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Panel studying violence against emergency room workers
Ashley Krus keeps track of patients registration on her computer cart inside the Northeast Georgia Medical Center’s emergency department.

The patient had already given police trouble, and what happened next would leave an indelible mark on the young nurse attending to her.

The woman lunged off a table in the emergency room at Northeast Georgia Medical Center and wrapped both her hands around the neck of Kay Hall, as she was about to give an injection.

“As I was drifting away into loss of consciousness, I was thinking I was fixing to die ... and I have a 3-month-old child I’m never going to see grow up,” said Hall, a registered nurse who is now serving as operations manager at the hospital’s ER.

Police finally used a nightstick to subdue the patient. By then, the damage to her nerves was done and Hall struggled for a week as to whether to return to work.

Not only did she come back, but she has stayed in the ER the past 30 years. And now she serves as a Gov. Nathan Deal appointee on a legislative joint study committee addressing the very thing that haunts her still: violence against emergency room workers.

A resolution approved by the General Assembly earlier this year created the committee to study the issue and recommend any actions or legislation it “deems necessary or appropriate.”

The resolution states that more than 80 percent of all hospital staff have been assaulted at least once in their career.

“In 2013, an emergency department nurse was seven times more likely to be injured in the line of duty than an on-duty police officer,” said Van Haygood, a registered nurse and NGMC’s emergency room director.

“There are cases where the argument would be that (the patient) didn’t know what they were doing, and those are gray (areas) to maneuver through.

“But it happens almost daily ... where somebody is hit by a patient in here,” said Hall, who starts to choke up as she talks about nurses’ role in the ER. “I’ve been hit, had my hair pulled, been pinched to the ground by an elderly patient with Alzheimer’s.”

And NGMC operates one of the state’s busiest ERs, seeing 110,000-112,000 patients per year in a space that’s designed for 70,000 patients per year, Haygood said.

The hospital’s ER also serves as a trauma center that treats more serious injuries than it once did. That designation, bestowed by the state in December, adds one or two cases per day.

However, most health care officials say the problem of ER violence isn’t confined to the state’s busiest ERs.

“It’s a statewide issue,” said Kevin Bloye, spokesman for the Georgia Hospital Association. “It has caused frustration and anxiety among many health care workers.”

A large part of the problem is an inadequate mental health care system, he said.

A chart prepared by NGMC officials for the legislative committee also hits on that point. Mental health “budget cuts are forcing drug addicts, alcohol abusers and psychiatric patients into emergency rooms, fueling an increase of violence against health professionals,” according to the chart, which shows expected cuts in most U.S. states, including Georgia.

Also graying the issue are the reactions and behavior of patients, family or friends who have just gotten bad news, such as an unexpected death or diagnosis, the presentation points out.

“Should we expect verbal and physical acting out?” one slide shows. “Yes, in some situations.”

Plus, there’s general stress of being in a busy ER.

“Your 90-year-old grandmother may need to be admitted and you may not take it very well when I tell you it’s going to be 10 hours before she gets a bed upstairs,” Haygood said. “We can’t give you a bed we don’t have.”

But there are clearly serious and criminal infractions, such as the one Hall experienced as a young nurse.

“When a patient is being extremely aggressive, that’s when they’ve crossed the threshold and they’re no longer a patient,” said Mike Raderstorf, the hospital’s director of security services and emergency preparedness.

“That’s when they’re a citizen committing a crime and that’s what we want to talk to the legislators about.”

In Georgia, “it’s up to the individual health care provider (as to whether) they want to press charges,” Raderstorf said.

“We need to allow the organization ... to tell people (violence) isn’t allowed on our property and if you do it, you’re going to be prosecuted. Other states that have implemented similar laws have seen a decrease in the amount of workplace violence on their property.”

“As we did our homework, this is an issue across the United States,” said Deb Bailey, director of government affairs for the Northeast Georgia Health System.

She said the hospital approached state senators Butch Miller, R-Gainesville, and Renee Unterman, R-Buford, and asked for a study committee on the issue.

“We certainly didn’t have the answer to it, but we wanted to see … what were our opportunities to remedy this,” Bailey said.

One possible solution calls for making the criminal charge of assault on an emergency room worker a felony.

“Health care workers, by and large, are kind, compassionate, caretaking people, and I think they have grown very immune to the fact that this goes on in their environment and are very accepting of it,” Bailey said.

“There’s never been a realization that it could be any different.”

That was certainly the case when Hall was attacked so many years ago.

“That was a time when you didn’t file charges,” she said. “You just accepted that was a part of your job.

“There has to be some (law) with teeth that everybody is aware when you commit a violent act against a health care worker, there will be repercussions.”

Miller said, “Ultimately, as far as the committee work is concerned, all I want to do is improve the safety and lessen the vulnerability of the health care worker or other patients that are in the hospital.”

So, for the public, new laws could have a couple of key impacts. First, guard your behavior as best as you can when you enter the ER.

“Just because you’re in a stressful situation doesn’t mean you can act violently toward the people taking care of you,” said Melissa Tymchuk, NGHS spokeswoman.

“There are people who do that and use that excuse, but they’re very cognizant of what they’re doing and they’re using threat and force to get what they need,” Hall said. “And that can’t be tolerated.”

But also the hope is that, by extension, the general public is safer if those treating patients are safer.

“If the public knows that they can come to this front door and be assured that, if there are those types of things going on, they’ll be dealt with so that their visit is safe,” Hall said.

The legislative committee also is planning meeting at Habersham Medical Center in Demorest and Grady Memorial Hospital in Atlanta, Miller said.

The committee must report its findings by Dec. 2.

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