Three months ago, a woman was kicked in the neck and suffered a serious injury that would require fusion of her entire cervical spine. The grievous injury wasn't the result of a bar room brawl or a public assault that led to an arrest, but a sight that has become all too common: an attack on a hospital worker.
Each year, hundreds of health care workers in Santa Clara County hospitals are punched, kicked, spat on, slapped or worse, state filings reveal. Health care officials say the problem is getting more widespread -- noting a nationwide uptick -- yet some hospital staffers say not enough is being done locally to keep them safe.
Stanford Hospital reported 176 incidents of workplace violence from January through September 2020, according to state data. Santa Clara Valley Medical Center (VMC) had 103 violent incidents, and El Camino Hospital reported 30. Attacks range from no injury at all to serious trauma, but only reflect what was voluntarily reported by victims.
Though working in a hospital may not seem like a dangerous job, nurses and other frontline staff must frequently work with hostile and combative patients, withstanding a hail of more than 9,400 attacks in California in one year alone. These assaults used to be quietly considered part of the job, but new state requirements in 2017 compelled hospitals to start keeping track of every scratch, bite, hit and kick.
These attacks happen around the clock but tend to get worse during busy hours, and almost always consists of a patient attacking a nurse or hospital staff member who has frequent patient contact. Typical injuries include bruising and abrasions, but numerous health care staffers last year suffered open wounds, head injuries and dislocated bones.
Nurse leaders at VMC have raised alarm bells in recent months over what they call hazardous working conditions, and believe COVID-19 has only made things worse. They argue a mix of lax law enforcement and a failure to take seriously the reported assaults has left them feeling vulnerable to being attacked and cynical that the state's data collection means anything.
"The amount of assaults that happen would quadruple if we reported it every time," said Allan Kamara, president of the Registered Nurses Professional Association. "We are such a busy department and when staff get assaulted, nobody is doing anything about it."
Kamara, who works in VMC's emergency department, scoffed that the state data is just the tip of the iceberg. On any given day, he said nurses are getting assaulted between 3 and 5 times in his department alone, and some aggressive patients are downright terrifying to handle. He recalled one incident in which a muscular man, probably 6-foot-7-inches tall, was hopped up on PCP and was going berserk -- standing up with an entire gurney still attached to his back. It takes several nurses to do a "takedown" for a person like that, often leading to more injuries.
Many nurses are less than 5 feet tall and just over 100 pounds, he said, and are hardly equipped to control intimidating patients.
"All they want to do is go to work and do their job," Kamara said. "Yet some of these patients are on PCP, and when they are, they will kill you and they will not know it."
Proactive or complacent?
In 2016, it was clear to Santa Clara County hospital officials that workplace violence was a growing problem. Assaults, while tracked differently at the time, were on the rise, and there was no strong cross-department communication on what more could be done to keep nurses and other health care workers safe.
Coinciding with the statewide efforts, the county drafted a workplace violence task force that sought to hear from administrators to hospitals techs, nurses and janitorial staff. Even one attack on hospital workers is too many, said Carolyn Brown, the county's director of quality and safety, and shows that VMC has room for improvement.
"We really wanted to hear from the front line. There's nothing worse than having a bunch of suits trying to figure out what's happening," Brown said. "We want to be as safe as possible -- no one should come to work and be injured."
What came from these meetings was better violence prevention training, including a system for flagging patients as potential threats. A sheriff's deputy was stationed in the emergency room during peak hours, which acted as a deterrent and led to a drop in attacks. Brown said there was a "major push" to get staff to report all assaults -- however minor -- so that they can be tracked, and that there would be a follow-up after every incident.
"We keep our eyes and ears peeled so if we hear anything, we make sure that the reports get filed," Brown said. "There is no downside. We want to know because we want them to be safe, and we continue to reinforce that with everyone."
But Kamara said he and other nurses have lost confidence, and that filling out an incident report feels like submitting information into the void. Nobody will ever contact you for a follow-up, he said, and it never seems to lead to real changes. The result is that fewer nurses are willing to take the 10 minutes needed to submit a report.
The task force, he said, feels ceremonial at best -- a way for county officials to claim they're taking action.
"That task force has no authority, they can do nothing and the data they collect is so inaccurate," he said.
Hospitals all across California are going through the same process, tallying up violent incidents and trying to solve a problem that’s gone unexplored for decades. Catherine Waalke, president of the nurses' union at El Camino Hospital, said her task force meetings have been amiable and staff seem pretty willing to report all assaults, however minor they may be.
