Oregon bill aims to decrease violence against hospital workers

The American Nursing Association found 1 in 4 nurses are physically assaulted on the job. Currently, assault against a nurse is a misdemeanor but advocates say this isn’t enough. HB 4142 aims to address this issue by making any assault committed against a person performing their duties in a hospital a Class C felony. We’ll hear from Bill Shueler, the government affairs chair for the Oregon Emergency Nurses Association, on why this law is needed and KC Lewis, the managing attorney for Disability Rights Oregon’s Mental Health Rights Project, on how this law could affect people with mental illnesses.

Note: This transcript was computer generated and edited by a volunteer:

Dave Miller: From the Gert Boyle studio at OPB, this is Think Out Loud, I’m Dave Miller. We turn now to a bill in the Legislature aimed at making hospitals safer; not for the patients in them, but for staff. This is because of reports of increased attacks on hospital workers. As it stands now, intentionally, knowingly, or recklessly injuring a hospital worker is classified as a misdemeanor. Under the new bill, it would become a felony. In a few minutes, we’ll hear from an opponent of this bill, but we start with somebody who is in favor of it. Bill Shueler is the Government Affairs Chair for the Oregon Emergency Nurses Association. Welcome to the show.

Bill Shueler: Thanks Dave. Thank you for having me.

Miller: Thanks for joining us. What’s the idea behind this bill?

Shueler: The idea behind this bill is to give violence in health care the seriousness that it is due. Now, violence in health care is not unique to Oregon. It is a nationwide problem. In fact, it’s a worldwide problem. We’ve been trying to enhance penalties in Oregon since about 2015. And statistics really do show that in healthcare, we do suffer a good brunt of the violence. It’s known that we suffer five times the assaults than any other profession in the private business sector. If you look at a recent Oregon OSHA report that looked at disability claims from 2016 to 2018, there were 1,997 claims, and healthcare and social services is at the top. When you look at national data, national OSHA has the same thing.

Oregon did its own study from House Bill 2022 in 2007, and all the hospitals responded to that. There was documented over 1000 assaults. 11% of those were in the emergency department. And 2% of those resulted in severe injuries, such as a bone fracture or head injury. And the Emergency Nurses Association did its own study of over 7,000 nurses, and published this study in 2011. Over 54.5% of nurses experienced violence in the previous seven days. 12.1% of those were physical violence, and 42.5% of those were verbal abuse.

Miller: How do you explain the increase over the last decade?

Shueler: Yeah, that’s a good one to unpack. It’s difficult to explain why it’s increasing. But we think our emergency departments, it’s a high energy area. So we do get folks in crisis. Per federal law, we cannot turn anybody away regardless of their physical or mental state. So that, in and of itself, puts us at risk. We haven’t implemented safety interventions. Sometimes, we’re doing the best we can. We don’t know why there’s been an increase, but we know that it’s increasing despite our efforts in Oregon. We have to have violence prevention programs in Oregon, per Oregon state law. The Joint Commission just instituted new standards that all hospitals have to have a violence prevention program. So we’re doing this. And yet the data shows that violence is still going up.

Miller: Is there data to show that increasing penalties for a particular crime decreases the likelihood that people will commit that crime?

Shueler: That’s a great question. And the brief answer to that is no, that study has not been done.

Miller: Is the idea that people who would otherwise, say, punch a doctor or a nurse, would think to themselves, oh, this is a felony now, not a misdemeanor, so I guess I won’t?

Shueler: Well, there is hope that there would be some deterrent effect, similar to if you assault a law enforcement officer, the penalties can be fairly stiff. So we don’t have scientific data or the numbers, but we hope anecdotally and from what we’ve heard from some of our emergency nursing colleagues is that sometimes it could act as a deterrent.

Miller: We’re going to hear from an opponent of this bill in just a minute or two, as I noted. As you know, one of the big arguments against this bill is that it could end up putting more people who are dealing with serious mental health problems into the criminal justice system, as opposed to the mental health world. What’s your response to that concern?

