As More Hospitals Create Police Forces, Critics Warn of Pitfalls

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Yves here. This development is yet another sign of social breakdown in the US. However, this article fails to examine why attacks on hospital staff are increasing. Is it more substance abuse? More mental health issues (and potentially interruptions in medication triggering them)? Is it failure to provide ER care in what is perceived to be soon enough (rumor has it that private equity, which controls ER staffing in most hospitals in the US, has been cutting staffing in an apparent bid to increase wait times to the degree that hospitals are relieved of their universal service obligation)? Or inexcusable care lapses? One time, when my mother was hospitalized, she came back with bruises all over her, which the hospital implausibly insisted she inflicted on herself. Another time, it took 20 minutes to get her water (there was no cup in her room, otherwise I would have done it) even with a nursing station right there and no one busy.

By Renuka Rayasam, KFF Health News Senior Correspondent. Previously she worked for Politico, the Austin American-Statesman and U.S. News & World Report, and before that freelanced for The New Yorker, The Atlantic, the Los Angeles Times and The Wall Street Journal. Originally published at KFF Health News

When Destiny heard screams, she raced to a hospital room where she saw a patient assaulting a care technician. As a charge nurse at Northeast Georgia Health System, she was trained to de-escalate violent situations.

But that day in spring 2021, as Destiny intervened, for several minutes the patient punched, kicked, and bit her. And by the time a team of security guards and other nurses could free her, the patient had ripped out chunks of Destiny’s hair.

“We are not protected on our floors,” she said as she recapped the story during testimony later that year to the Georgia Senate Study Committee on Violence Against Healthcare Workers. Destiny used only her first name at the hearing, for fear of retaliation for speaking out against the patient who assaulted her.

In May, Republican Gov. Brian Kemp signed a law that boosts criminal penalties for assaults against hospital workers and allows health care facilities in the state to create independent police forces. The law is a response to that testimony as well as hospital lobbying and data documenting a rise in violence against health care workers. In enacting the law, Georgia joined other states attempting to reverse a rise in violence over the last several years through stiffer criminal penalties and enhanced law enforcement.

Nearly 40 states have laws that establish or increase penalties for assaults on health care workers, according to the American Nurses Association. And lawmakers in 29 states have approved or are working on similar laws, as well as ones that allow the creation of hospital police forces. Members of those forces can carry firearms and make arrests. In addition, they have higher training requirements than noncertified officers such as security guards, according to the International Association for Healthcare Security and Safety.

Groups representing nurses and hospitals argue that such laws address the daily reality of aggressive or agitated patients who sometimes become violent. Still, such interventions are relatively new. Critics worry that establishing hospital police forces will escalate violence in health care settings and could have downstream effects.

“I worry about all the reasons patients have to not trust me and trust the health care system,” said Elinore Kaufman, a trauma surgeon at the University of Pennsylvania.

Health care workers are five times as likely to experience violence as employees in other industries, according to federal data. The day after Kemp signed the Safer Hospitals Act into law, a person opened fire in a midtown Atlanta medical office, killing one woman and injuring four others, including workers at the medical practice.

Verbal and physical threats, which increased during the pandemic, are exacerbating a dire nursing shortage, said Matt Caseman, CEO of the Georgia Nurses Association. Destiny testified that one of her co-workers left nursing after the 2021 assault, in which the patient smashed the care technician’s face into a wall and the floor. Destiny also suffered from post-concussion headaches for months, she said.

The Centers for Medicare & Medicaid Services noted the alarming rise of violence in health care settings last November. The federal agency recommended hospitals implement a patient risk assessment strategy, increase staffing levels, and improve training and education for staffers. There was no mention of boosting law enforcement presence.

Health centers say they are better able to retain workers and improve patient care when they can reduce the number of violent incidents, said Mike Hodges, secretary of the Georgia chapter of the International Association for Healthcare Security and Safety. State laws governing how hospitals can respond to violence vary.

In Georgia, the new law boosts criminal penalties for aggravated assaults against all health care workers on a hospital campus, not just those in emergency rooms, which were already regulated. And hospitals can now establish law enforcement offices like those on university campuses. The officers must be certified by the Georgia Peace Officer Standards and Training Council and maintain law enforcement records that can be made public.

