Anyone who attacks a hospital worker anywhere on hospital grounds could be charged with a felony starting Dec. 1, when a new state law takes effect that supporters call a needed response to increases in such incidents.
However, opponents say the legislation could have unintended consequences for patients experiencing mental illness, given the harsher sentences that accompany a felony charge.
Emergency departments are the wrong place for people in mental health crisis, but they have nonetheless become a frequent safety net, said Julie Henry, a spokeswoman for the North Carolina Hospital Association.
The measure passed by large margins in both houses of the General Assembly and was signed into law by Gov. Pat McCrory last month. It comes as hospitals are seeing more patients with behavioral health concerns, substance abuse, or a cocktail of both, according to sources including the National Alliance on Mental Illness.
81 number of attacks against hospitals workers across WakeMed in 2014
Earlier this year, the lack of psychiatric beds caused WakeMed to close its emergency department to non-serious cases for more than 3 hours because it was crowded with 65 psychiatric patients. WakeMed reported 81 attacks against hospital workers across the hospital system in 2014.
“We can’t stop the violence,” said Barb Bisset, executive director of WakeMed’s Emergency Services Institute. “We can do early detection, we can try to do as much prevention as possible, but we can't stop it.”
Ann Akland, a member on the board of directors for Wake County’s chapter of the National Alliance on Mental Illness, said hospital workers don’t deserve to be attacked on the job. However, she doesn’t see how a law expanding penalties for attacks against them benefits anyone.
“I think it’s a sad commentary on the stigma and lack of insight into what mental illness really is,” Akland said.
Effect of the law
The new legislation expands on a law that makes it a felony to attack emergency personnel.
In the 2013-2014 fiscal year there were eight convictions in North Carolina under current law, which specifically concerns nurses and physicians in emergency departments, according to data collected by the state Sentencing and Policy Advisory Commission. Because there is no data indicating how many non-emergency personnel have been attacked at hospitals in the past, the commission could not predict the effect of the new law.
Dr. Linda Butler, chief medical officer for Rex Healthcare, said reports of violence by patients and others come from staff across all departments. But every incident is different, and a certain amount of violence is common in the hospital setting, as when patients with dementia become confused and lash out.
Attacks on health care and social service workers comprised nearly 75 percent of all workplace violence in the U.S., according to a 2011-2013 study by the federal Occupational Health and Safety Administration.
“We need to do everything we can to maintain that hospital environment as a place that delivers safe, quality care,” said Tina Gordon, CEO of the North Carolina Nurses Association.
Experts note that many attacks against hospital staff occur as a result of substance abuse or mental illness. That has put pressure on hospitals to find a way to balance staff safety with the well-being of patients and their families.
“As long as you’re having behavioral-health patients and substance-abuse patients it’s going to happen quite a bit,” Butler said.
The law passed unanimously in the House. Sen. Erica Smith-Ingram, a Northampton County Democrat and a first-time legislator, cast the only opposing vote in the Senate. In an interview, she said she was concerned about a lack of research into how the penalties might affect patients experiencing mental illness.
“I just don’t think that we have done a comprehensive study to find out how that category of people can be protected,” Smith-Ingram said.
The question of possible effects on people with mental illness was brought up, she said. It was dismissed in part because the state sentencing commission, which reviews bills proposing changes to offense classifications, found the bill was consistent with existing laws.
Rep. Josh Dobson, an Avery County Republican and a primary sponsor of the bill, said he supported the new law because it made sense to extend penalties beyond nurses and physicians working in an emergency department. Dobson noted that there are options for mentally ill patients charged with felonies, such as using an insanity defense in court.
“There are still protections in place,” he said. “We weren’t changing the law to interfere with mental health issues.”
Tension in hospitals
Akland said patients experiencing mental illness are spending more time in emergency departments as they wait for a spot in a psychiatric hospital. The delays could be contributing to violence against hospital workers, she said.
North Carolina cut 700 psychiatric beds between 2005 and 2010, according to the Treatment Advocacy Center. Patients in emergency care wait an average of about eight days to be transferred to a state psychiatric hospital, according to 2014 information from WakeMed, Akland said.
Butler, of Rex HealthCare, maintained that many instances of violence have little to do with mental health. In cases where attackers with mental illness are aware of what they are doing, Butler said, they should be held responsible.
This makes the patients accountable for some of their actions.
Dr. Linda Butler, chief medical officer for Rex Healthcare
“This makes the patients accountable for some of their actions, when they can be held accountable,” Butler said.
Bisset said few hospital staff choose to press charges, and are even less likely to seek legal action if they know mental illness played a role in the incident.
Henry said the law is intended to ensure a safe environment. The problem of hospitals dealing with more mental health cases “is such a much larger issue that our state needs to respond to,” she said.