番茄社区

Mark Boucot has his signs ready.

"The signs that will be hung around my facility [will] say 'It is a federal crime to commit a violent act against a healthcare worker,' and I am just waiting to hang the signs," Boucot, president of the Potomac Valley Hospital in Keyser, West Virginia, said Wednesday at a press conference held by the American Hospital Association (AHA) and the American College of Emergency Physicians (ACEP). "So help me hang my signs."

All About the SAVE Act

Boucot was one of several speakers calling on Congress to pass the , or the SAVE Act, which would make it a federal crime punishable by up to 20 years in prison to physically assault a healthcare worker. The legislation includes exceptions for those with physical, mental, or intellectual disabilities. It also would require the Government Accountability Office to conduct a study on the law's effectiveness.

"All we're asking for is the same protections that workers in aircraft industries and workers at the airports [have] ... The violence they may [experience] -- they're able to basically say, 'We have a federal law that protects us,'" said Sen. Joe Manchin (I-W.Va.), the chief sponsor of the bill in the Senate, who attended the press conference. "That's all we're asking for -- the same federal protections that other industries have."

"I want to make sure that you live in a safe environment, you work in a safe environment, and you go to the comfort of your home knowing that you're protected at work and providing for your families," Manchin said. The bill would not usurp any state laws on this issue, but instead "we're saying you have to have at least this minimum protection."

He noted that even with a very politically divided Congress, "we have overwhelmingly bipartisan support" for the bill, which currently has five Senate cosponsors -- three Republicans, one Democrat, and one independent who caucuses with the Democrats. The of the bill, introduced by Rep. Larry Bucshon, MD (R-Ind.) has 117 cosponsors; it also would provide grants for training hospital staff on violence prevention measures and for buying equipment such as video cameras and metal detectors. Both bills are in the early stages and haven't yet been considered by any House or Senate committees.

Effects of the Violence

The number of physicians choosing to specialize in emergency medicine has been declining because of problems leading to burnout, including workplace violence, said James Phillips, MD, an emergency physician in Washington who represented ACEP. "Violence in healthcare exists in all the different specialties and all different locations -- inpatient, outpatient -- but certainly in the emergency department we're the epicenter of the violence," he said.

"When I'm seeing patients in emergency rooms, it's because they're having the worst day of their lives -- something so bad that they had to come to the emergency department. And we're very empathetic and sympathetic to that," Phillips said. "And rarely, patients are having such a bad day that it gets taken out on the people that are there to try to help them."

Phillips said that he himself "has been the victim of violence numerous times. I've had felony charges pressed against two patients." In one instance, while working in Chicago, "this gentleman ... had known hepatitis C and decided to spit a mouthful of blood into my eyes," he said. "I had to get tested for 6 months. I could have gotten hepatitis C, liver disease, cancer -- fortunately, I didn't. That happened in front of the police, and no one even blinked an eye."

And when he was training in Boston, "a patient got tired of waiting and hit me in the face with an iPhone," Phillips continued. "If it happened in this building, the police would get called, but in medicine you have to move on ... and you also have to care for that person."

Meth Makes It Worse

The problem has gotten worse with the increased abuse of methamphetamine, said Boucot. "Drugs like that make patients more elevated, and so we're seeing more and more patients come into the organization with these types of challenges," he said. "On Monday night of this week, my [nurse] on the [medical/surgical] unit left their shift with a black eye. So for the next 2½ weeks, our hospital has to explain to everyone how [the nurse] got a black eye because they were actually caring for somebody that was sick. Doing any other thing, you wouldn't expect to go to work and walk away with a black eye or punched nose or to be beaten or to have urine thrown on you."

Current efforts to prosecute healthcare workplace violence are insufficient, said Chad Golder, general counsel for the AHA. "What's going on in the states is not enough," he said. "Many states have increased penalties in recent years, but the problem is still ongoing and getting worse. A federal solution will provide a deterrent."

Asked by 番茄社区 whether he thought having a federal law would encourage police officers to take these incidents more seriously, Phillips said he thought it would. "When you're a police officer, there's a difference between responding to a call that is a nuisance and something that is a much higher charge," he said.

Golder agreed. "Currently, as the law stands, it's a patchwork -- there are 50 states with 50 different laws, and within each state there are dozens of police departments and dozens of district attorneys' offices," he said. "If there's a federal law, the buck stops with the Attorney General and individual U.S. attorneys. So if a particular hospital is facing a spate of violence, they can send the CEO in with a single individual -- a U.S. attorney or the Attorney General -- and say, 'We really need to enforce this. This is a problem.' So just the ability to get a centralized place of attention, we think, will improve the ability to have something like that enforced."

While they await the bill's fate, hospitals are training their workers on how to address the problem. At Indiana University Health West Hospital, in Avon, Indiana, the hospital has created a program called "Handle With Care," said Rachel Culpepper, DNP, RN, the hospital's general medicine service line director. "We teach bedside clinicians -- nurses, [physician assistants], physicians -- how to help de-escalate a situation, how to identify [that a situation] is becoming escalated, and how to defend themselves, if needed."

Boucot said that two hospitals he runs have created a workplace violence task force "to educate people that [violence] shouldn't be an accepted part of the work you do. We have to ... get our [care] teams to realize this is a problem, and have me as leader to stand up and say, 'We're not taking that anymore.' I have to prosecute people that are of sound mind that commit workplace violence against a healthcare worker. It's a valuable thing to say it's not OK."

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