Having a dedicated police force helps hospitals better train officers to work in a health care setting, said Republican State Rep. Matt Reeves, who co-sponsored the Georgia bill. Officers can get to know staff members and regular patients, as well as the layout and protocols of hospital campuses. “If you have a specialized police department, they are more in tune with the needs of the facility,” he said.

That’s the case at Atrium Health Navicent, which operates hospitals across central Georgia, said Delvecchio Finley, its president. The health system was one of a handful to staff certified law enforcement before the new law.

Atrium Health recruits officers who reflect the diversity of the community, conducts training to counteract implicit biases, and holds debriefings after any incidents, Finley said. Officers are trained to react when someone becomes violent at one of the facilities.

“The biggest thing for us to convey to officers is that they are in the setting where we provide a safe environment where we care for anyone,” he said.

Unlike other businesses, hospitals can’t merely throw out patients who misbehave, said Terri Sullivan, an emergency nurse in Atlanta. A patient once punched her in the chest, fracturing two ribs, before running out of the room and trying to punch his physician. Sullivan said that, in her experience, the presence of hospital security can prevent patients from acting out.

Still, little data exists on whether such forces are effective at preventing hospital violence. Ji Seon Song, a University of California-Irvine law professor who studies policing in health care settings, worries about the “unintended consequences” of legislation that boosts the presence of law enforcement in places people receive medical care.

“You can see where there might be a lot of problems,” she said, “especially if the patient is African American, undocumented, Latino — something that makes them prone to being criminalized.”

A ProPublica investigation found Cleveland Clinic’s private police force disproportionately charges and cites Black people. And in March, a video emergedshowing police and hospital staff members in Virginia holding down a patient who was experiencing a mental health crisis, leading to his death. In 23% of emergency department shootings from 2000 to 2011, the perpetrator took a gun from a security officer, according to a Johns Hopkins University study. The CMS memo noted several hospital incidents involving police, in which the agency cited the facility for failing to provide a safe environment.

The Georgia law doesn’t require hospital police officers to arrest patients with outstanding warrants for offenses that occurred off a hospital campus, such as violating probation. But it doesn’t limit those powers either, said Mazie Lynn Guertin, executive director of the Georgia Association of Criminal Defense Lawyers.

“Unless discretion is limited, it will be exercised at some point, by someone,” she said.

Law enforcement should always be the last resort, argued Kaufman, the trauma surgeon. While the threat of violence is concerning, hospitals can spend more on health care staffing, boost overall training, and teach de-escalation skills.

“Our primary lens shouldn’t be that our patients are a danger to us,” she said. “It’s a harmful lens and a racist one. We should develop safe and healthy workplaces through other ways.”

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  1. Gregory Etchason

    When I practiced medicine I used to say “try not to piss off the people trying to help you.”
    Trump released tantric bullying and violence to an already pathological individualism.

  2. Donnish

    I’ve worked as an ICU nurse for 12 years. I was attacked every weekend I work. I’ve been bit, chocked, punched, spit on and kicked. Some were sundowning, others in ICU delirium, some were just plain mean. That trauma surgeon can shove it, she’s not the one getting hurt all the time, they barely even see patients in the hospital setting. They swan in for 2 minutes then never come back. I’ve seen a patient knock a nurse to the floor then start slamming the door on her head, and no one came. We almost always had to handle this ourselves because theres no security around. So the vast majority of nurses and techs will be 100% behind having security that’s able to deal with hostile and violent patients. And this isn’t new, it’s something we’ve all dealt with for years. Covid made it worse, but it’s always been a violent workplace.

  3. Rip Van Winkle

    Advocate Christ Medical Center on 95th Street just outside of Chicago is a happening place on the weekends. Rival fans of the some of the incoming patients have been known to attempt to settle their differences outside and inside the ER receiving area.

    When this occurs the hospital goes on ‘bypass’, not necessarily because they are full up, but to shunt the ambulances with the old goats with heart attacks and stokes to more distant hospitals.

