Attacking those trying to help: Healthcare workers face increasing violence

POWELL — In March, a patient objected to being discharged from Powell Valley Healthcare. According to an affidavit, the patient said she didn’t want to go home because she didn’t have shampoo and shoes. The hospital’s nurses accommodated the patient’s needs as best they could, but as a nurse was putting on the patient’s shoes, she began to hit the nurse. The patient continued attacking the nurse, and so the police were called. The patient would eventually hit the responding officer, who took her to jail, which was what the patient said she wanted rather than going home. The nurse who was attacked suffered minor injuries. 
It’s a situation that’s becoming increasingly common. 
With staffing levels stressed and recruitment already difficult in the state, the problem is making the job far less appealing. 
In 2021, the police were called to the PVHC eight times to assist with a patient who was acting violently. By April of this year, police had been called 11 times. “So a huge increase in violence here at our organization,” Arleen Campeau, chief nursing officer for PVHC, said at the board of trustees meeting in June. 
It’s a problem across the state, as well as the nation. 
Representatives of the state’s health care industry, including Campeau, addressed the Wyoming Legislature Judiciary Committee in May to discuss a bill that would enhance penalties for violence against health care workers, in the same way assaults on law enforcement personnel trigger more severe sentences. 
Josh Hannes, vice president of the Wyoming Hospital Association, said members of the organization have been speaking more about this problem and saying it’s becoming more frequent and severe. 
Nationwide, between 2016 and 2020, Hannes noted, there have been 44 workplace homicides against healthcare workers. He added that he wasn’t aware of any of those murders happening in Wyoming. 
Tracy Garcia, vice-president and chief nursing officer at Cheyenne Regional Medical Center, said that between Jan. 1, 2021 and April 15, 2022, the provider had 34 assaults on hospital staff. Another assault was committed by a family member of a patient. 
“Those include verbal abuse, slapping, hitting, scratching, grabbing the head of an employee and slamming it into a door, grabbing staff by the arms and reaching for their throat, punching them in the chest, shoving them against door, kicking them in the chest and face, pulling hair… [and] sexual harassment,” Garcia testified. 
Keith Ungrund, chief clinical officer for Cody Regional Health, argued that hospital staff are obligated to treat patients for emergencies, and that includes people with mental illnesses and those who are under the influence of drugs and alcohol. 
“So healthcare workers have an obligation to treat those patients and not turn them away, and these patients can become very violent,” Ungrund said. 
He told the story of a patient who regained consciousness in an ambulance on the way to the hospital. The patient assaulted a paramedic and a police officer. The patient was charged with a felony for the assault on the officer, but only a misdemeanor for attacking the paramedic. 

 
“I think we’re sending the wrong message. We’re asking them to care for the sick and not turn patients away … but we’re not recognizing the risk they put themselves into,” Ungrund said. 
Some of the committee members, while sympathetic to the problem, questioned whether enhanced penalties were the best way to address it. Garcia had mentioned that these cases of assault aren’t often prosecuted, and it’s sometimes seen as part of the job of caring for people. 
Ember Oaklee, R-Riverton, asked how enhanced penalties would help if these cases aren’t being prosecuted with existing laws. 
“It is illegal to kick someone in the face, currently,” Oaklee said. 
Hannes said that while he agreed more prosecution would help, people serving in health care roles are trying to care for people, which is hard to do in an unsafe environment. 
“There’s value in saying this type of attack is different, and we are not going to tolerate it,” he said. 
Sen. John Kolb, R-Cheyenne, questioned if health care workers and law enforcement personnel can be so easily equated. He also pointed out that since mental illness plays a role in many of these attacks, enhanced penalties against people who aren’t always considering consequences aren’t going to be very effective. 
“What we are looking for is the recognition that violence in health care facilities is rampant,” Hassen countered, “that it detracts from patient care, in an already struggling health care environment in this state.” 
Karlee Provenza, D-Laramie, asked if the penalty enhancement resulted in decreases in violence. Hassen said he didn’t know, but he would research it as the legislature and association worked together to find a way to address the problem. 
Rep. Rachel Williams-Rodriguez, R-Cody, discussed how the committee had taken up the interim topic of bias-motivated crime laws last year, which wasn’t viewed favorably. She pointed out that workers in other institutions — including schools and airports — face the same problem of violence. Those institutions have responded with enhanced security measures and training. 
Campeau said PVHC has been doing that since an incident three years ago in which a person entered the facility after hours and attacked nurses with an IV pole. The hospital has since added an array of security cameras and automatic locks that prevent access at night without being buzzed in. It is also working with the Powell Police Department, but that will only go so far. 
“They’re wonderful. They come when we call, but they tell us they have limited resources,” Campeau said. 
Brian Jones, chief information officer at Billings Clinic, which is affiliated with PVHC, said at the PVHC board meeting that his clinic has been working on the issue for months.
 It has been implementing into the patient records software a way for staff to indicate potentially hostile patients so that when they are transferred between facilities, the staff at the admitting provider can take precautions. 
Scott Shopa, director of facility management for PVHC, has been putting together mock drills and training to help staff respond to “code Armstrong,” which is a call for help with a hostile situation. 
Last month, Shopa coordinated an unannounced mock drill with a hospital employee who played the part of an unruly patient. The drill started as nurses went about their duties. Shopa hadn’t told the two house supervisors who were on duty at the time that he was conducting the exercise. 
“I think they figured it out, as I was watching and they know I do exercises once in a while,” he said. 
The result was the hospital staff was able to identify weaknesses and areas for improvement in how it responds to these situations. Shopa said these policies get reviewed, but they haven’t had a lot of scrutiny since before the COVID pandemic, and with the frequency increasing, it’s a good time for it. 
“I think it was a good learning exercise. It’s good to get back our stride,” Shopa said. He’s currently organizing a classroom training session on responses to an active shooter event. This will involve hospital directors playing out a tabletop simulation. They will take turns making quick decisions on whether to shelter in place, organize an evacuation or possibly confront the assailant. 
Shopa said in the past, law enforcement helped the hospital conduct mock active shooter drills. 
For now, the enhanced security and training is the most available tool for PVHC and other Wyoming providers to address the growing problem of hospital violence. 
“Our providers shouldn’t have to take it,” he said.
 
 
This story was published on July 12, 2022.