As COVID-19 cases increased, so did attacks on health care workers, documents show

Reported instances of threats or verbal abuse went up 13% from 2019 to 2021 at the state’s four largest health care systems.

(Rick Egan | The Salt Lake Tribune) University Hospital, on Wednesday, Aug. 11, 2021.

The disgruntled patient walked into the University of Utah urgent care facility without a mask, and when staff gave him one to wear, he left it dangling against his chest.

A security member told the patient that the face covering was important for protecting him, staff and other patients. The man pulled the mask up but left his nose jutting out over the top of it.

A report on the standoff over face coverings describes the ensuing escalation, as the man continued to argue with nurses and other staff members. He lunged toward a medical assistant with his arms raised as if he “was going to hit” the health care worker, the report states. The patient hurled misogynistic profanities at the assistant, threatened to sue and spat in the security officer’s direction as he was leaving the building.

The clash appears among more than 200 pages of incident reports from the University of Utah Health, documenting the harassment and abuse suffered by workers at one of the state’s largest health systems during the pandemic.

The documents echo many of the stories Utah medical providers have been sharing — about patients and families pushing back against masking and or lashing out at them in conspiracy-fueled rants about COVID-19.

“I had several health care workers contact me that said they were the victims of this type of aggression,” said Utah Rep. Robert Spendlove, who sponsored legislation this year to protect hospital and clinic staff. “One of the things that really struck me was they said there’s not only the physical harm but there’s mental harm from having to withstand this kind of abuse.”

The incident reports, obtained by The Salt Lake Tribune through a public information request, show that these conflicts ranged from some minor grousing to physical aggression or threats of violence. Health care workers were accused of being foot soldiers for a political agenda; struggled to calm belligerent visitors; and faced heightened exposure to disease when people with COVID-19 refused to cover their faces.

The increase in workplace violence showed up across the state’s health care systems during the pandemic, not just at the University of Utah Health, according to data collected by the Utah Hospital Association.

Within the state’s four largest health care systems, reported instances of threats or verbal abuse went up 13% from 2019 to 2021, the association found. And the number of times police had to get involved jumped even more dramatically, increasing by 18% between the two years.

Representatives of the University of Utah Health say these conflicts are not the norm within their workplaces but don’t dismiss the impact that aggression and harassment can have on their employees.

“Our staff are a cornerstone of our success as a health system,” said Dustin Banks, director of support services for U of U Health. “If we don’t give the tools for our staff members to be safe, they will leave the workforce. That is not something that we want.”

Treating COVID-19 patients

(Charlie Ehlert | University of Utah Health) Health care workers attend to patients in the intensive care unit at University Hospital in Salt Lake City, Wednesday, March 9, 2022.

The incident reports describe several conflicts that flared up between hospital staff and visitors of COVID-19 patients or sick people who were resisting the medical care they needed.

One patient hit a nurse on her arm while she was trying to perform a COVID-19 test. Other people argued with their health care team about what treatment they would receive.

A man who was in the hospital with coronavirus became confused and demanded to leave, even though his care team had determined it wouldn’t be safe. The patient shoved an aide and cursed at one of the nurses who was giving him a low dose of sedatives.

The records show there were conflicts over oxygen masks, with one coronavirus patient complaining that the supplemental oxygen made his belly “blow up like a balloon.”

Another time, the daughter of a patient with COVID-19 rushed into a critical care unit without permission and was going from room to room looking for her father. When staff members tried to stop her, she hit one of them and screamed: “You people gave my father COVID. I’m going to kick your asses.”

And even when the disagreements weren’t directly about coronavirus, the disease made arguments more dangerous, the records show.

One report describes an interaction between security staff and an irate woman who was walking from car to car at a hospital, yelling that she needed a ride. Because she wouldn’t stop screaming, the security officers began walking her off the property while she mocked and threatened to cough on them.

They later learned she’d recently been diagnosed with COVID-19.

Mask fights

(Francisco Kjolseth | The Salt Lake Tribune) A sign encourages people to continue wearing masks on the University of Utah campus on Tuesday, Nov. 30, 2021.

Mandatory masks were among the most common sources of pandemic-related friction between health care workers and patients or visitors, the University of Utah Health records suggest.

For instance, a woman at an eye center refused to wear a face covering, telling the staff that masks were “all an experiment.” Others blew off the rules and argued they didn’t have to don a mask because they’d already been vaccinated or because they believed it would cause health problems.

