Georgia Hospitals Form Police Forces To Curb Rising Violence Against Staff

Hearing screams, Destiny ran into a hospital room, where she saw a patient attack a nursing technician. As a senior nurse at the Northeast Georgia Health System, she was trained to de-escalate violent situations.

However, on that day in Spring 2021, when Destiny intervened, the patient punched, kicked, and bit her for several minutes. And by the time a team of security guards and other nurses was able to free her, patient Destiny had already pulled out tufts of hair.

“We’re not protected on our floors,” she said, summarizing the story during a testimony before the Georgia Senate Trials Committee on Violence Against Healthcare Workers later that year. Destiny only used her first name at the hearing, fearing retribution for speaking out against the patient who assaulted her.

In May of this year, Republican Georgia Gov. Brian Kemp signed legislation increasing criminal penalties for assaults on hospital workers and allowing state health facilities to establish independent police forces. The law comes in response to that statement, as well as hospital lobbying and data documenting a rise in violence against healthcare workers. In passing the law, Georgia joined other states in trying to reverse the rise in violence in recent years through tougher penalties and increased prosecutions.

According to the American Nurses Association, nearly 40 states have laws that allow or increase penalties for assaulting healthcare workers. And lawmakers in 29 states have passed or are working on similar legislation, as well as ones that will allow for the creation of hospital police forces. Members of these forces can carry firearms and make arrests. Additionally, they have higher training requirements than non-certified officers such as security guards, according to the International Association for Healthcare Security and Safety.

Groups representing nurses and hospitals argue that such laws take into account the daily reality of aggressive or agitated patients, who sometimes turn violent. Nevertheless, such interventions are relatively new. Critics fear the establishment of hospital police forces could escalate healthcare violence and have unintended repercussions.

“I worry about all the reasons patients don’t trust me and the health care system,” said Elinore Kaufman, a trauma surgeon at the University of Pennsylvania in Philadelphia.

According to federal data, healthcare workers are five times more likely to experience violence than other industries. On May 3, a day after Kemp enacted the Safer Hospitals Act, a person opened fire at a doctor’s office in Midtown Atlanta, killing one woman and injuring four others, including employees at the doctor’s office.

Verbal and physical threats, which have increased during the COVID-19 pandemic, are exacerbating serious nursing shortages, said Matt Caseman, CEO of the Georgia Nurses Association. Destiny testified that one of her colleagues left nursing after the 2021 assault, in which the patient slammed the nursing technician’s face into a wall and the floor. Destiny also suffered from post-concussion headaches for months, she said.

Last November, the Centers for Medicare & Medicaid Services (CMS) noted the alarming rise in healthcare-related violence. The federal agency recommended that hospitals better identify patients who could pose a safety risk, increase staffing levels, and improve staff training and education. There was no talk of an increased presence of law enforcement agencies.

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

In Georgia, the new law increases criminal penalties for aggravated assaults against all healthcare workers on a hospital campus, not just those in emergency rooms, which were already regulated. And hospitals can now set up law enforcement like they do on college campuses. Officers must be certified by the Georgia Peace Officer Standards and Training Council and maintain law enforcement records that may be released.

A dedicated police force will help hospitals better train officers to work in healthcare, said Republican Rep. Matt Reeves, who co-sponsored the Georgia bill. Officers can learn about staff and regular patients, as well as hospital campus layout and protocols. “If you have a specialized police department, they are better suited to the needs of the facility,” he said.

That is the case with Atrium Health Navicent, which operates hospitals across central Georgia, said Delvecchio Finley, its president. The health system was among the few to employ certified law enforcement officials prior to the new law.

Atrium Health recruits officers who reflect the diversity of the community, conducts training to counter implicit bias and conducts debriefings following any incidents, Finley said. Officers are trained to respond if someone becomes violent at any of the facilities.

“The most important thing we can convey to officers is that they are in an environment where we provide a safe environment and we care about everyone,” he said.

Unlike other companies, hospitals can’t just kick out misbehaving patients, said Terri Sullivan, an emergency room nurse in Atlanta. A patient punched her once in the chest and fractured two ribs before running out of the room and attempting to hit his doctor. Sullivan said in her experience, the presence of hospital security personnel can discourage patients from behaving.

Yet there is little data on whether such forces are effective in preventing violence in hospitals. Ji Seon Song, a law professor at the University of California, Irvine who studies health care policing, worries about the “unintended consequences” of laws that increase law enforcement presences in places where people receive medical care.

“You realize there could be a lot of problems,” she said, “especially if the patient is African American, undocumented, or Latino — something that makes them vulnerable to criminalization.”

A ProPublica investigation found that the Cleveland Clinic’s private police force is making and leading a disproportionate number of charges against black people. And in March, video surfaced showing police and hospital staff in Virginia holding down a patient who was going through a mental health crisis, resulting in his death. According to a study by Johns Hopkins University, in 23% of ER shootings between 2000 and 2011, the perpetrator took a gun from a security guard. The November CMS memo mentioned several incidents at the hospital involving police, with the agency citing the facility for failing to create a safe environment.

Georgia law does not require hospital officers to arrest patients pending warrants for crimes committed off hospital property, such as probation violations. But that doesn’t limit those powers either, said Mazie Lynn Guertin, executive director of the Georgia Association of Criminal Defense Lawyers.

“If the discretion is unrestricted, someone will eventually exercise it,” she said.

Law enforcement should always be a last resort, argued Kaufman, the trauma surgeon. Although the threat of violence is worrying, hospitals can spend more on health care staffing, improve general education and provide de-escalation skills.

“Our primary goal should not be that our patients pose a threat to us,” Kaufman said. “It’s a harmful and racist lens. We should develop safe and healthy workplaces in other ways.”

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