Hospitals Tracking Physical, Verbal Assaults on Healthcare Personnel

(TNS) A seasoned emergency room physician remembers a patient storming off after being refused narcotics for back pain that supposedly made walking difficult.

"The patient jumped off the bed (and) got right in my face," said Dr. Jay Falk, an emergency room physician at Orlando Regional Medical Center.

The patient was a drug seeker who threatened to complain to hospital administrators.

Physical and verbal assaults are ever present in emergency rooms and elsewhere in hospitals. State legislatures are being pressed to pass tougher penalties for violence against health care workers.

Georgia and Utah became the latest states this spring to act, according to the Emergency Nurses Association, based in the Chicago area. Eighteen states have taken steps since 2012 to toughen penalties, and another dozen are looking at measures. Florida is not included, according to the group.

Nearly 56 percent of emergency room nurses in recent surveys said they faced physical or verbal violence in the prior week, said Lisa Wolf, director of research with the nurses group. Historically, they are reluctant to report it or press charges, she said.

The assumption is that dealing with combative patients is part of the job. That's a mindset that needs to change, especially among hospital leadership in light of one-third of emergency room nurses considering a switch to a less risky environment, Wolf said.

The potential for an enormous amount of experience and expertise to walk out the door is pretty significant, she said.

More than 75 percent of emergency room physicians experience at least one incident of violence each year, Falk said. He is incoming president of the Florida College of Emergency Physicians.

Combative patients are not just intoxicated or drug seekers but include older patients with dementia, people with psychiatric disorders, and people angry over long waits, he said. Uninsured patients also believe physicians and nurses don't want to treat them, he said.

So far the Florida chapter of emergency physicians has not approached the state Legislature about tougher penalties against violent patients or family members, Falk said.

Hospitals are reluctant for the public to learn about violence in emergency rooms out of concern patients won't seek care when they need it, he said.

There's also potential backlash to emergency department staff when negative patient satisfaction surveys are submitted by patients who faced long waits or from drug seekers who get sent away empty-handed, he said,

"Some of these people are very creative and very manipulative," he said. "And there's a huge number of patients caught in the middle, and it is heartbreaking for the guy in chronic pain."

The Florida Hospital Association doesn't have current data on violence in hospitals but is starting to collect it, coupled with broader information about injuries for a safety campaign, said Martha DeCastro, vice president for nursing.

She disagrees that hospital administrators are more focused on positive patient satisfaction surveys over the judgment of emergency room staff when it comes drug seekers or other combative patients.

"I've never heard any practitioner was pressured in any way to provide a drug not in the best interest of the patient," she said. "They are focused on patients having a satisfying experience, but it wouldn't be at the expense of their overall care."

Dr. Eliot Goldner, an emergency room physician with the Lee Memorial Health System, a publicly operated system in Lee County, said combative patients take a toll on staff and mean resources are directed at problem patients and away from others.

In March the health system's security department started using better software for tracking physical and verbal confrontations, Mary Briggs, the system spokeswoman said. Since March through late June, 99 incidents have been logged at the system's four emergency rooms treating adults.

"I think we see it on a daily basis but not always for the same reason," Goldner said. "I think it is something you always keep in the back of your mind and the (safety) of the department."

Drug seekers hoping to get pain drugs feel if they create a scene, the emergency room doctor may give the narcotics to get them out the door, he said.

When Florida created a prescription database as part of a crackdown on pill mills in 2010, the database became a resource to recognize drug seekers and enables the staff to have a conversation with these individuals about treatment, Goldner said. Some pill abusers simply leave and others will ask where to get help, he said.

The pill mill crackdown likely means more drug seekers go to the emergency room due to reduced street availability of pills, and that situation runs head on to the drug database and doctors being able to identify drug seekers, Falk said. In turn, they get turned down and become angry.

The emergency nurses group has found 5 percent of prescriptions for narcotics are written by emergency room physicians, and there is a big push to not write them, Wolf said.

"It is usually the nurse who delivers the news 'You are not getting the prescription,' " she said. "This is worrisome; the nurses, they are in front of them."

At the NCH Healthcare System in Collier County, emergency rooms historically were not reporting physical or verbal confrontations with combative patients, said Betsy Novakovich, director of emergency services.

"We realize we were somewhat deficient in collecting that data," she said.

The data is collected now and helps with training staff hospitalwide how to recognize signs of potentially combative patients, said John Griffith, NCH director of security.

Still, the emergency room is not the place with the most combative patients; incidents are reported everywhere, and there is no pattern, Griffith said. Last year there were 221 calls for security combined at NCH's two hospitals.

When it comes to drug seekers, the emergency room department has to remember addiction is a disease, Novakovich said. On the issue of patient satisfaction surveys, some may be filled out by drug seekers, but anyone can fill out the forms.

"You want that patient to be safe and sometimes to be safe is not what they want," she said. "Physicians are in a tough spot making those decisions."

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