Emergency Room Violence is Increasingly Common

I often warn patients to avoid the emergency room (ER) at all costs – mostly because it will cost you a fortune. I also advise patients to avoid hospitals in general unless they are too sick to go anywhere else. Hospitals are the most expensive place to have medical care done that can be done elsewhere.

It turns out, the ER is not just dangerous for patients financially, but also a dangerous place to work. The New York Times wrote about it last fall. More than half of ER physicians have been assaulted by either patients or their families. For ER nurses it’s even worse:

In a 2022 American College of Emergency Physicians survey of E.R. doctors, 55 percent said they had been physically assaulted, almost all by patients, with a third of those resulting in injuries. Eighty-five percent had been seriously threatened by patients. The risks can be even higher for E.R. nurses, with over 70 percent reporting they had sustained physical assaults at work.

Even when they are not attacked, shoved, or spat on, emergency department personnel suffer verbal abuse, in the form of threats, insults and slurs. In the worst of times most patients are probably not the most pleasant to be around because emergency rooms are no fun for patients either. More from the  New York Times:

In the E.R., there’s a certain level of resignation that violence is just part of the job, like getting bloodstains on our shoes. We have come to endure racist, sexist and homophobic slurs, choosing silence over confrontation, to fulfill our duty to care for human life.

The level of violence has increased in recent years. This from Kaiser Health News:

Data from the California Division of Occupational Safety and Health shows that reported attacks on ER workers by patients, visitors, and strangers jumped about 25% from 2018 to 2023, from 2,587 to 3,238. The rate of attacks per 100,000 ER visits also increased.

Covid made problems worse, but ER violence was already increasing before covid. More from the New York Times:

Even before the Covid pandemic, the trajectory was troubling. The U.S. Bureau of Labor Statistics reports that the rate of injuries from workplace violence against health care workers grew by nearly two-thirds from 2011 to 2018. The pandemic worsened the situation, cracking society wide open and exposing its systemic failures.

Many public health advocates blame the lack of indigent mental health facilities for violence in ERs. Insane asylums, as they used to be called, were closed nearly 50 years ago and replaced with a patchwork of outpatient care. Involuntary confinement was also abandoned decades ago.

The origins of violence in the ER are hard to remedy. In the meantime, STAT News has some simple things could help alleviate the problem of ER violence.

…more security guards, cameras, security for parking lots, metal detectors, and increasing visitor screening inside hospitals…

California is weighing whether those who instigating attacks on emergency room workers should suffer tougher penalties. Currently attacking ER health care workers in California is considered a simple assault, the maximum penalty for which is a $1,000 fine and at most six months in jail. Legislation to beef up penalties for ER violence was introduced in California twice before, in 2015 and 2019. Then Governor Brown vetoed stiffer penalties in 2015, believing they would be ineffective. It’s only gotten worse since then. More from KHN:

Punching, kicking, pushing, and similar aggression accounted for most of the attacks. Only a small number included weapons.

Some experts believe violence in the ER is just another symptom of a dysfunctional health care system. They are probably correct.

Most patients wouldn’t come to the ER if given other choices such as a timely appointment with their doctor or ready access to needed health services. When they discover the ER’s open door doesn’t translate into empty beds, it can push tired, frustrated, and otherwise reasonable people to their edge.

Security measures are unlikely to alleviate the underlying problems that lead to violence in emergency rooms. The root cause likely stems from a variety of problems: lack of access to care, drug addiction and federal laws that made the ER the usual source of care for people without a usual source of care. Perhaps the same conditions that have led to violence on airplanes have also led to increased violence in the ER. Dysfunctional health care system or not, violence in the ER needs to be stopped and tougher penalties may be the necessary solution to bad behavior.