Hospital ER violence is rising, workers fight to make assault of a provider a felony

By Emily Schabacker

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    BILLINGS, Montana (Billings Gazette) — When Dr. Jamiee Belsky got a call that shots were fired at her place of work, her stomach dropped. Carefully speeding through stop signs and red lights, she arrived at the scene as quickly as possible. It was a busy night at the Billings Clinic Emergency Department when two rounds of gunfire echoed through the lobby.

A woman seeking help for suicidal ideation allegedly snuck a handgun into the ED on Oct. 16. In a triage room, the woman fired a round into her abdomen before a police officer on the scene shot her in the face.

Earlier this year, an inmate receiving treatment at Billings Clinic took a nurse hostage, grabbing her by the throat and threatening to kill her. The nurse managed to reach the panic button that every Billings Clinic employee began clipping to their scrubs earlier in the year, said Belsky, Clinic’s emergency department director.

Following a nationwide trend of increasing violence in EDs, the phenomenon has taken a turn in Montana’s hospitals. Once saluted as heroes during the darkest months of the pandemic, health care workers are now facing violence and aggression on a daily basis.

Since 2020, Billings Clinic has made huge investments in new safety and security resources for staff and patients, said Zach Benoit, a community relations employee at the Clinic.

Workplace violence has become so commonplace in emergency departments that many employees now feel verbal and physical assaults on ED doctors and nurses is now part of the job.

“I don’t think you’re going to find an emergency physician or an emergency nurse who hasn’t at some point in their career been assaulted,” said Dr. Nathan Allen, a member of the Montana Chapter of the American College of Emergency Physicians. “And you won’t (find an emergency physician or an emergency nurse who hasn’t) been either verbally abused or threatened within the last few months.”

Increased aggression is a national trend, and Montana where state laws allow any person to conceal carry a weapon without a permit is no exception.

The catalyst for the increasing violence in EDs is two-fold, according to providers throughout the state. The first being the societal strain, stress and the spread of misinformation during the pandemic. Distrust in health care caused a flare of aggressive behavior that still lingers.

Separate from the pandemic is a severe lack of mental health resources that has led to pervasive untreated mental illness both nationally and locally. Often masked with a substance use disorder, emergency physicians say that usually assaults come from people under the influence of drugs or alcohol.

Pandemic related violence Allen has been struck by patients, sustained a cut from a patient during a restraint and been threatened with violence against him and his family. Both verbal and physical assaults have increased since the pandemic spread over Big Sky Country.

A national survey found that 66% of emergency doctors report being assaulted in the last year and more than a third of respondents had been assaulted more than once, according to American College of Emergency Physicians. Most physicians, 85%, up from 45% in 2018, have noticed the rate of violence in EDs has increased significantly over the last five years.

State specific data wasn’t included in the survey, but Allen said his colleagues in Montana share similar experiences.

Nurses, who provide direct bedside care are at an even greater risk of assault than physicians.

Before the pandemic, Montana nurses were five times more likely to be assaulted in their place of work compared to any other state, said Vicky Byrd, CEO of Montana Nurses Association. And since the pandemic that number has only increased.

“You ask someone if they’ve had their COVID shot and they get aggressive with you,” Byrd said. “The misinformation has added to the anxiety.”

Focus on security Over the last three years, Billings Clinic has dedicated more than $500,000 in new security measures and technologies.

The addition of panic buttons has already proved to be worth the expense. When pressed, the provider’s exact location is shared with security personnel.

Now, the Clinic funds three Billings Police Department officers in order to have an on-campus BPD presence every day of the week. And certified security team members offer self-defense classes and training to Billings Clinic staff

Metal detectors have been installed at the ED doors, regularly stopping visitors from carrying in firearms, pocket knives and other weapons.

The ED has its own lockdown system that can close off one area from the rest of the hospital.

Indicator lights are turned on above doors with aggressive patients, and now the ED staff will spend more time focusing on safety protocols, the police-involved shooting being a stark reminder to keep staff up to date with the safety measures in place.

More than 700 security cameras dot the ceilings throughout each of the Clinic campuses. All are connected to the dispatch center and can live stream to local law enforcement in the event of an emergency. And more are added every year to control access and to increase security presence and awareness.

So many new technologies and monitoring systems have been added that a full-time position was created in order to have an in-house security technician available at all times.

“The number of times we’ve had to re-write our list of…the things that are in place, the safety measures, like it is just like every month,” said Brad Von Bergen, Billings Clinic ED manager.

Von Bergen has been a registered nurse at the Clinic for 30 years. He has seen violence play out in the ED for decades, but in recent years he’s watched the safety needs evolve.

Legislation Montana is one of 16 states that has not made assault of a health care worker a felony crime, akin to assaulting a law enforcement officer. But it’s not for a lack of trying.

Since Byrd started working for MNA in 2014, the organization and others have brought some sort of ask to legislators to heighten penalties for assault on health care workers. Once in 2015, again in 2017, in 2019 and in 2021.

In 2017, more than 100 nurses gathered to support the bill and shared stories of being attacked while on the job, according to previous reporting by The Gazette. But the bill was tabled after a motion by Rep. Theresa Manzella. She told the committee that nurses weren’t using avenues available to them to report assaults, and therefore there wasn’t enough data to support the claims.

Others told Byrd that they didn’t want to add another protected population to the list, which includes police dogs, sports professionals, judges and more.

Many attacks in the hospital go unreported because of a belief that reporting won’t be taken seriously or won’t be prosecuted, Allen said.

“It’s going to be difficult to find accurate, objective numbers on the physical assaults of health care workers because many of them go unreported. Some may go unreported because people have falsely decided that it’s part of the job,” Allen said. “Being hurt while you are at work should not be part of the job.”

During the 2023 legislative session, ED providers plan to rally once again behind a bill that would make it a felony to assault a health care provider in Montana. And MNA will revive the Your Nurse Wears Combat Boots campaign, which advocates for workplace safety for health care workers.

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