  4. jackiebass63

    My wife has had to go to the emergency room several times. Most of the times it was in the evening. It is quite an eye opening experience.In every case she had to be admitted to the hospital.From arriving to being admitted took 10 hrs. or longer.Most of the time is spent waiting for care or someone to make a decision.Private insurance doesn’t help the process because they require prior approval.At most times they are understaffed. Probably because the emergency room is run by a private contracted corporation. I live in a county with two prisons. There are always shackled prisoners waiting for treatment. It ends up being a very stressful experience.

    1. DorothyT

      (Re: admitting his wife to ER) From arriving to being admitted took 10 hrs. or longer.Most of the time is spent waiting for care or someone to make a decision.Private insurance doesn’t help the process because they require prior approval.At most times they are understaffed. Probably because the emergency room is run by a private contracted corporation.

      Why would it be a ‘cost savings’ to create a hospital-based police dept. rather than proper patient staffing? 40% of ER rooms are said to be owned-and-or-managed by ‘Private Equity.’ Recommend reading “These Are the Plunderers: How Private Equity Runs — and Wrecks — America” (recently published, authors Gretchen Morgenson and Joshua Rosner). Their research and reporting exposes damage by PE in many industries, not only healthcare where it is so nakedly exposed.

    2. Brunches with Cats

      > From arriving to being admitted took 10 hrs. or longer.Most of the time is spent waiting for care or someone to make a decision.

      I had a medical emergency in October 2021, 19+ hours in the ER.

      When the ambulance dropped me off, there were no ER beds available. So dizzy that I couldn’t sit up straight, I sat hunched over in a wheelchair, hands braced on the footrest, for 3+ hours. When I finally did get a bed, it had one flat sheet, too small to cover the cold, hard vinyl, no pillow. Around midnight — just short of 7 hours since arriving at the ER — a doctor came in to say I was being admitted for further testing but had to wait for an available inpatient bed. She got all huffy when I asked how long that would be.

      Maybe an hour later, a nurse hooked me up to a blood pressure monitor, with a cuff that inflated every 15 minutes. She left without turning out the bright overhead lights. I had an IV in the other arm, badly bruised from three botched attempts to find the vein, so essentially was pinned down. There was no call button. After 30 minutes of this, with a massive headache and in desperate need of sleep, I was getting angry enough that, were I a violent person, I could have lashed out at someone. Instead, I ripped off the BP cuff and hurled it to the floor — so hard that it disconnected from the archaic machine, which responded with a loud screeeeeeeeeee. Well, I thought, at least that ought to get someone’s attention. Nope. After nearly 10 minutes, I got up, carefully maneuvering around the IV, and looked for an on/off switch on the monitor. Failing to find one, I followed the power cord to the electrical outlet behind the bed and yanked the plug out of the wall. No one ever noticed. While I was up, I killed the overheads.

      Around 5 am, I was finally starting to sleep, when the lights came on abruptly. Two ER workers literally were dragging in a barely conscious 6-foot AA man named Allah, whom they put in the bed next to me. Allah evidently had ODed on heroine, and the staff were angrily shouting at him, shaking him down for his source (another whole story).

      Didn’t get to inpatient room until nearly 1 pm, total of 19+ hours in ER. What happened there was equally shocking and infuriating — yet another whole story, for another day…

  5. Lexx

    Patients are entering the health care system frightened, angry, and combative, long before they walk in the doors of a health care facility, armed to the teeth with the emotions of their last deeply unsatisfying experience. They’re looking for an enemy they can see and confront.

    At CSU vet hospital there are volunteers who attend to the humans while they’re waiting, offering to get them something to drink, hunt up magazines, sit with them if they’re alone, and talk with them in soothing tones about the reason for their visit that day. All the animals present are in a high state of anxiety; they’re worried and possibly in pain. Most likely it’s not their first rodeo. They just need someone to see them, to recognize them individually and project confidence that the people who work there care about animals (and their caretakers) and will try to help. The volunteers help deescalate the lobby and sometimes the parking lot where animals are loaded and unloaded. Their tools are attentiveness, empathy and kindness.

    Such volunteers probably work in human hospitals, but I’ve never met one… and Covid didn’t help.

