Under the Knife

We must all work together to stop the violence that explodes [in] our emergency rooms.

--President Clinton, State of the Union Address, January 25, 1994

The plum-colored bruises on the left side of Pauline Hanusosky's face have healed since she was assaulted by a patient more than four years ago. But the memory lingers, still fresh in her mind.

It was a Friday at dawn when Hanusosky, the charge nurse at a hospital in north Phoenix, prepared to wrap up an uneventful 12-hour shift in the emergency department (ED). At 5 a.m., emergency technicians wheeled in a stretcher bearing a patient in his late 20s. What began as a routine assessment quickly turned ugly.

Without warning, the patient rose from the stretcher, grabbed an IV pole and swung it in circles around the room. Hanusosky hit a panic button, summoning hospital security. Within minutes, six people had restrained the patient on a bed. Just as things seemed under control, the patient thrust his head backward, hitting Hanusosky's face. The nurse lost consciousness and suffered a severe concussion and internal facial bleeding.

During the next week, Hanusosky received calls at her home from co-workers, urging her to file an assault charge. But she knew that assaulting a health-care worker was a misdemeanor and the offender would be on the streets in less time than it would take for her to fill out the paperwork.

"It made me feel like a human target," Hanusosky says. "There was no legal recourse. I just had to sit and take it."

In the past decade, 106 health-care workers have been murdered in hospitals around the nation. Assaults like the one that happened to Hanusosky have become commonplace in health-care settings, threatening the safety of workers and patients alike. Hospitals, once considered havens, are now grappling with a chronic problem of violence that has spread within their own walls.

* In 1990, a distraught family member entered the ED of a small community hospital in San Diego and opened fired on the staff, killing a nurse and injuring an emergency medical technician (EMT).

* In 1991, the husband of a former patient fatally shot a nurse and held the maternity ward hostage at Alta View Hospital in Salt Lake City, Utah, after his wife received a tubal ligation.

* In 1993, a man seeking narcotics stabbed a patient-care technician (PCT) in the arm at John C. Lincoln Hospital in north Phoenix. The incident helped spark a new state law making it a felony to attack a health-care worker.

* In 1993, a Chicago man stabbed an emergency nurse with a syringe loaded with his own HIV-positive blood.

* In 1993, three physicians were shot at Los Angeles County University of Southern California Medical Center by a patient who thought the waiting times were too long in the ED. One of the victims is now a paraplegic.

* In 1993, a man who had just been treated at a hospital in Michigan City, Indiana, began shooting in a hallway outside the ED, wounding two security guards and a visitor.

* In 1995, a Mesa, Arizona, woman shot up a nurse's station at Valley Lutheran Hospital, injuring a nurse and an ambulance driver.

Emergency workers are especially prone to assault. Round-the-clock exposure to the public makes workers vulnerable to the intoxicated, the disenfranchised, the gang member or the addict seeking narcotics. The number of violent incidents is staggering. At 127 teaching hospitals recently surveyed by the American College of Emergency Physicians (ACEP), 80.3 percent reported staff injury because of violence in the ED over a five-year period and 7 percent described acts of ED violence resulting in death.

By the end of last decade, the Occupational Safety and Health Administration issued voluntary safety guidelines for health-care facilities, where two thirds of all workplace violence occurs. The guidelines were intended to help hospitals and health-care workers handle violent patients and visitors and to improve security measures.

Although some Arizona hospitals have beefed up security in recent years and have provided aggression-control education programs for staff members, their efforts may be lacking. Health-care workers and prosecutors say that Arizona's 1994 law making it a felony to attack a health-care worker is often rendered useless because of a loophole in the statute. And hospitals are often reluctant to press charges because they fear bad publicity.

Allan Morphett, a risk-management specialist for Farmers Insurance Group who conducts national seminars on hospitals' liability, says more needs to be done. "Arizona is under the federal mandates of OSHA, but everybody is like an ostrich with their head in the sand. They just ignore the problem of violence until something happens."

The 24-hour security dispatch center at Samaritan Health System on 12th Street and McDowell Road looks like the cockpit of the Enterprise. A cluster of monitors flashes images from the corridors and stairwells of SHS' four hospitals, while a row of computers monitors fire alarms, distress signals and ED lock-down systems. The $300,000 unit, the only one of its kind in the Valley, was installed three years ago in response to an escalation of violent incidents.