last resort. While the threat of violence is a concern, hospitals could invest more in staffing medical staff, increase overall training and teach de-escalation skills.

“Our focus should not be that patients are a danger to us,” she says. “This is a toxic lens, a racist lens. We need to develop safe and healthy workplaces in other ways.”

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