One man declared that he was exempt from masking and would get a stroke if he covered his face. When he finally relented, he warned that if he had a health complication because of the mask, the hospital would “hear from his attorney.”

Hospital workers told security about a patient who — angry that she had to wear a surgical mask rather than a mesh one — ripped through a provided package of face coverings and contaminated all of them. She then threw the box at an employee’s head.

In one document, a pair of visitors wouldn’t comply with the hospital’s masks even though one was unvaccinated and the other had tested positive for COVID-19 just a few days before.

Several of the conflicts described in the records escalated to aggression or threats of violence.

The husband of a cancer patient who was getting an MRI exploded at medical staff who asked him to put on a mask and began yelling and swearing at the workers and another patient in the waiting room.

The man “made everyone feel in danger and unsafe when he stood up” and got in the face of the hospital workers, according to the report.

Security officers were so alarmed by the man’s aggressive behavior that university police led him off the property. They decided he could drop his wife off at the hospital in the future, but he wasn’t allowed to enter the building for her subsequent treatments.

Another time, a man wearing a gaiter mask became enraged when hospital workers told him that it wasn’t an approved face covering but told him he could contact the university offices to ask for an exemption. A security officer told the man that if he wouldn’t comply and wasn’t at the medical center for an appointment or emergency, he needed to leave.

“I’d like to see you try,” the man mumbled, according to the report.

As he was leaving the building, the man apologized to one of the officers for getting angry. But he continued to criticize the center’s customer service manager, pointing to a pocket knife on his cargo shorts and suggesting he might have used it if the security officers hadn’t arrived.

Finding solutions

Health care workers nationwide are five times more likely to be injured because of an on-the-job attack than people in other industries, and they’ve been experiencing growing levels of aggression over the last decade, according to federal labor data.

Banks said the University of Utah Health has been proactive in tamping down these incidents, launching a program to send multidisciplinary behavioral response teams into potentially volatile situations. The teams typically include a security staff member, nurses and a social worker and focus on non-violent responses when a patient or family member begins acting aggressively, he said.

The team receives a briefing before heading into the situation and chooses one point person to do all the talking during the encounter, with the other members standing by for support.

“We have found that is incredibly successful,” Banks said.

To head off these flare-ups, the university’s security officers also make rounds through the hospitals every day to check in with the nurses and help prevent patients from becoming agitated in the first place.

But the pandemic has exacerbated hostilities, with the rancorous fights over public health measures such as vaccines and masks, says David Gessel, executive vice president of the Utah Hospital Association.

“That became a proxy for a lot of people in feeling like … with the pandemic, that they had no control in their lives or they didn’t like where things were going or were just fed up,” he said.

Urged by state health care leaders to help stem this rise in violence, Utah lawmakers earlier this year passed a bill that would stiffen penalties for assaulting medical providers or hospital staff.

Previously, state law only enhanced criminal penalties for attacks against health care workers if they were “performing emergency or life saving duties” at the time of the assault. But with the changes brought forward by Spendlove, someone could face increased repercussions for harming nurses, doctors and other hospital staff whenever they’re at work, regardless of the care they’re providing.

A handful of lawmakers raised concerns about offering special protections to a particular profession, and Spendlove said he’s generally against these types of carveouts. But health care workers are essential employees, he notes, and they’re also legally prohibited from turning away people who need help.

“So these workers are essentially forced to care for these people that may be abusive or aggressive,” the Sandy Republican said. “I think they definitely merit and deserve an extra layer of protection.”

As he prepared his bill, Spendlove says he heard alarming stories about attacks in health care settings, including a nurse who suffered a concussion after being assaulted in the workplace.

Gessel said even with the jump in workplace violence, attacks are still relatively uncommon in the state’s hospitals and health clinics. And he recognizes that hospitals are often reluctant to speak out about harassment and abuse toward employees, not wanting to make people feel uncomfortable or fearful walking through their doors.

“We want the public to feel like they can come, and it’s a place of healing and hope and health and safety,” he said.

He’s also optimistic that as the pandemic recedes, so will some of the anger and aggression toward medical providers.

Spendlove’s bill, which took effect in May, contains a five-year sunset provision — meaning it will go away at that point unless legislators extend it. Gessel hopes by that time, the state won’t need it anymore.

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