While nurses need to be vigilant, it's important to understand why patients may be lashing out in the first place, Waalke said. It could be pain, a change in medication, Alzheimer's or something as simple as low blood sugar or electrolytes. Lately, she said the loss of having loved ones at the bedside due to COVID-19 restrictions seem to be exacerbating the problem.
"You think about the times we're in, those family members who might have stayed with someone and lessened their anxiety and their fear -- because of COVID they're not there," Waalke said.
A representative for Stanford Hospital declined to comment for this story and would not provide information on its workplace violence incidents. State data shows the bulk of the 176 reported incidents at the hospital occurred in the inpatient rooms (103), the emergency room (26) and the behavioral health unit (26). In six incidents, staff reported unwanted sexual contact.
Trouble in the mental health units
What sets VMC apart from other hospitals across California is the sheer number of assaults taking place in the mental health wards. Nearly 44% of violent incidents reported by VMC between January and September last year occurred in Emergency Psychiatric Services or the hospital's inpatient mental health unit, the Barbara Arons Pavilion.
It's been stressful and exhausting, said Jennifer Hughes, a nurse who works in the Barbara Arons Pavillion. Staff members have been calling in sick because of the stress, and people are putting in double shifts and getting burned out. While she and her colleagues aren't fearing for their lives all the time, it can be scary for long stretches.
"We've had patients who are violent for a month and a half before a medication is changed, and people come up to me during a big patch of violence saying someone is going to die," Hughes said.
Some victims of patient assaults have needed surgeries or been awarded workplace compensation. Hughes said she's been bitten, and one of her colleagues had his thumb dislocated. One woman was beaten in the head with a blood pressure machine until she bled.
"We make pretty good money, but nothing is worth dying for," she said.
Previously, the unit had no security officers or sheriff's deputies, marking a glaring deficiency that wasn't a problem elsewhere in the hospital. Hughes joined her unions' leadership solely for that issue, arguing it was absurd to rely on a security office three blocks away from Barbara Arons.
"The director of my department said unless you want to give up your job, we have no money to hire a security guard for inpatient behavioral health," Hughes said.
But getting help from security and law enforcement has turned out to be a mixed blessing. While it can be a deterrent that keeps reckless patients under control, arrests practically never happen. That means problematic patients with a history of assaults on nurses and nurses' aides will be there for a long time, and there's not much anyone can do about it, Hughes said.
"The deputies will say, 'They're mentally ill, give them medication,' but sometimes it's more than that," she said. "Sometimes they know what they're doing and they aren't going to be taken to jail."
Between January and September last year, only one arrest occurred at VMC, according to state data, and it was in an outpatient clinic.
Kamara, who complained of similar problems in the emergency room, said he understands the optics: Patients are sick or injured and need care, and putting them in jail is an unpleasant solution. But to take such a hands-off approach puts the health and safety of frontline hospital workers at risk, he said, and the last year has shown the consequences. Having a nurse manager who needs seven vertebrae in her spine fused all because she came into work that day is not acceptable.
"Being a nurse is not a waiver to lose your right to health and safety," Kamara said. "All we're asking is when we go to work and do our job, we should be protected."
In the latest bid to bring attention to the problem, Kamara said he has been meeting with the county's top executive leadership and members of the Board of Supervisors. Supervisor Cindy Chavez requested a report diving into the workplace violence data, which came before the board in November. It was deferred for one month, then unceremoniously placed on the consent calendar with no discussion.
Chavez said she and her colleagues are taking the problem seriously, and that staying mum on workplace violence through 2020 is not a sign of disinterest. The attacks, specifically in places like the Barbara Arons Pavilion, are a serious problem, but the staff reports to date have fallen short of diving into the data and coming up with real solutions.
"What's certain is that workplace violence is not to be tolerated, period," Chavez said. "The reason that I deferred it was because I did not believe the (VMC) staff had been responsive to my requests."
The plan is to explore workplace violence in hospitals this year through the county's Health and Hospital Committee, Chavez said, which has a less-packed schedule than the Board of Supervisors and can give the problem the time it deserves.
But to Kamara, the deferral felt like a major blow, and a sign that this wasn't a high priority. Even though nurses have been hailed during the pandemic as "heroes," he said the long hours, stress, burnout and willingness to face violence at work goes underappreciated. And right now, it doesn't feel like the pay outweighs the downsides.
"You are getting paid but washing out your soul -- your normalcy is gone," he said. "These politicians who are in office can never understand that."