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HB 4142 could prevent violence in emergency departments

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Among the many ripple effects of the pandemic, in the last two years health care workers have reported a disturbingly prolific increase in assaults while they are providing care. According to surveys by the American College of Emergency Physicians and the Emergency Nurses Association, almost half of emergency physicians and 70% of emergency nurses reported being physically assaulted on the job. This phenomenon is not simply something that is showing up in esoteric statistical data, but it is playing out every day in Oregon’s hospitals.

Several weeks ago, I was toward the end of one of a string of 5 p.m. to 1a.m. emergency department shifts that had prevented me from seeing my two young children for four days straight. A COVID test on an older patient I was taking care of came back positive. The patient had a low oxygen level necessitating admission to the hospital. As I started to discuss the unfortunate result with the patient and family, the patient’s son stood up from his chair and walked up to me screaming that he wouldn’t’t let me admit his father to the hospital so that I could put his father on a ventilator and kill him. I explained that my only goal was to do everything possible to make his father get better and that a ventilator was only a last resort. He pushed his jacket back to reveal a gun holster strapped to his hip and said “If anything happens to my father, I will kill you and your family. It will be World War III.”

Fortunately, I was able to get out of the room and call security and subsequently police. Police officers escorted the patient’s son out to his car in the parking lot where he undoubtedly left the firearm that he carried in the holster he was wearing. I was left in the emergency department unarmed and virtually defenseless.

Acts like this don’t just affect the health care provider personally but send shockwaves that reverberate long after the incident’s immediate aftermath.

For the remainder of my shift, I caught myself regularly looking at the security camera video screen, hoping not to see the ED doors sliding open to reveal this person returning. I listened for any commotion in the waiting room, instead of focusing on a nurse asking me to confirm the correct medication for another patient. While trying to see the remaining patients who had overwhelmed us during the latest COVID surge, I found my mind regularly drifting to my two sons whom I hadn’t seen in four days. This person had my name and, therefore, would be able to find my address where my children were sleeping.

Unfortunately, this type of experience is far from unique and numerous Oregon hospital workers have stories where threats have progressed to actual assault. An emergency department technician was tackled, causing ligaments in his knee to tear, requiring surgery. A pregnant nurse was kicked in the abdomen and went into premature labor. A provider was strangled with the stethoscope that hung around her neck. The effect of these assaults goes far beyond the immediate physical and emotional trauma they cause by fueling the never-before-seen exodus of health care workers and leaving the most vulnerable Oregonians sicker and further marginalized with substandard care.

Oregon has an opportunity to make a major stride toward addressing this by passing House Bill 4142. In doing so, Oregon would join 34 other states with similar laws, which make it a felony to assault a hospital employee while specifically shielding vulnerable Oregonians in mental health crises from being charged. Currently, it is only a misdemeanor to assault a hospital employee. Victims of assault have been told by police that it is not worth the paperwork to charge the assailant. It is past time for this to change.

House Bill 4142’s greatest impact will be its effect on the numerous patients I see daily who have red flags on their chart for previous history of assaulting health care workers. Currently, these repeat offenders know that there are virtually no legal repercussions from past assaults and, therefore, are completely uninhibited and emboldened to do it again. Having actual consequences will change this calculation.

The Oregon Legislature is currently debating House Bill 4142 the coming week and I implore you to join me in urging our legislators to enact this bill so that my colleagues and I can continue to provide care for our community and worry less about whether we will get home safely to see our families.

Alex Skog, MD, is an emergency physician and president-elect of the Oregon Chapter of the American College of Emergency Physicians.


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