Patient Violence: A Different Kind of Pandemic

Frontline healthcare workers are increasingly facing verbal and even physical abuse while on the job, as the COVID-19 pandemic continues to wax and wane.

EDITOR’S NOTE: With today’s article presenting an overview of the issue of healthcare worker abuse, stay tuned to RACmonitor Friday for a special feature in which three of our top contributors offer their thoughts and opinions on the topic.

The chart depicting the seven-day rolling average of new COVID-19 cases in the U.S., maintained continually by the New York Times since last year, looks a bit like a panoramic outline of a sprawling mountain range – the soaring twin peaks of early January 2021 (about 260,000 weekly cases) and mid-September 2021 (about 175,000 cases) being surrounded by smaller hills and valleys. The good news, in the short term, is that the current downhill slope is steep, with the rolling average falling by about half in barely more than a month.

Another metric, however, is headed in the wrong direction.

According to a report by Business Insider published last week, 31 percent of hospital nurses have reported a recent increase in physical violence by patients, up from 22 percent in March 2021.

The anecdotal reports from across the country are nothing short of shocking:

• Dr. Ashley Carvahlo, a physician working in Idaho’s Treasure Valley, told a local television news station that when she refused to prescribe medication not federally approved for human use to treat one unvaccinated patient, a family member told her “I have a lot of ways to get people to do something, and they’re all sitting in my gun safe at home.”
• Karen Garvey, vice president of patient safety and clinical risk management at Parkland Health & Hospital System in Dallas, told The Texas Tribune that confrontations over the last several months have included “people being punched in the chest, having urine thrown on them … verbal abuse, name-calling, racial slurs,” and physical attacks resulting in broken bones and broken noses.
• Cox Medical Center Branson in Missouri recently announced that it was issuing 400 panic buttons for its staff, after patient assaults tripled over the course of a single year.

Kevin Romanchik, an emergency room nurse in Michigan, told Business Insider that even asking some patients a simple question – like whether the patient has received a COVID-19 vaccine – can induce anger and aggression.

The phenomenon is leaving many in the industry scratching their heads – after being lauded as “heroes” in the news media, on lawn signs, and across social media in 2020, healthcare workers now find themselves being demonized, harassed, and attacked by actual patients in 2021.

It could very well boil down to a matter of statistics. As the ranks of those fully vaccinated against COVID-19 soars (currently approaching 200 million individuals, or nearly 60 percent of the country), the unvaccinated population is being disproportionately impacted by the virus, putting such individuals in increased contact with healthcare workers. And with that population more prone to being negatively impacted by misinformation about medical topics, this means interacting directly with professionals whose advice and guidance can fly in the face of that misinformation.

A massive recent study appears to support that notion – a whopping 600,000 COVID-19 cases in 13 states, arising from April through mid-July, were scrutinized for it. The study found that those who were unvaccinated were 4.5 times more likely than the fully vaccinated to get infected, over 10 times more likely to be hospitalized, and 11 times more likely to die, according to the Centers for Disease Control and Prevention.

Yet it’s important to note that healthcare worker abuse isn’t a new issue – it’s just a worsening one. Before the pandemic began, hospital employees in the U.S. were reported to be nearly six times as likely as the average worker to be the victim of an intentional injury, according to the Bureau of Labor Statistics. Hospitals recorded more than 221,000 work-related injuries in all in 2019, according to the U.S. Occupational Safety and Health Administration (OSHA), with a workplace injury rate almost double the average for all private employers.

In April 2020, the month after the pandemic began in earnest, Reuters reported that the World Health Organization (WHO) identified a priority for “authorities (to) protect nurses and other health workers from harassment and attacks, compounding the already heavy toll they are paying in the pandemic.” The world’s 28 million nurses, accounting for nearly 6 in 10 of all health workers, were overstretched before the crisis began, according to the WHO, which contributed to creating the first-ever “State of the World’s Nursing Report”.

David M. Glaser, a shareholder in Fredrikson & Byron’s Health Law Group, recently tackled the issue in an article published on RACmonitor.

“I’ve had more conversations in the last few months about this problem than in the prior 29 years of my career about patients who are belligerent, yelling, screaming and threatening staff,” Glaser wrote. “Medical professionals are already overworked – now they are scared.” 

Glaser’s advice for providers concerned about the issue is to focus on legal responsibilities.

“You certainly have a duty to your staff to make sure they’re safe; that responsibility extends to everyone in the building. And of course, you have a duty to your patients, including the obnoxious ones,” Glaser wrote. “In particular, you need to be sure that their poor behavior is not a result of a health issue. And that’s why my first tip with any inappropriately behaving patients is to confirm that the issue isn’t medical. If you have a policy discussing aggressive patients, the first bullet point should be ‘evaluate the patient.’” 

If the patient is having a mental health crisis, or is delusional or is hypoglycemic, addressing the medical condition may mitigate the bad behavior, Glaser noted.

“But the unfortunate reality right now is that many of these aggressively behaving patients are simply angry,” he added. “Can you terminate the relationship of a patient for behaving badly? Can you discharge them from the hospital? The answer will depend largely on the setting, and the patient’s overall condition.”

In an emergency room, federal statute mandating care provision makes it “nearly impossible” to send a patient away for being difficult or violent, Glaser noted. But the calculus changes in a clinical setting.

“If the patient’s behavior is bad enough, it may be worth taking the risk that the patient will complain to a medical board or bring a malpractice action,” he said.