President's Message: Violence Against Health Care Workers Must Stop

Michael Schrader, MD, PhD

VIOLENCE AGAINST HEALTHCARE WORKERS MUST STOP

Physicians suffer violent attacks by patients with increasing

frequency. These violent assaults often occur in emergency departments. One of our colleagues at St Francis ED told me she has been attacked by patients many times over the years. Most recently she was punched in the face by a patient she was caring for which resulted in her having double vision. These assaults were reported to the police. Under California law an assault that does not involve a deadly weapon or result in serious bodily injury is classified as a misdemeanor assault. Offenders may be cited and released. This was what occurred in the above incident. The assailant was released and did not show up in court. Although the physician followed up and pursued the case with the district attorney’s office, ultimately the assailant was not penalized.

According to a 2018 survey by the American College of Emergency Physicians, 47% of ED physicians report being assaulted at work. The US Bureau of Labor Statistics has published that healthcare workers are 5 times more likely to suffer a workplace violence injury than workers overall.

Physicians and nurses are protected from violent acts under Section 241(c) of the California penal code if they are providing medical aid in an emergency setting outside of a hospital. An assault under these circumstances doubles the potential fine and imprisonment term. But an assault against a physician or healthcare worker in an emergency department, hospital, or clinic carries no increased penalty.

Other states have felony statutes against assaulting physicians and healthcare workers performing their duties in a healthcare setting. Nationally there are two similar bills H.R. 1195 and S.4182 both entitled “Workplace Violence Prevention for Health Care and Social Service Workers Act” that are progressing through the House and Senate respectively. These bills would both direct the Secretary of Labor to issue an occupational safety and health standard that requires covered employers within the health care and social service industries to develop and implement a comprehensive workplace violence prevention plan. This includes hospitals and clinics that operate within a hospital license.

Reproductive clinics are frequently subject to harassment and occasionally to violence. On March 19, 2022, the Women’s Reproductive Clinic at Zuckerberg San Francisco General was forcibly invaded. While there was aggressive intimidation there was no physical assault. The San Francisco DA did press charges for unlawful trespass. Although no one suffered bodily injury, the threat of violence and the fear it created left a lasting impact on the providers.

SFMMS Delegation District VII submitted a resolution to the CMA about healthcare worker violence. Authored by Drs. ManKit-Leung and Roger Eng, the resolution “Protection of Healthcare Workers Against Physical and Verbal Violence,” called for CMA support for legislating equivalent sentences for assaults against healthcare workers whether these incidents occur inside or outside of a healthcare facility. In addition the resolution called for CMA to support legislation that bans online “doxing” of all healthcare workers. It proposes:

“To decrease the prevalence of violence against physicians and healthcare workers and to mitigate threats of violence, We propose that the California penal code be modified to include hospitals, emergency departments, and clinics as well as emergency aid sites under Section 241(c). This would create deterrence but also allow repeat violent perpetrators to face maximal penalties.”

In addition, I propose that the maximal penalties be levied under existing laws. We need to encourage the police to arrest and the DA to fully prosecute those who attack physicians and healthcare workers at their workplaces.

It’s a start. No doubt there is more we can do, including in some of our own hospitals and other clinical settings. No one should be afraid in the workplace. No one should be beaten at work.

Dr. Schrader practices internal medicine at Dignity Health, is President of the SFMMS, and co-chairs the SFMMS delegation to the CMA.