Over a year after workplace violence bill, are Georgia hospitals safer?

Health care workers across the country have reported an increase in violent acts by patients and their families in hospitals. According to a 2023 survey by National Nurses United, nearly half of nurses felt violent incidents had increased in their units over the past year. 

During this time, more than 80% of respondents said they had experienced some form of workplace violence, including behaviors such as verbal or physical threats, battery and sexual harassment.

In response to the uptick in workplace violence in health care, the state of Georgia passed the Safer Hospitals Act in 2023. The bill increased the minimum prison sentence for aggravated assault or battery on a health care worker at a hospital campus, expanding the definition of health care worker to include any employee or contractor working at a health care facility. The law also authorized hospitals to form their own police forces.

So far, there is little evidence of decreased workplace violence in the year since the passage of the bill, said Anna Adams, the chief government relations officer of the Georgia Hospital Association, which worked with state representative Matt Reeves (R-Duluth) as he authored the legislation. But the full impact of the law may not be obvious until more hospitals establish police departments.

Only seven certified law enforcement officers were hired by Georgia hospitals in the year after the new law took effect in July 2023, according to data from the Georgia Peace Officer Standards and Training Council obtained by Duke University researchers.

All of these hires were at Atrium Health Navicent, one of the only health care systems in the state to establish a hospital police department before the new act. The system’s flagship hospital in Macon has had a police presence since the 1950s, when it was known as the Macon Hospital, and in 1975 began swearing in officers through its own police department, authorized in coordination with the city council.

Police departments do not appear on hospital campuses overnight. After a 2013 bill enabled hospitals in Indiana to form police departments, the first hospital to do so did not swear in its first class of officers until April 2014.

Adams said that since Georgia’s law went into effect in July, during the middle of a hospital’s budget year, health care organizations have only recently begun to set aside resources for a police force. She expects that the sprawling network of Piedmont hospitals in the state will form a police department soon, as the system had advocated for the ability to hire certified officers that were eventually included in the Safer Hospitals Act. 

This prediction was echoed by Jonathan Del Castillo, a lieutenant public safety officer at Piedmont, who said the system could have a police department in two or three years.

Police officers hired by a hospital differ from traditional security guards because the former attend a police academy to be certified by their state’s Peace Officer Standards and Training council, Del Castillo explained. This certification allows officers to perform arrests and grants them qualified immunity in the course of their duties.

Existing security teams can call local police to make arrests, but having law enforcement on site could lead to faster response times as officers are more familiar with the facility and have a rapport with staff, according to Jesse Crowder, the police chief for Atrium Health Navicent. 

While he believes there is a place for police in hospitals, Del Castillo questioned the need for a “fully fledged” department of armed officers. He said such a show of force could be bad for optics and that there is little evidence that police departments curtail hospital workplace violence.

Del Castillo said hospitals often hire off-duty officers from local police departments as security guards, allowing them to ramp police presence without forming a hospital force. Individual police forces may track their officers’ secondary employment, but the Georgia POST Council does not keep records of these arrangements, making it hard to determine whether off-duty officer contracts are more common as the state’s hospitals attempt to tackle workplace violence.

Existing security forces in hospitals have ramped up their efforts in recent years. Del Castillo said a reorganization of the Piedmont security team this summer created lieutenant positions, including his current role. 

Since the reorganization, officers at all Piedmont facilities are licensed to carry Glock 9 mm handguns in addition to tasers and batons. The Wellstar hospital system has also recently introduced armed guards at its facilities.

Del Castillo expressed skepticism that firearms prevent violent acts, as many patients who act out against health care workers are experiencing a mental health crisis and may not be deterred by an officer with a weapon.

There is little public data about hospital policing, but one literature review concluded police may perpetuate further violence through excessive force, cause psychological distress to patients and compromise the patient-provider relationship. 

While that review did not distinguish between police and security forces, a recent analysis of over a decade of media stories about police violence in hospitals found the roles of hospital police officers, local police and security guards were often intertwined.

A police presence in the hospital “changes the culture of the health care institution,” said law professor Sunita Patel of the University of California, Los Angeles. In 2022, she published a review of law enforcement practices at Veterans Health Administration facilities, criticizing the “health care policing web” that creates unjust outcomes for marginalized patients such as disabled veterans and people of color. 

Patel acknowledged unique conditions that set the Veterans Health Administration apart from other organizations, namely the program’s inability to terminate a patient’s care, that shaped their unique law enforcement approach. Still, she believes most of her conclusions apply to other health care institutions.

Patel cited the Detroit Life is Valuable Everyday program at Detroit Medical Center, which seeks to address the root causes of violence in the community, as one effective violence prevention strategy, though violence on the hospital campus itself is not the program’s main focus.

The debate about appropriate safety strategies for patients and health care workers alike is taking place against a backdrop of increased hospital violence. Adams of the Georgia Hospital Association described the COVID-19 pandemic as “the catalyst” for the rise in violence against health care workers. 

Mistrust and frustration from mask and vaccine mandates may have contributed to this growing violence, according to a 2021 report from the U.S. Department of Health and Human Services assistant secretary of preparedness and response.

Adams observed that attacks from patients and their families have not subsided significantly in the years since the pandemic’s peak. “We’re already experiencing such a huge shortage of health care workers,” she said. “Having them leave the workforce because they’re afraid to go to work and they’re afraid of being attacked is really only exacerbating that problem.”

Last spring, Adams attended the annual meeting of the American Hospital Association in Washington, D.C., where she and her colleagues from other states expressed uncertainty over how to make hospitals safer for employees and patients.

“Nobody seems to have the answer to preventing these acts of violence,” Adams said. “It’s been a tough nut to crack.”