by ELENA DURNBAUGH
In May, a patient with a history of substance abuse came into the emergency room at Troy Beaumont. The hospital did not give her any narcotics, and the patient demanded a private room. No private room was available, so she became angry and physically lashed out at a pregnant nurse.
“We were not giving her what she wanted, and she out-and-out, closed-fist punched this pregnant woman – this pregnant nurse – in the belly,” according to Beaumont ER Nurse Naomi Ishioka.
The nurse, who was 38 weeks pregnant, was taken up to labor and delivery. Fortunately, the baby was not hurt. The charge nurse on duty during the incident was also assaulted by the same patient. That nurse had to be seen in the emergency room.
The police were called and charges were filed, but the patient was not removed from the ER.
“She didn’t get taken out in handcuffs. She got to stay in the ER,” Ishioka said.
Under federal law, if someone believes they have a medical emergency and shows up at an ER, they cannot be turned away.
Ishioka said that the hospital frequently calls the police, but the cases rarely go any further than filing charges. She said that some officers have discouraged staff members from filing charges because they “wouldn’t stick.”
The Michigan Emergency Nurses Association is working to pass legislation to provide greater protection for Emergency Room personnel. Senate Bill 80 and House Bill 4327 seek to increase the penalties for assaulting healthcare workers.
A History of Violence
In another incident in May, a patient came into the emergency room at Troy Beaumont Hospital, angry and seeking narcotics. The man had a history of assaulting and injuring ER staff and was becoming increasingly agitated, according to Ishioka who witnessed the scene.
Hospital staff stepped in to deescalate the situation and warned the patient that if he did anything to threaten them, hospital security and the police would be called, but he did not back down.
“This guy literally goes, ‘Well, nothing ever sticks because I was intoxicated last time, and I’m intoxicated this time,” Ishioka said. “When that guy said ‘Call the police, nothing will stick,’ it made me angry.”
Under current Michigan law, assaulting an ER worker is a misdemeanor, just like assaulting a teacher, restaurant worker, or other professional. However, there are often fewer repercussions for people who assault ER workers because they are patients seeking care and prosecutors don’t bring charges against them. Nurses also don’t have the option to turn patients away, even if they have a history of violence against hospital staff.
Legislation Aims To Increase Penalties for Assaulting Hospital ER Staff
This isn’t the first time bills to protect nurses have come before the state legislature.
Similar bills have been brought before the House and the Senate, including four House bills just last year, and four in the Senate since 2013. None of the bills were signed into law, and in fact, only two Senate bills ever made it out of committee, both of which died in committee after being passed over to the House.
Democratic Sen. Mallory McMorrow, who represents Troy, is a cosigner on SB 80.
“Troy Beaumont is the number one employer in my district, and after having gotten to know a number of nurses and medical professionals, I think it’s been pretty shocking to me that assault and violence against medical employees – nurses, doctors, and particularly emergency room personnel – is on the rise,” she said. “This is an issue that has come up numerous times… Every year that we do nothing… it’s just getting worse.”
Sen. McMorrow said that she hoped the Senate bill would get a hearing this year, but that decision was up to the committee chairperson, Lucido.
Republican Sen. Peter Lucido, who represents Michigan’s 8th district, is the Chairman of the Senate Judiciary and Public Safety Committee this session. He is also a cosigner on SB 80.
Lucido said one of the challenges for passing bills like this is the volume of legislation committees have to review.
“You’ve got almost half the bills coming through Judiciary and Public Safety, so we’ve got to be very concerned on which ones we need right away. The fact that we already have laws on assault, that is telling me we’ve got something in place,” he said.
For this bill, Lucido wanted to hear discussion in committee to determine whether it was a good idea to increase penalties for assaulting a nurse.
“I don’t have a problem stiffening penalties for people who are trying to take advantage of those who are trying to make us better,” Lucido said. “Stiffening penalties doesn’t mean giving carve-outs, and here’s why. Will we sit there having carve-outs for everything? What are we going to go to next, gas station attendants?
“I mean, they’re just trying to do their job. At the end of the day, we’ve got to weigh what’s in the best interest of the citizens in light of our laws, and we want to protect those that have jobs that are dealing with the public.”
Lucido: Change Could Be “Too Broad”
Other emergency responders are more protected. In Michigan, it is a felony to “assault, batter, injure, resist, or endanger a law enforcement officer, firefighter, or emergency medical service worker.”
Lucido was concerned that a law protecting nurses or medical personnel could be too broad.
“At the end of the day, do we carve out the entire medical profession, and then do we carve out in the office of medical professions? I mean, we’re talking about a big lift here as far as the dialogue is going to be concerned. See, how many cases do we have where medical personnel have been assaulted? We’ve got to look at how many people are affected by this and are getting assaulted out there,” he said.
