Washington is just one of many states that makes an assault on a health care worker a felony offense, but recent reporting from the Marshall Project and the Seattle Times found that this law is disproportionately affecting those in a mental crisis. From 2018 to 2022, there were 151 cases of felony assault on a health care worker in King County. A little more than three-quarters of those cases involved someone experiencing symptoms of a mental illness. Oregon has tried to pass a similar law, but these attempts have failed. Christie Thompson is a staff writer for the Marshall Project. She joins us to share more.
Note: This transcript was computer generated and edited by a volunteer.
Dave Miller: This is Think Out Loud on OPB. I’m Dave Miller. In 29 states around the US, any assault on a health care worker can be charged as a felony offense. Oregon is not one of those states. State lawmakers have, so far, resisted efforts to increase those penalties, even in the face of more reports of violence against healthcare workers. But Washington has had this kind of law on the books for almost 30 years. New reporting from the Marshall Project and the Seattle Times found that this law is disproportionately affecting people experiencing symptoms of mental illness. Christie Thompson is a staff writer for the Marshall Project. She joins us to talk about what she found. It’s great to have you on the show.
Christie Thompson: Thanks for having me.
Miller: Can you first tell us the story of Kevin Page? This was early on in the pandemic.
Thompson: Absolutely. So early in the pandemic, Kevin, who lives outside of Seattle, called 911. He says that there were kids who were throwing rocks at his house and harassing him. When the cops showed up, they thought that he was having a mental health crisis. So they brought him to a hospital on an involuntary mental health hold. When Kevin got there, he was freaking out. He didn’t know where he was or why he was there. He wanted to leave and they wouldn’t let him leave. So he starts getting really upset. And that’s when nurses restrain him to a gurney, strap down his arms and his ankles, and one nurse holds his head. So Kevin describes having a full panic attack, feeling like he can’t breathe. like he doesn’t know what’s going on, and he spits.
If he had spit on you or me, that would be a misdemeanor offense. But in Washington, because he spit on a nurse, that’s a felony. So officers from the same department who had just brought him to that hospital, returned to the hospital to arrest him, take him to jail, take him out of treatment and charge him with felony assault.
Miller: There’s another person in Washington who you focus on, who was also charged with assault. You refer to him as with his initials, I.M., based on his preference. What did he tell you?
Thompson: I.M. was a college student who had been dealing with schizophrenia for a long time. He had recently tried going off his medication, and ended up under an involuntary commitment order. That means that a civil court said this person is so seriously mentally ill that they are a danger to themselves, a danger to others, and not in control of their behavior.
But being found under an involuntary treatment order doesn’t prevent you from criminal charges. So while in the hospital, I.M. was acting out, getting upset. He spit on some health care workers in the psychiatric facility, he slapped one in the hand, he made threats. And so cops showed up to the hospital where he had been receiving treatment, arrested him, pulled him out of treatment, brought him to jail where he continued to get very, very sick. We looked at jail notes that found he was smearing food and feces around his cell. He was clearly totally delusional.
He was ultimately able to stabilize and be released to the care of his family. But his case is still ongoing, and he’s still facing felony charges that could make it really hard for him to get treatment in the future or put his life back together after this incident.
Miller: Both of these men were prosecuted under this Washington law that dates back to 1997. What does it say?
Thompson: The law states that any assault on a health care worker … and assault is a big word, but what it means is really any action against a health care worker. So that could be, like we said, spitting, slapping. Things that would otherwise be considered minor crimes against a civilian, can be an automatic felony offense when it happens against a health care worker. And this law also covers other people in public servant positions like firefighters, EMTs, police officers, bus drivers. And the idea behind it was we need to protect these people, they face a higher level of violence in the community and so there should be higher criminal consequences. But what we found in our reporting is that the majority of the people who were charged under this law were people who were encountering health care workers because they were having a serious mental episode.
Miller: You focused on data from King County from 2018 to 2022. How many cases were filed as a result of these kinds of assaults?
Thompson: We looked at a five year span just in King County, and found that there was 151 cases filed for felony assault on a health care worker. And then what we did was we dug through each of those cases, we built our own database, we read the court records in each of them. And the most striking finding to us was that 76% of those cases were filed against people who had indicators of very serious mental illness. Many of them, like I.M., had been in the hospital under an involuntary treatment order, or like Kevin, had been in the hospital receiving a mental health evaluation, or some of them were people who might have assaulted an EMT when an ambulance responded to their mental health crisis in the community.
Miller: What did you hear from healthcare workers about what they’re dealing with day-in day-out?
