Disruptive Patient Behavior: Balancing Patient Rights and Protection for California Emergency Workers

Abstract

Emergency Department nurse Jessica Leigh Taylor recounts an encounter in which a patient threatened to kill her.  “Grabbing my hand he squeezed it until I thought it would break. It took several staff members to restrain him.  I will never forget how he looked into my eyes and smiled as I screamed in pain.”   The police arrived and Jessica provided a detailed statement but the patient was not arrested as his attack had not resulted in “serious bodily injury.”  As defined by California Penal Code§243 serious bodily injury involves impairment of an individual’s physical condition.  California Penal Code§ 243(b) makes “battery causing serious bodily injury against peace officers, firefighters, emergency medical technicians, lifeguards, security officers and animal control officers engaged in the performance of his or her duties, whether on or off duty, punishable by a fine of up $2,000 or imprisonment not exceeding 1 year in county jail.”  However, Penal Code §243 only applies to physicians and nurses during the provision of emergency medical care “outside” a health care facility.   This confirms the already looming belief that violence within the hospital comes with the job. 

Several states have already answered the call for increased penalties for those who assault health care workers.  But California health care workers are not afforded the same legal protections as police officers and other public servants.  While some states have failed to pass laws that would better protect nurses, others have by classifying the assault of a nurse as a class “D” felony.  California is in need of legislation that protects health care workers by increasing the penalty for individuals demonstrating acts of aggression.  California emergency workers also need greater support from healthcare institutions and increased knowledge about their rights.  As concluded in a 2009 study conducted by Smith et. al, of violence in U.S. emergency departments “without legislative action at the state and federal level and innovative strategies at the hospital and department level, there can be no realistic hope of significantly decreasing ED violence.”

This study will focus on violent and disruptive behaviors in the emergency department as it is one of the most vulnerable settings for workplace violence.  This paper begins with an overview of the ineffectiveness of California legislature in protecting emergency personnel.   Part I begins by discussing current legislation and where it falls short in its efforts to protect workers.  Part II provides background of the increasing problem of disruptive behavior in the emergency department.  Part III describes the establishment of patients’ rights and offers some examples of how they sometimes impede the emergency worker’s right to a safe work environment.  Part IV defines disruptive behavior and identifies contributory factors. Part V examines California law and how it fails to protect emergency department personnel by increasing penalties for assaultive and disruptive individuals.  In Part VI, the study will determine the degree to which California legislature pales in comparison to that of some other states and countries.   Part VII evaluates the health care worker’s attitude about reporting disruptive behavior while Part VIII explores what California healthcare organizations are doing to support and protect workers.   Part IX of the study intends to prove the extensiveness of disruptive behavior by demonstrating the financial and staffing implications of workplace violence.  The study concludes with Part X by suggesting legislative efforts critical to California’s ability to offer greater protections.