ATLANTA — When Destiny heard screams, she rushed to a hospital room where she saw a patient assaulting a medical technician. As a charge nurse at the Northeast Georgia Health System, she was trained to defuse violent situations.
But that day in the spring of 2021, as Fate intervened, for several minutes the patient punched, kicked and bit her. And by the time a team of security guards and other nurses were able to free her, the patient had torn bits of Destiny’s hair out.
“We are not protected on our floors,” she said recapping the story during testimony later that year before the Georgia Senate Study Committee on Violence Against Workers. health. Fate only used her first name at the hearing, for fear of reprisals for denouncing the patient who assaulted her.
In May, Republican Gov. Brian Kemp signed legislation that strengthens criminal penalties for assaults on hospital staff and allows state health facilities to create independent police forces. The law is a response to that testimony as well as hospital lobbying and data documenting an increase in violence against healthcare workers. In enacting the law, Georgia joined other states that were trying to reverse rising violence in recent years through tougher criminal penalties and stronger law enforcement.
Nearly 40 states have laws that establish or increase penalties for assaults on healthcare workers, according to the American Nurses Association. And lawmakers in 29 states have approved or are working on similar laws, as well as those that authorize the creation of hospital police forces. Members of these forces can carry firearms and make arrests. Also, they have higher training requirements than uncertified officers such as security guards, according to the International Association for Safety and Security in Health Care.
Groups representing nurses and hospitals argue that such laws respond to the daily reality of aggressive or agitated patients who sometimes turn violent. Yet these interventions are relatively new. Critics fear that the creation of hospital police forces will escalate violence in health care facilities and have downstream effects.
“I worry about all the reasons why patients don’t trust me and don’t trust the healthcare system,” said Elinore Kaufman, a trauma surgeon at the University of Pennsylvania.
According to federal data, healthcare workers are five times more likely to be victims of violence than employees in other industries. The day after Kemp signed the Safer Hospitals Act, a person opened fire at a medical office in downtown Atlanta, killing one woman and injuring four others, including medical office workers.
Verbal and physical threats, which have increased during the pandemic, are exacerbating a severe shortage of nurses, said Matt Caseman, CEO of the Georgia Nurses Association. Destiny testified that one of her co-workers left nursing after the 2021 assault, in which the patient smashed the healthcare technician’s face into a wall and the floor. Destiny also suffered from headaches after a concussion for months, she said.
The Centers for Medicare & Medicaid Services noted the alarming rise in violence in healthcare facilities last November. The federal agency recommended that hospitals implement a patient risk assessment strategy, increase staffing levels and improve staff training and education. There was no question of reinforcing the presence of the forces of order.
Health centers say they are better able to retain workers and improve patient care when they can reduce the number of violent incidents, said Mike Hodges, secretary of the Association’s Georgia chapter. international health care safety and security. State laws governing how hospitals can respond to violence vary.
In Georgia, the new law strengthens criminal penalties for aggravated assault against all healthcare workers on a hospital campus, not just those in the emergency room, which were already regulated. And hospitals can now establish law enforcement offices like those on college campuses. Officers must be certified by the Georgia Peace Officer Standards and Training Council and maintain law enforcement records that may be made public.
Having a dedicated police force helps hospitals better train officers to work in a health care setting, said Republican State Rep. Matt Reeves, who co-sponsored Georgia’s bill. Agents can get to know staff members and regular patients, as well as the layout and protocols of hospital campuses. “If you have a specialized police department, they are more in tune with the needs of the establishment,” he said.
That’s the case at Atrium Health Navicent, which operates hospitals in central Georgia, said Delvecchio Finley, its president. The health system was one of the few that had certified law enforcement personnel before the new law.
Atrium Health recruits officers who reflect the diversity of the community, conducts training to counter implicit biases and conducts debriefings after any incident, Finley said. Officers are trained to respond when someone becomes violent at one of the facilities.
“The most important thing we have to convey to officers is that they are in an environment where we provide a safe environment where we care for anyone,” he said.
Unlike other companies, hospitals can’t just expel misbehaving patients, said Terri Sullivan, an Atlanta emergency nurse. A patient once punched her in the chest, fracturing two ribs, before running out of the room and trying to punch her doctor. Sullivan said in her experience, the presence of hospital security can prevent patients from acting out.
Yet, little data exists on whether these forces are effective in preventing hospital violence. Ji Seon Song, a law professor at the University of California, Irvine who studies policing in healthcare settings, worries about the ‘unintended consequences’ of legislation that increases law enforcement presence in places where people receive medical care.
“You can see where there could be a lot of trouble,” she said, “especially if the patient is African American, undocumented, Latino — something that makes them susceptible to criminalization.”
A ProPublica investigation found that private police forces at the Cleveland Clinic disproportionately accuse and cite black people. And in March, video emerged showing Virginia police and hospital staff restraining a patient who was going through a mental health crisis, leading to his death. According to a Johns Hopkins University study, in 23% of ER shootings between 2000 and 2011, the attacker took a gun from a security guard. The CMS memo noted several hospital incidents involving police, in which the agency cited the facility for failing to provide a safe environment.
Georgia law does not require hospital police to arrest patients with outstanding warrants for offenses committed off hospital campus, such as violating probation. But it doesn’t limit those powers either, said Mazie Lynn Guertin, executive director of the Georgia Association of Criminal Defense Lawyers.
“Unless discretion is limited, it will be exercised at some point, by someone,” she said.
Law enforcement should always be the last resort, argued Kaufman, the trauma surgeon. As the threat of violence is of concern, hospitals can spend more on healthcare staff, strengthen overall training and teach de-escalation techniques.
“Our main focus shouldn’t be that our patients are a danger to us,” she said. “It is a harmful and racist lens. We should develop safe and healthy workplaces in other ways.
KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism on health issues. Along with policy analysis and polls, KHN is one of the three main operating programs of the KFF (Kaiser Family Foundation). KFF is an endowed non-profit organization providing information on health issues to the nation.