Thompson: You noted that these laws are spreading across the country, and it’s driven by this very real concern about increasing violence against people who work in health care settings. The folks that we talked to for this story described a pretty frequent, if not constant, onslaught of verbal abuse, sometimes physical abuse, especially folks who work in emergency rooms who are dealing with people on their worst day, in their most traumatic situations. It’s hard to fully encapsulate the scope of this violence. But we do know, according to research, that this violence is increasing and is very widespread.
Miller: You talked to Kimberly Mosolf, the former director of the treatment facilities program at Disability Rights Washington, who wrote a report about this a few years ago. What did you hear from her?
Thompson: Kimberly had been looking at this issue for a while. And what stuck out most to her was similar to what jumped out to us, how frequently these cases were being brought against people who were already under involuntary commitment orders. I said this already but just to reiterate, that’s someone who a civil court has said this person is not in control of their behavior and we know that they are a danger to themselves or others. But that does not keep you from facing criminal charges for that same behavior that landed you in the hospital in the first place. Kim looked at not just assault threes, but all arrests out of hospitals, and was finding that there was hundreds of times where people were being pulled out of treatment settings, arrested out of a hospital, and potentially jailed instead, which we know can make people even sicker.
Miller: What did you hear from prosecutors? I’m curious what they see as the purpose of this law - if it’s more to punish people for bad behavior, as a disincentive for future bad behavior, or as a way to force them into treatment. The last one doesn’t make sense because they were already getting treatment. I’m just curious what the rationale for this in practice is.
Thompson: The King County prosecutor’s office spoke to us at length. One thing they clarified was that they don’t necessarily see these felony charges as a deterrent. When these laws are being passed, it’s really talked about “we need to prevent violence against healthcare workers, so we should increase these criminal penalties.” The prosecutor’s officer was saying that’s a misunderstanding. And multiple people told us, especially if somebody is in crisis, they’re not going to stop and think “this is a felony offense, I should change my behavior.” So that wasn’t the goal.
The goals that they said were “we often use criminal charges to try and compel someone into treatment.” Whether that be by them getting competency restoration, which is not exactly treatment but getting them into a healthcare facility, or if we can use those criminal charges to then pursue civil commitment, or through diversion services. They told us that they’re using these charges in some cases to get people into treatment. But as you said, the cases that we looked at, we found many where the opposite seemed to be true. Somebody was in treatment, they were arrested out of that treatment, and then they were put in jail and actually put on a waiting list to get back into a hospital where they had been already.
The other thing that they noted is that it’s also about accountability. It’s also about, for the health care workers who are being harmed, showing that that’s not OK and that there are consequences for that.
Miller: Charging someone is just the beginning of the slow grind of the criminal justice system. What happens as these cases make their way through the system?
Thompson: So when you’re charged with a crime, you have to be found competent to stand trial. That means that you are mentally capable of understanding the charges against you, helping your public defender or helping your attorney with your case, and showing up in court and knowing what’s going on. And not surprisingly, in a lot of these cases, people are found incompetent to stand trial, they are so mentally ill that they can’t actually proceed with their case.
So then that means that someone has to be potentially sent to a state hospital to be “restored.” But the problem in Washington and in many states is that there’s such a long wait list to get into that competency restoration treatment that it leaves people stuck in jail just waiting for that process. So these cases can stall for long amounts of time, they were often dismissed because someone could never reach that level of competency to be able to be tried. And in those cases, all that really happened was someone spent some time in jail, had their cases dismissed, and potentially got sicker in the meantime.
But I also want to note that that’s not the case for all of them. Even in cases where it was very clear that someone was in a serious mental health episode while this was happening, maybe they were on an involuntary treatment order at the time, we still saw people ending up with felony charges because of those cases. Or someone might plead down to a misdemeanor conviction and then have that on their record.
Miller: So if this law is not necessarily working as intended, what are other options? What are evidence-based policies that could prevent violence in health care settings?
Thompson: We talked to a lot of health care workers on this story, and people were mixed about how they felt about these felony criminalization laws. But things that people were not mixed about is all of the other things that we know that can help prevent violence against health care workers in the first place. The biggest one is staffing. If you have a better staffed facility, that means that you have more backup with really difficult cases. It means people aren’t waiting as long, which we know can lead to them being more agitated. It can cut down on wait times for people in waiting rooms. So higher staffing is a big one.
More preventative mental health care. We talked to one official from a nursing union here in Washington who said “when I look at this data that you found, 75% of these people, maybe we could have helped them before they got to that point of assaulting a nurse.” We know that there’s a huge crisis in the mental health care system across the United States right now. So more preventative mental health care seems to be a big part of this.
Miller: Christie, thanks very much.
Thompson: Thanks for having me.
Miller: Christie Thompson is a staff writer for the Marshall Project. Her recent reporting found that Washington’s law intended to protect health care workers is leading to prosecutions of people with severe mental illness.
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