Shueler: Well, I think we share the same concern. We don’t want those with mental illness to be unfairly treated. I would just go back to the language of this bill. We would ask that it be a Class C felony to intentionally and knowingly cause physical injury to a hospital worker. So this bill would not remove any defenses or any protections that those with mental illnesses have. It’s just hopefully addressing it with seriousness and parity with those that already have these protections within the law. And that includes taxi drivers, public transit vehicle operators, EMTs and paramedics, highway workers and flaggers.

Miller: Bill Sheuler. Thanks for your time today.

Bill Shueler: Thank you.

Miller: KC Lewis is a managing attorney for Disability Rights Oregon’s Mental Health Rights Project. He joins us now. It’s good to have you on Think Out Loud.

KC Lewis: Thank you very much for having me.

MIller: What is your biggest concern with this bill?

Lewis: I will tell you, through our experience of Disability Rights Oregon, we see these kinds of cases coming across our desks all the time. Someone says “I had a family member who was in crisis, I took them to the only place that I could think to take them, which was the hospital, the emergency room, to try to get them the help that they needed. While they were there, someone didn’t like the way that they looked, didn’t like the way they were acting. They got a security guard called on them. And because they were in crisis, maybe someone grabbed for them, and they were flailing around, they end up hitting somebody. Suddenly they’re in the criminal justice system.”

I can tell you, even now, under our current legal regime, these cases do get charged. They do get taken through the system. People do end up with serious charges. They end up going to the state hospital, they end up going to jail. Under this bill, I think that would get much worse for those people.

Miller: So, this gets to the language of the bill that Bill Shueler said would prevent what you’re just talking about from happening, that people would have to be convicted of intentionally and knowingly injuring someone. You’re saying that those two adverbs don’t provide a legal shield for people in the throes of a serious mental health crisis?

Lewis: Absolutely not. Those are what’s called a mental state. Those are attached to every single criminal law that we have in the state of Oregon. And people with mental illness still get swept up in that criminal system disproportionately, still get harmed by it disproportionately. I will tell you that after this bill was in its first hearing, we received a number of emails from public defenders all over the state who basically confirmed what we have been saying, that we see this happen in every hospital that we’ve seen people getting charged with these crimes.

Our current law still requires that they be shown to be intentionally or knowingly committing the assault. I think it’s important to note that this new bill does not provide any additional protection for people with mental illness to go along with the additional sentencing that they’d be potentially facing. So it’s our anticipation that having those words attached to the bill would provide absolutely no protection for people with mental illness.

Miller: The overall goal of this bill is not to punish people who assault hospital workers. That’s a means to an end. The end is to reduce those assaults. What do you think it would take to accomplish that goal that you too share?

Lewis: Well, I think you’ve zeroed in on what the issue with this bill is, in terms of meeting that goal. It’s hard to imagine somebody in a mental health crisis in an emergency room stopping and thinking, “Well, is this going to be a misdemeanor or a felony?” and making a decision about their behavior based on that. Often they have no control over their behavior at all. And to sort of revisit one of your questions, not only do we not have data that shows that increased sentences act as a deterrent to crime, we in fact have data that specifically shows that increased sentences do not act as a deterrent to crime. So this bill is not going to accomplish what the proponents want it to accomplish.

That being said, we completely agree that this is a serious issue that needs to be addressed. The way that we address it is by providing more upstream services in behavioral health for people with mental illness. The only way that you stop incidents like this from happening is by preventing people with mental illness from getting to the emergency room in the first place. And that means providing more community supports to them. That means providing more access to medication, access to therapists. And then I think it also means that once you get to the hospital, you need to have sufficient staffing, sufficient training, to be able to deescalate people and prevent these kinds of incidents from happening. We do very much agree that health care workers should not be living in fear of assault every day.

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