ER doctors speak out against growing physical assaults

Two new surveys find that ER doctors are increasingly assaulted, both physically and verbally. They want legislation to protect them and hospitals to support them.
by Avichai Scher /

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When Dr. Leigh Vinocur was a resident in the emergency room of a big hospital in the East, a patient popped out of his bed and choked her, clawing his fingers into her neck. He was screaming that his high was ruined after doctors reversed his overdose with Narcan.

“I thought I was going to pass out,” Vinocur told NBC News on Tuesday. “I was struggling to get away when a radiology technician managed to get him into a chokehold.” The attack left her with strangulation marks on her neck and popped blood vessels in her eyes.

“People think doctors facing violence is something that happens in war-torn countries, but it’s all too common here,” Vinocur said.

“I can’t take care of someone else when I’m scared to be there.”

The American College of Emergency Physicians released the results of a survey Tuesday showing a rise in verbal and physical assaults on ER doctors. The group commissioned a poll of more than 3,500 ER physicians across the country in August and found that 47 percent reported being physically assaulted at work. Over a quarter of those said that assaults happened more than once a year and that they were physically injured. Doctors were hit, punched, slapped and spit upon — almost always by patients, but sometimes by patients' relatives and friends.

Nearly 70 percent said violence had increased in the past five years.

A second survey, published Tuesday in the Annals of Emergency Medicine, looked at ERs in Michigan. It found that 72 percent of ER doctors in that state reported experiencing violence in the past year, and almost 22 percent said they are constantly fearful, up from just over 9 percent in a similar survey in 2005.

“Emergency physicians across all demographics experience various forms of violence and are increasingly concerned about becoming a victim of violence,” Dr. Terry Kowalenko, an emergency physician in Michigan and co-author of the Michigan survey, said in a statement. “Despite increased risks, our research found that there is very little published on topics such as situational awareness, verbal de-escalation, self-protection techniques or weapons awareness for emergency physicians to use.”

Vinocur, who has over 20 years’ experience as an ER doctor and administrator, said a number of factors make ERs a risky place to work. “Patients coming to the ER are generally in a vulnerable and volatile state,” she said. “They’re often on drugs or the victims of gang or domestic violence, or need to be in a psychiatric facility.”

It presents a dilemma for doctors who want to help but are increasingly unwilling to accept violence as part of the job.

“We don’t want to police our patients, we feel compassion for them,” said Vinocur. “But do you know of any other workplace where employees just accept being attacked?”

The ER physicians group is advocating for a number of solutions. It wants state-level laws to make assaulting health care workers a felony, just like assaults on police and transit officers, and increased security. It also wants individual hospitals to consider adding metal detectors.

But the group also stressed that there needs to be a culture change among health care workers who underreport assaults, and hospitals that often don’t offer support. The survey found that 70 percent of those assaulted said their hospitals had responded to the attacks, yet among those whose hospital responded, only 3 percent said security officials actually pressed charges.

Speaking at a news conference on Tuesday, Dr. Vidor Friedman, president of the ER physicians group, said that in his 30-year career, he had been violently assaulted three times. Each time, his hospital asked him not to press charges. “Where else does that happen?” he asked.

The Emergency Nurses Association has also sounded the alarm on this issue. Its president, Jeff Solheim, an ER nurse for over 20 years, told NBC News that he has been physically assaulted several times in his career. In a 2011 survey, the nurses association found that over 54 percent of ER nurses reported being physically assaulted or verbally abused by a patient in the past seven days.

Solheim rejected the notion that the assaults are primarily carried out by people unaware of their actions because of substance abuse or mental illness.

“I had to tell a family that their father died, and the son pushed me against a wall and banged my head,” he said. “Another time I was putting an IV into a college-aged woman who was mildly inebriated, and out of nowhere, she punched me in the face.” He didn’t report the incidents, he said, because “back then, it wasn’t an issue.”

Both Solheim and Vinocur said that beyond physical assault, verbal assault is an almost daily occurrence. “I doubt any ER nurse gets through a shift without being sworn at and called terrible things,” said Vinocur.

“We need the public to stand alongside us so we can feel safe going to work,” said Solheim. “I can’t take care of someone else when I’m scared to be there.”

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