    1. DorothyT

      Volunteers are useful, if properly trained, in some situations. I especially think of education: reading, etc. However, in healthcare, be it human or veterinary private equity owned-managed facilities, I see issues. If I have a question of a ‘volunteer’ I don’t need soothing, I want answers to healthcare questions. I see possible, inevitable insurance issues.

      And I see having volunteers in healthcare as a seemingly inadequate response to smooth over private equity short staffing of appropriate nurses, doctors, aides, etc. I just spent many days with a post-surgery friend who was a patient in an NYC hospital. Even housekeeping was inadequate, and this was a ‘top’ hospital. The nursing staff was buzzing about short staffing.

      To Lexx I’ll say that some veterinary clinics/’hospitals’ in NY have been taken over by private equity firms. Check out the staff of vets at one if posted online. Instead of maintaining a relationship with a particular vet doctor who knows your dog or cat’s condition, there are scores of vets listed on some PE websites who work under contract. You never know who you are going to see or if they take medical orders by that office’s ‘managers’.

      1. Lexx

        Hold yer horses there, Dorothy, not all or even most veterinary practices are private equity owned… not yet. Short-staffing is going on everywhere in almost all industries, but most critically to everyone involved in healthcare.

        The volunteers at the vet hospital are prohibited from answering any patient health care questions, though they will go find someone who can if your wait has been unusually long. They offer instead hospitality and an empathetic ear. Nothing more should be asked of them and nothing more can be offered. They are not licensed trained professionals. The vets don’t want the volunteers making messes they have to clean up, heavens forbid!

        Their presence serves to calm and deescalate the anxiety of the caregivers. The pee/poo/barf accident that needs to be cleaned up; a pat on the head, a biscuit, a cup of tea and tissues for tears.
        My dog could have given two poops, he had his own agenda, but I thought it was smart to attend to animal and human as a unit, recognizing that everyone who showed up for the appointment had needs. It softens the blows to come by starting with a smile, eye contact from a kind and familiar face.

        It’s a bit like something I saw for the first time in the women’s can yesterday at the grocery store — a sharps disposal box attached to the wall. Pragmatic on so many levels… and kind, okay it’s corporate kindness, but still…

        1. DorothyT

          To Lexx: Please quote me accurately. I wrote, “To Lexx I’ll say that some veterinary clinics/’hospitals’ in NY have been taken over by private equity firms.”

          I have nothing to add to my previous comments regarding using volunteers in healthcare, be it for humans or animals.

  6. KD

    The problem for hospitals–and it will be a problem–is that your hiring standards for hospital security are typically no better than mail security, rent-a-cop types who would blow out of the police academy or have other issues making them unfit.

    America has a mental health crisis, and most cops are inadequately trained to deal with mentally ill populations (who often have paradoxical reactions to police show of force viz. sane people), leading to most of the police shootings of unarmed personnel in the US. That is, we already have a problem with the trained professionals in this respect.

    The hospital rent-a-cops have even less training and experience, in general, and are set loose working with an extremely challenging population generally under severe duress. My prediction is its going to play out bad for hospitals, bad for patients, and good for trial lawyers.

  7. JustTheFacts

    I find it interesting that no one is asking why the patients are violent. Instead they are claiming “it’s a violent workplace” as if that were a normal state of affairs, just as they seem to think that bankrupting people is normal.

    Certainly there may be some difficult patients, but the environment they are kept in may also play a role. Why have I only ever seen 1 poorly behaved patient in any of the other Western hospitals I have visited and he had head trauma from a horrible car accident (something the nurses understood and were compassionate about)

    Luckily I only rarely visit hospitals in the US. There’s little point anyway: all they seem interested in is how I am going to pay them, not actually addressing my problem. Imagine going into a store, and they ask for your payment method before allowing you in to even see whether they have what you want.

    If Yves’ mother needed water, and no one bothered to provide it, they’re not doing health care. They’re doing something else which isn’t actually caring for their patients. If her mother came back with bruises, they obviously didn’t care about her either. If they treat people like meat to be processed, why are they surprised if people feel resentful and show it?