The Violence Is Getting More Frequent, More Severe
According to the most recent data from the Bureau of Labor Statistics, violence experienced by registered nurses is at a five-year high. For every 10,000 full-time RNs, there were 8.8 cases of intentional injury caused by another person. The national average for all occupations in 2017 was 1.9, and for EMTs and paramedics, the rate was 7.6. According to statistics from the Emergency Nurses Association, one in five healthcare workers is assaulted while on the job every day.
Naomi Ishioka, an ER nurse and past president of the Michigan Emergency Nurses Association, said this is the third legislative session where she’s worked to get a workplace violence bill to protect ER nurses signed into law.
“Violence is getting a lot worse in emergency rooms around the country, not just in Michigan,” Ishioka said.
“We bear the brunt of that every single day. It’s worse this year than it was last year. It was worse last year than it was the year before. And not just in the number of incidents, but in severity as well.”
Multiple factors contribute to the increase in violence, according to Ishioka. One reason is that it’s more difficult for people to use the system to abuse prescription drugs. Hospitals now have wider access to a patient’s medical records, allowing staff to see what prescriptions a person has been given, where they got them filled, and when. If staff refuses to fill a prescription because they suspect abuse, the patient may become violent. Ishioka said that she has noticed a correlation between the rise of the opioid crisis and the increase in ER violence.
Overcrowding is another contributing factor. According to Ishioka, more and more people are turning to emergency rooms for non-emergency care. The ER is also treating more psychiatric patients. Ishioka said these patients are often brought to the ER because there aren’t enough beds for psychiatric patients in the state. Finally, general practitioners will often refer anxious patients to the ER for treatment if they aren’t available.
More people coming to the emergency room means longer wait times. This can lead to people getting impatient and reacting violently.
The proposed legislation isn’t aimed at solving the underlying causes of violence, but Ishioka said that people are working to solve problems at other levels.
“There’s a lot of different groups working on the different pieces. In the meantime, there are nurses that are getting hurt,” she said.
Even When Charges Are Filed, Prosecutors Do Not Prosecute
“A lot of time these cases literally are thrown out, or they don’t go anywhere,” Ishioka said. “We love the police officers, don’t get me wrong. We have a lot of respect for them. We have a very good working relationship with the police – and I don’t think it’s necessarily the police. I feel like it’s just not taken seriously.”
According to the Troy Police Department, officers have been called to Troy Beaumont 197 times since July of 2018, though that number does not factor in what triggered the call.
Troy Police Sergeant Meghan Lehman said that the department responds to calls at the hospital like anywhere else.
“If anything, we would take it more seriously. This is someone trying to do their job,” she said. “It being in a hospital, it’s an even bigger public safety issue.”
According to Lehman, the police are responsible for taking the report and investigating to see if a crime has occurred. It is not a department practice or policy to discourage anyone from filing charges, she said. After police conduct an investigation, the case is turned over to a prosecutor and is out of their hands.
Sen. Lucido said that assault cases had to be viewed on an individual basis.
“Every assault has an intent. You have to look at the intent,” he said. “And if a person lacked the mental capacity at the time of the assault, that’s a defense, and it could be thrown out… That’s going to be a factor in the discussion, and I will be asking that question. What happens if they lack the mental intent? How do you handle that?”
Despite the legal challenges, Lucido said he thought the bill was important.
“I have a true appreciation for nurses, I think they are God’s gift to humans,” he said. “Do I think they should be assaulted? Hell no… These are individuals that are out to make the public better.”
Some Nurses Are Leaving The Field Altogether
As violence continues to rise, more nurses are leaving the field. According to a study done by Montana State University published in 2015, the number of nurses leaving the field each year has been growing steadily, from around 40,000 in 2010 to a projected 80,000 by 2020. The same study found that nearly 40% of RNs are over the age of 50.
Ishioka said she hoped that more awareness would lead to legislative action.
“We just want the same protection that is afforded to other people… but because it’s a pregnant nurse who gets punched in the belly, somehow it’s part of our job. Somehow it’s part of our job to get injured.”
Sen. McMorrow said that she hoped the bill would be heard by the committee this session.
“Far and away, I hope we get a committee hearing,” she said. “My advice back to anybody in the field is to send letters to their representative, their senators, the committee chair, so that we can hopefully get a hearing in committee.”
To learn more about the violence faced by emergency nurses, visit ENA.org/.
To contact Sen. Mallory McMorrow, call (517) 373-2523 or email firstname.lastname@example.org.
To contact Sen. Peter Lucido, call (517) 373-7670 or email SenPLucido@senate.michigan.gov.