By Rachel Raskin-Zrihen
Contra Costa Times
December 12, 2010

A doctor visit may be becoming a lot more dangerous -- especially for medical personnel -- and local nurses union officials say they want urgent changes made in light of two recent local killings.

Most people don't think of a medical career as particularly dangerous, but they'd be wrong, California Nurses Association-National Nurses United spokeswoman Liz Jacobs said. Union members are calling for tougher safety measures like better lighting in parking lots and security guards in emergency rooms.

"Nurses have more back injuries than truck drivers and a study shows that, like 50 percent of nurses have experienced violence on the job," Jacobs said. "We're introducing some language addressing the issues at (Oakland's) Children's Hospital to be used as a model elsewhere -- things like having a barrier between the exam rooms and the entrance to the emergency room."

Hospital management has issued no official reaction to the proposed enhancements.

But officials of some local hospitals say safety issues are already being addressed and that they're always analyzing procedures.

"At Sutter, the safety and security of our patients, visitors and staff are of primary importance," Sutter Solano Medical Center spokesman Russell Sy Neilson said. "We have policies and procedures in place to protect our staff, and we comply with all the federal, state and local codes as well as The Joint Commission."

Sutter provides training for staff on managing aggressive behavior, "and we conduct drills to practice our response to security issues," Neilson said. "We have security officers on site and we perform annual security risk assessments to identify and correct opportunities for improvement."

But officials acknowledge that hospital workers "see people at their worst, who may be experiencing many emotions" and Sutter officials are "concerned with the limited mental health services provided by the county as well as a reduction in local law enforcement," Neilson said. "In some states it's a felony to assault health care workers, much like fire and police personnel. We would be supportive of measures that would prevent or deter assaultive behavior at our hospital."

Hospital staff attacks

The renewed effort of healthcare workers is partially in response to a series of violent medical-related incidents.

In October, psychiatric technician Donna Gross, 54, of Concord was strangled to death and robbed at Napa State Hospital. Some jewelry and less than $2 cash and a pack of gum were taken.

Gross was allegedly attacked by mentally ill patient Jess Willard Massey, 37, in a hospital courtyard. It was a killing that hospital personnel reportedly say is just the latest in a string of incidents making them feel unsafe.

This was followed days later by the death of a registered nurse who allegedly was assaulted by an inmate at Contra Costa County's correctional facility in Martinez.

A statement from Contra Costa Regional Medical Center Chief Executive Officer Anna M. Roth, confirmed that longtime Contra Costa Health Services nurse Cynthia Barraca Palomata, 54, died of injuries suffered at the hands of new inmate Aaron Nygaard.

Nygaard, 34, of El Cerrito, allegedly faked a seizure, and when Palomata went to check on him, he grabbed a lamp and struck her in the head with it.

And on Nov. 29, a Santa Cruz County inmate escaped custody outside Santa Cruz's Dominican Hospital, using a stun gun on a sheriff's deputy and shooting at a woman who tried to help.

Maurice Ainsworth, 6 feet 7 inches tall and 275 pounds, was reportedly being transported wearing a yellow jail jumpsuit when he punched a female deputy, took her gun, Tased her, and ran with both weapons into a pre-school across the street. He held a teacher there at gunpoint and demanded her car keys.

Ainsworth, who reportedly has a criminal history of vandalism, arson and weapons theft, was recaptured and no one else was injured.

New safeguards studied

CNA's Jacobs said union officials are working on state legislation that will include safety measures for medical personnel in correctional facilities, which aren't included in current laws.

The National Institute for Occupational Safety and Health Administration and the Occupational Safety and Health Administration define workplace violence as any physical assault, threatening behavior, or verbal abuse. Violent behaviors range from verbal harassment to murder. Officials there say healthcare and social service workers face significant risk of job-related violence which sometimes comes from patients and other times, co-workers.

They also say the number of incidents is likely much higher than reported. This may be due partially to the perception in the healthcare industry that assaults are part of the job. It also may reflect a lack of institutional reporting policies, employee beliefs that reporting won't help, or fears that employers may blame assaults on employee negligence or poor job performance, they say.

CNA officials say workplace violence has grown substantially in the past decade.

California passed a law in 1993 requiring hospitals to have a security plan, but it doesn't cover correctional facilities, Jacobs said.

The nurses at Contra Costa County, for example, have called for stronger security measures to protect staff, especially in the jail, psychiatric unit and emergency rooms, Jacobs said. They haven't come up with specifics for the jail yet, Jacobs said.

"Psych units and emergency rooms have seen problems with violence increasing," she said. "It's usually one place in the hospital with access available to the public and there are a lot of potential emotions."

The recession has caused more people to lose jobs and with them, their health coverage, driving them to emergency rooms and creating longer wait times, which can raise tensions, Jacobs said.

"And in the psych unit, you have people who may be off their meds and unpredictable. They're there for a reason," she said.

Though not wanting to "criminalize patients," nurses union officials say stronger laws and penalties for non compliance are needed.

"Metal wands and detectors, maybe," she said. "And maybe there needs to be a barrier between the public and the triage nurse."

Other patients are also at increased risk, she said.

"We can no longer tolerate inadequate security measures which threaten not only RNs and other staff, but also put families and other patients at risk," union president emeritus and longtime Contra Costa County resident Kay McVay said.

The cost of this type of violence includes not just the physical, emotional and mental toll on victims, but also financial loss from insurance claims, lost productivity, legal expenses, property damage and possible staff replacement, McVay said.