    As far as I can see, the solution of increasing security demonstrates a wish to continue mistreating patients without suffering any consequences, rather than actually fixing the underlying problem. History has shown such high handed disrespectful behavior leads to Guillotines, something those making such decisions might want to consider.

    1. jobs

      They continue to do it with the realization that they will be long dead before there will be any consequences for them.

      In fact, it’s probably one of the reasons why they have no respect for us – we are weak, disorganized and thus no threat to them, even though we outnumber them by orders of magnitude.

      Divide et impera.

  8. Brunches with Cats

    To understand how adding cops to hospitals would work, we need only look at the VA healthcare system, which has its own police force at all hospitals and clinics. As a veteran, I can tell you with certainty that there’s a pervasive attitude within the system of seeing patients as the “enemy.” Obviously, this doesn’t apply to all healthcare workers; there are many competent, kind, compassionate and dedicated providers. I’ve been lucky enough to be assigned to some of them, and often wonder how they are able to survive in that environment, especially since the VA seems to do all it can to make life difficult for those who really care and to reward those who don’t.

    There is a process within the VA of flagging “difficult” patients within the system, so that whenever they have scheduled appointments or show up in the ER, they are escorted by VA police. VA police also become involved when healthcare providers file complaints about patients, which can be as minor as calling your psychologist a jerk.

    OSHA has workplace safety rules for healthcare workers that include, IIRC, rules on abuse by patients. It’s been a while since I’ve read them, but I vaguely recall that they indeed include transgressions such as calling your psychologist a jerk. I also vaguely recall that the rules gave me a definite feeling of being seen as the enemy, or at the very least, that every patient is a potential enemy.

    Then, the same could be said for education workers. I know of two who have been hit, kicked, and had hair torn out.

    As many others have pointed out above, there is little consideration for how patients are treated within these dysfunctional systems that can trigger violent outbursts. I left a long comment above (3:52 pm, response to JackieBass) detailing a personal ER experience, 19+ hours, 7 hours of which were after the decision had been made to admit me for further testing. No doubt, others have even worse horror stories.

  9. Brunches with Cats

    Correction: The decision to admit me was made after 7 hours in the ER. It was another 12 hours — overnight — before transfer to an inpatient room. I’ve often wondered whether they kept me in the ER an extra 12 hours because they knew the VA was paying the bill, and ER care is more expensive than inpatient — even though it should be clear from my description in long comment at 3:52 p m. that “care” in that 12-hour period was minimal.

  10. Cetra Ess

    In Toronto at the start of the pandemic antivaxxers and antimaskers protested staff entering and exiting hospital entrances, in some cases preventing ambulances from entering emergency bays; harassed anyone wearing masks, including patients, and sent people with cameras to infiltrate the Covid wards to “prove” there wasn’t really a pandemic going on, that people weren’t really dying. (They succeeded in getting footage of wards of people facing down, beds crammed in hallways, but somehow in their minds it was proof that nothing was happening.)

    So when I read that violence has increased in American hospitals the first question that came to mind was is it due to this particular group?

  11. Space Station 11

    ER doc here.

    I work at an academic urban trauma hospital. We encounter violent patients every day. Nearly all of them are from the growing population of homeless with polysubstance abuse and untreated psychiatric disease (or both). We routinely have ambulances lined up down the street with these patients. They are challenging, unpredictable, and spend countless hours (sometimes days) in the ER while we wait for them to sober or until a safe disposition can be found. I do not know what the solution is for improving care of these patients (and, by association, the rest of the ER patients who are waiting for beds). I am grateful that we have security.

    One thing I’d like to say in response to a few of the above comments: ER docs and nurses *do not* care about patients’ ability to pay, and it does not affect our treatment or medical decision making. This is partially because, for better or worse, we are completely illiterate w/r/t billing practices and hospital finances. I am speaking from my own experience, of course, but I have worked in all types of hospitals in this role. Just my two cents there.

    I’ll also state that I know that visiting the ER can be a bewildering and frustrating experience, and I am sorry. Like many ER docs, I have been looking for an off ramp out of clinical medicine. We lost a majority of our skilled, experienced nurses during the pandemic. Burnout rates are incredibly high. It is a broken system and I don’t blame patients for being upset and angry.

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