Kan. hospital officials urge action to deter patient, visitor violence

By TIM CARPENTER
Kansas Reflector

OVERLAND PARK — Hospital administrator Alan Verrill recalled the horror of a patient delivering a knock-out punch to a nurse who fractured her skull falling to the floor.

The nurse was wheeled directly from the offending patient’s room to the hospital’s intensive care unit. She went through six months of rehabilitation, but didn’t return to bedside nursing.

Verrill, chief executive officer of Advent Health South in Overland Park, also recalled working in a Colorado hospital when someone pulled the trigger on a gun while inside the emergency department. The bullet lodged in the ceiling and no one was injured.

Both examples, he said, pointed to precarious challenges of human interaction in medical facilities that at times led to violence by patients and visitors targeting health professionals. The problem has escalated in recent years, he said, despite introduction of staff training in de-escalation strategies, key-coded entrances, panic buttons, bulletproof glass, metal detectors, deployment of additional security personnel and adoption of zero-tolerance policies for misconduct.

“Yes, we’re having it happen here,” Verrill said. “Even the most state-of-art security that you can put into a building, it doesn’t mitigate. Decisively, this is not a new problem. We’ve seen a significant acceleration both in the amount of violence … and then the degree of violence.”

Verrill and representatives of Saint Luke’s Health System, the University of Kansas Health System, Children’s Mercy Hospital and three Kansas law enforcement organizations came together Wednesday to urge the Kansas Legislature to approve a bill creating new crimes of interfering with a health care worker. It would be modeled on comparable law protecting on-the-job emergency medical service employees, law enforcement officers and firefighters.

The informal coalition also requested Kansas lawmakers increase the sentence for battery of a health care provider, a concept House and Senate negotiators appear to have accepted. It’s not clear the interference measure has enough traction to survive final days of the 2023 session, which resumes next Wednesday.

“Legislation sends a strong signal that we take this seriously,” Verrill said. “If we choose not to, what signal does that send?”

Inside the numbers

The group of health professionals agreed violence in hospitals against nurses, doctors and other staff had risen over the past decade. The result has been a rise in physical and mental harm to employees and disruption of patient medical care. It has exacerbated hiring and retention issues as health professionals changed career paths.

“This is something very near and dear to me because I see staff members every day struggling with trying to provide excellent care in an atmosphere they shouldn’t have to work in,” said Kristi McGowin, senior director of emergency services at Children’s Mercy. “We’ve got to show these nurses and physicians that we care about their safety.”

The U.S. Occupational and Safety and Health Administration says health care workers account for 50% of all victims of workplace violence. The federal Bureau of Labor Statistics said violent attacks against medical professionals grew 67% from 2011 to 2018, while health care personnel were five times more likely to experience workplace violence than people in other industries.

The American Nurses Association indicated one in four nurses had been assaulted at work. A Kansas Hospital Association survey indicated 13% of hospitals in the state reported physical violence multiple times each week, 21% reported incidents multiple times each month and 46% reported more than one incident per year.

Putting a finer point on the issue, Ascension Via Christi in Wichita reported 378 episodes of violence from January 2022 to November 2022. Advent Health in Shawnee Mission said the hospital experienced nine intentional, non-medical workplace violence incidents per month. KU Health System facilities in the Kansas City area documented 353 physical assaults in the 2022 fiscal year and 292 physical assaults in the fiscal year 2023.

At NMC Health in Newton, a gun was flashed at employees while a nurse was securing an infant car seat in the family’s vehicle. Stormont Vail Health in Topeka said an assailant who violently attacked a nurse was charged with a misdemeanor and released 17 hours after the assault.

‘Complicated environments’

Elijah Thompson, director of physical security at Saint Luke’s Health System, said violent episodes in 2023 would outpace transgressions in 2020, 2021 and 2022.

“Hospitals are complicated environments,” Thompson said. “They’re already filled with a lot of emotions. We always say some of the best parts of life and some of the worst parts of life all happen under our roof, and we’re looking at the best way to manage all of that.”

He said health professionals understood the obligation to examine and treat appropriately people walking through hospital doors. There was a high level of empathy and commitment for individuals admitted or visiting a hospital who could be dealing with dementia, mental illness, substance abuse, trauma and anger issues, he said.

Meanwhile, he said, Saint Luke’s employees had recently suffered concussions, cuts, dislocations and bite wounds performing those duties.

“We’re very sensitive to the fact that we want to be able to provide for these patients in a safe environment,” Thompson said. “The same time, you know, we need some level of protection for our staff as well. This is absolutely the right thing to do for our staff in the health care industry. I can also make a very strong argument this is the best thing to do for patient care.”

Ed Klumpp, a retired chief of the Topeka Police Department and a Statehouse lobbyist for three law enforcement organizations, said proposals to amplify criminal penalties for violence against Kansas health workers had been proposed as early as 2015.

“Everybody thinks our problems are COVID related, and they really were happening way before that,” Klumpp said. “This has been going around for quite some time. It’s time something happened.”

Aggravating staff shortages

The issue of violence in hospitals contributed to burnout among staff who struggle against disruptive patients and visitors, said Heidi Boehm, program manager for enterprise initiatives at KU Health Systems. There is a public interest in putting in place a criminal statute to deter improper behavior in hospitals, she said.

“I do agree that this legislation would send a message to our staff that they’re cared about, they matter, they’re seen and that we as a state want to keep them safe,” Boehm said. “We just want these additional protections. We’ve been asking for them for years now. This is taking a tremendous toll on our health care workers. They’re leaving the profession.”

There are more than 1,000 vacant nursing jobs in the Kansas City market, and instances in which employees were harmed don’t contribute to a sense of security for existing and prospective employees.

Boehm said statistics on violence against hospital staff were likely underreported because there were times nurses and other health care workers decided not to file a complaint. Some conclude the injury wasn’t serious enough or that some level of violence was part of the job, she said.

“We’re really trying to shift the culture away from that,” Boehm said.

Klumpp, who works on behalf of the Kansas Association of Chiefs of Police, the Kansas Peace Officers Association and the Kansas Sheriffs’ Association, said pending legislation at the Capitol would require charges filed in a case of battery against health workers to be documented separately from other battery cases.

He urged hospital administrators to meet with sheriffs, police chiefs and prosecutors to use data to make them aware of the severity of the problem in health facilities.

“Above all,” Klumpp said, “they (incidents) need to be reported, and we encourage that. That is the first step in the process. If you don’t report it to police, it isn’t going anywhere.”