The potential for violence is not limited to prison hospitals and other secure facilities, either. Sometimes inmates are escorted for specialized treatments to regular hospitals.

One hospital's experience

Jaime Peñaherrera, a spokesman for Napa's Queen of the Valley Medical Center, which has a state contract to treat local inmates, said inmate patients are always shackled and accompanied by guards.

"For many years, Queen of the Valley has successfully and safely collaborated with law enforcement agencies to provide necessary health care services to area inmates while ensuring the safety and well being of other patients who are also receiving care at Queen," Peñaherrera said. "We continually work with law enforcement officers and welcome their input to review and update our policies to ensure the success and safety of all Queen's patients and staff."

Queen of the Valley Licensed Vocational Nurse Cara Lotz, said she gets a little nervous when inmates are brought in for treatment, shackles and armed guards notwithstanding.

"I don't really feel unsafe, because I'm aware of who the officers are, and they're armed and I know the policies," Lotz said. "I stay prepared and I'm a black belt in Tae Kwon Do and can do some damage myself."

Nevertheless, Lotz said she removes her identity badge, takes safety precautions and "I never turn my back on them."

Lotz and several other Queen of the Valley employees noted that prisoners and inmates of other secure facilities are human and deserve to be treated respectfully during treatment.

But Lotz said hearing about the recent killings frightened her, though as far as she knows there's never been an incident at Queen of the Valley.

"Some of them creep you out, the way they look at you," she said of some prisoner patients. "And when I take their vital signs, I know I'm vulnerable, and I'm relieved when I'm done."

Radiology oncologist Jim Knister said he feels perfectly safe around the prisoner patients.

"We all worked closely with the California Department of Corrections to set up a system that works," Knister said. "We're all careful, we watch out for each other and the hospital plans for any situation."

He said in his experience, the prisoner patients are "cooperative and appreciative."

Registered Nurse Maryianne Flynn-Degoede said she, too, feels relatively safe around the inmate patients.

"The criminally insane are chained and also have medical restraints, so their behavior patterns are expected," she said. "Something must have gone wrong in those (recent, deadly) cases. But ordinarily, I feel safe. They are guarded and have a personal caregiver. And we have a handbook."

Contact staff writer Rachel Raskin-

Zrihen at (707) 553-6824 or rzrihen @timesheraldonline.com.

At a glance

Healthcare professionals are at high risk for workplace violence, a recent study shows. An Emergency Nurses Association survey released in 2009 found that:

* More than half of ER nurses had experienced violence by patients on the job.

* More than a quarter of ER nurses had experienced 20 or more violent incidents in the past three years.

* The healthcare industry constitutes 45 percent of the two million incidents of U.S. workplace violence between 1993 and 1999 -- the highest of all sectors, according to the U.S. Bureau of Labor Statistics.

Source: nursingceu.com

Violence in the workplace includes:

* Verbal threats to inflict bodily harm, including vague or covert threats.

* Attempting to cause physical harm-- striking, pushing and other aggressive physical acts against another person.

* Disorderly conduct, such as shouting, throwing or pushing objects, punching walls and slamming doors.

* Verbal harassment -- abusive or offensive language, gestures or other discourteous conduct towards supervisors or fellow employees.

* Making false, malicious or unfounded statements against coworkers, supervisors, or subordinates which tend to damage their reputations or undermine their authority.

Source: Healthcare and Social Service Workers

Workplace violence at a glance:

* Workplace homicide is the fourth-leading cause of fatal occupational injury in the United States. According to the Bureau of Labor Statistics Census of Fatal Occupational Injuries, of 5,734 fatal work injuries in 2005, 564 were homicides.

* Although workplace homicides attract more attention, the vast majority of workplace violence consists of nonfatal assaults. From 1993 through 1999, an average of 1.7 million people annually were victims of violent crime while working or on duty nationwide.

* Health care and social service workers face significant risk of job-related violence. The Bureau of Labor Statistics reported 69 homicides in the health services from 1996 to 2000. Bureau data shows that nurses, aides, orderlies and attendants suffered the most nonfatal assaults resulting in injury in 2000.

* Workplace violence costs an estimated $55 million annually in lost wages. Lost productivity, legal expenses, property damage, diminished public image and increased security measures add up to billions of dollars per year.

Source: Healthcare and Social Service Workers

Workplace violence risk factors, especially for healthcare and social service workers, include:

* The prevalence of handguns and other weapons among patients, their families, and friends.

* Increasing use of hospitals by police and the criminal justice system for criminal holds and the care of acutely disturbed, violent individuals.

* The increasing number of acute and chronic mentally ill patients being released from hospitals without follow-up care.

* The availability of drugs or money at hospitals, clinics and pharmacies, making them attractive robbery targets.

* Unrestricted movement of the public in clinics and hospitals and long waits in emergency or clinic areas that lead to client frustration over an inability to obtain needed services promptly.

* The increasing presence of gang members, drug or alcohol abusers, trauma patients, or distraught family members.

* Low staffing levels during times of increased activity such as meal times, visiting times and when staff are transporting patients.

* Isolated work with clients during examinations or treatment, often in remote locations, with no backup or access to help. This is particularly true in high-crime areas.

* Lack of staff training in recognizing and managing hostile and high-risk behavior as it escalates.

* Poorly lit parking areas.

Source: Healthcare and Social Service Workers