Emergency Room Violence Is Getting Worse

Dr. Avir Mitra, emergency medicine specialist at Mount Sinai Hospital in New York City, remembers not being able to sleep one night. Thoughts from the day were especially terrifying as a man with a bad back had demanded an MRI and wasn’t going to get one.

The man was getting aggressive, and Mitra was concerned as he got between the man and a nurse about what might happen in the minute or two before security arrived.

Mitra said that kind of incident occurs about every two weeks at the hospital where he works in the emergency room. It’s a trend all over the country: doctors and nurses being attacked violently by patients with no consequences.

The situation has gotten progressively worse over the last five or so years, and on March 22 doctors and nurses told Congress they’d had enough. Representatives from the American College of Emergency Physicians, the Emergency Nurses Association and the American Nurses Association met on Capitol Hill to ask for passage of legislation to mitigate the frequency and severity of workplace violence in health care.

“It’s definitely gotten worse,” Mitra said. “I’m five years out of residency so I’ve been experiencing it for eight years now, but it seems like something definitely changed. I don’t know if it was during the pandemic or what, but things have gotten worse for sure.”

Mitra said part of the problem is that it’s been normalized and that there are no consequences for someone assaulting a doctor or nurse as there are in other situations.

“It’s the one place that I can think of in the country that you can walk into and just punch a worker in the face and the response is something like, ‘Okay, we’re sorry that something upset you, do you want a sandwich?’” Mitra said.

The groups that visited Congress highlighted the importance of passing current bills, including the Workplace Violence Prevention for Health Care and Social Service Workers Act and the Safety From Violence for Healthcare Employees Act.

And they cited statistics, such as that the rate of serious injuries related to workplace violence is six times higher for hospital workers than for all other private-sector workers in the United States. Studies have also shown that emergency nurses and other members of emergency care teams experience a violent event about every two months on average.

Two years ago a man in the waiting room of the emergency department pulled out a gun and shot a patient at New York City’s Jacobi Hospital. At Mount Sinai they’ve installed metal detectors and deployed police at the hospital, but that hasn’t stopped the violence.

“We do have security, most places have security, but what can security do?” Mitra asked.

He said when he first started, security wasn’t allowed to put hands on a patient. “So that can be a very scary thing when a patient is trying to physically hurt you and security is standing next to them trying to convince them to leave. It’s a very scary thing when it happens to you.”

Mitra said he and other medical professionals would like to see consequences for violent actions for those who should be able to control themselves. He said emergency physicians are trained to handle episodes from medically influenced people or those with a psychiatric disorder, and for those there is understanding.

“People with medical conditions or maybe they have a developmental delay or they’re demented — those people can get physically aggressive and we have to deal with that,” Mitra said. “The things that bother us the most are the people who are angry because they are waiting too long and threaten to kill you, or assaults from people who are not medically or psychologically compromised for them to be acting this way. We have to say, ‘You can’t do this to people.’”

Mitra said the violence breeds burnout in staff and can lead to medical personnel seeing patients in a negative light. It also makes it hard to recruit the best medical students to do emergency room work. As an assistant professor of emergency medicine at the Icahn School of Medicine, Mitra is eager to share with his students the pride he has in emergency medicine and wants the best students to join him in the field.

“It’s hard when a med student can go and become a dermatologist and have a nice clinic with plants all around and I bring them into the emergency department, and they see someone threatening someone’s life or patients calling you a racial slur,” he explained. “It’s degrading and makes the specialty a really hard sell.”