Local health care providers worry about escalating violence

The word “unthinkable” is often used to describe the terror of mass shootings, but to those who work in the medical profession, the killing of four people Wednesday at St. Francis Hospital in Tulsa, Oklahoma, was distressingly “thinkable.”

Clearly, nowhere is safe these days. Not a supermarket in Buffalo, New York, or an elementary school in small-town Texas, or a hospital in Tulsa. And probably not in the North Bay, either.

“Can a hospital guarantee this won’t happen here? We can’t,” said John Hennelly, president and CEO of Sonoma Valley Hospital.

And that is deeply distressing to the people trained to preserve life and relieve human suffering.

“It is unconscionable that people who dedicated their careers to helping others and saving lives can lose their own, so brutally, in the blink of an eye,” Chuck Kassis, chief executive at Providence Santa Rosa Memorial Hospital, wrote in a statement. “To their loved ones and colleagues, we grieve with you and send our profound condolences.”

Working at a hospital has always included risk — especially in emergency room settings, where the patient population is more prone to mental health issues, addiction and trauma. The numbers bear that out.

According to the U.S. Bureau of Labor Statistics, at least 58 hospital workers died as a result of violence in their workplaces between 2011 and 2016; health care workers accounted for 73% of all nonfatal workplace violence-related injuries and illnesses in 2018; and registered nurses experienced more than three times the rate of those injuries compared to other occupations in 2019.

Since those figures were tabulated, the situation has almost certainly gotten worse, driven in part by the cumulative stress of an ongoing pandemic.

Nearly 45% of registered nurses reported experiencing physical violence at the hands of patients between February and May/June of 2020, and nearly 68% had experienced verbal abuse, as revealed in a survey of nurses published last August in the journal Workplace Health & Safety. The numbers were even higher for nurses on COVID wards.

Separate surveys conducted by National Nurses United found that reports of workplace violence have increased by 119% just since March 2021.

“At the beginning of the pandemic, there was this outpouring of thank-yous from the community, and that has definitely turned,” said Dr. Patricia Hiserote, president of Sonoma-Mendocino-Lake Medical Association. “There’s a lot more anger, frustration and threat of harm toward clinicians.”

But it isn’t just the stress of the pandemic driving erratic behavior. The Tulsa shooting was one in a string of episodes centered on pain mitigation, an issue complicated by the national opioid addiction crisis.

In 2017, an Indiana man killed a doctor who refused to prescribe opioid medication to his wife, then shot himself. Last year, a Minnesota man gunned down five people at a rural health clinic after he was denied opioids.

And, of course, hanging over hospitals — not to mention schools, offices and virtually every other employment setting — is the specter of America’s infatuation with guns, especially semi-automatic firearms.

“It’s always multifactorial, right?” Hiserote said. “So yes, we as a country need to have critical conversations with our government and our legislatures because based on the polls I’ve seen, they’re not representing us well when it comes to semi-automatic guns, and who is allowed to get a gun, what age and background checks.”

Hiserote, who also works as a Kaiser Permanente physician but stressed that she was speaking only as the association president, also noted that the U.S. needs to offer more mental health services. But she is among a growing chorus of health care professionals who are speaking out in favor of gun safety legislation.

Community clinics, where doctors tend to have longer-term relationships with patients, are generally seen as less chaotic than hospitals. But Naomi Fuchs, CEO of Santa Rosa Community Health Center, agrees with Hiserote on guns.

“Automatic weapons in the U.S. are simply far too easy to access,” Fuchs said. “People’s right to live free of the fear of gun violence should come before the right to own an automatic weapon.”

Outside California’s borders, it often doesn’t.

“Nurses report in other states we represent that everybody brings guns everywhere,” said Deborah Burger, who recently retired after more than 45 years as a registered nurse but remains president of National Nurses United. “If you just get the least bit upset, and your rage starts to take over because you’re feeling frustrated, because you’re feeling like you’re not heard or things are not going way thought they would go, it’s a bad situation. And families are paying more and more for health care services, so expectations are really high.”

Not that California is immune to firearm danger.

“Even in Sonoma County, we had a patient bring a gun into a clinic because he thought he was supposed to have it,” Burger said.

“We were doing outpatient sedation proceedings, so there was no reason for him to bring it there. We had to make a provision to get the weapon and lock it up. It was just bizarre that they would think to bring it. I mean, Sonoma County?”

Burger’s group, National Nurses United, wants common-sense gun legislation. But it also wants employers like Kaiser Permanente, Sutter Health and Providence to take more responsibility for creating a safe environment.

Thursday — the day President Joe Biden was set to address the nation on gun violence — the labor organization issued a press release urging U.S. Senators to pass S. 4182, the Workplace Violence Prevention for Health Care and Social Service Workers Act. It would direct the Occupational Safety and Health Administration to create a federal standard requiring health care and social service employers to develop and implement a comprehensive workplace violence prevention plan.

For Burger, a lot of it comes down to staffing shortages.

She said Kaiser Permanente used to do post-op discharge evaluation, for example, to ensure a patient’s home situation was stable before sending them out the door.

“There’s a lot of things hospitals have cut back on, because they don’t make money from it,” Burger said.

Santa Rosa Memorial has taken a wide range of steps to prioritize safety, Kassis said. They include beefed-up security staffing to allow for faster response times in emergent situations; increased training for security in understanding workplace violence risks and verbal de-escalation; and semiannual active shooter drills.

Sonoma Valley Hospital has a formal security presence in the evening and overnight, but during the day it’s up to an administrative leader to intercede in and de-escalate dangerous situations, Hennelly acknowledged. The hospital does have standard emergency protocols that any employee can initiate, including steps to isolate someone acting in a threatening manner.

“We have not had to do that in recent memory, no,” Hennelly said. “I’ve only got 14 months here, so I can’t speak to farther back. But we do training every year on it.”

Regardless of how blame or responsibility might be apportioned, one thing is clear to Burger: The threat of violence, and especially gun violence, is one more factor compounding the stress of overburdened health care workers, and driving many of them from the work they once embraced.

“It absolutely is adding to the moral distress and the moral injury of an entire profession,” Burger said. “It’s all health care workers, social workers, doctors, nurses. The level of violence is taking its toll.”

You can reach Phil Barber at 707-521-5263 or phil.barber@pressdemocrat.com. On Twitter @Skinny_Post.