It’s long past time to stop the scourge of workplace violence in our community hospitals and health care settings. These are places for health and healing, peace and recovery. They are
staffed and run by the most talented, caring and loyal group of providers and staff anywhere in the world. Violence within their doors is a rampant and unrelenting problem, and we need to address it.
In this week’s VAHHS update, you’ll read two commentaries from providers in our emergency departments about the increased violence they are experiencing, and you’ll read a heartbreaking story about an individual known to cause harm and upheaval in at least three of our southern Vermont hospitals. If you’re a regular reader, these stories are all too familiar to you. In a meeting just this week with our staff, we heard from providers who shared stories of incidences that resulted in hearing loss, traumatic brain injury (TBI) and ripped tendons. I have heard providers who have weathered serving in the military, responding to the Sandy Hook shooting or delivering care at Ground Zero on 9/11 say that their subsequent experiences of workplace violence in health care settings have resulted in PTSD for them. One provider had a family member of a patient threaten to harm him and his children. I could fill multiple columns with stories of horrific, terrifying and completely unacceptable acts of violence. And that’s not all—nearly every single provider and hospital staff member is subject to regular verbal assault. For many, the verbal abuse, threats and hateful, racial and discriminatory slurs leave gaping but invisible wounds.
I do not share these examples lightly or without the consent of those involved. I’m sharing in hopes that airing them will lead to change. Our health care providers desperately need this dynamic to improve. The impact on staff is low morale, workplace fear, disruptions in career development, burnout and turnover. For patients, it means their care is interrupted and they can be victims themselves. It causes some to fear being in a health care setting like an emergency department, which is already very scary for many.
Workplace violence and threatening behavior have to stop if we expect to make any progress toward population health, a strong and stable health care workforce and hospital financial and operational sustainability.
Hospitals are making significant investments to hire more security, install new monitoring systems and cameras, pay for sitters for violent or potentially violent patients and fund capital projects that retrofit space to keep patients and staff safer. In budget hearings this past year, many, if not all, of our hospitals identified both security and capital construction investments as meaningful areas of increased costs. This is all necessary and important, but it cannot be the answer. We cannot ask our doctors, nurses, staff and leaders to continually build, buy and borrow their way to health care settings that better protect providers and patients.
That is why VAHHS and health care leaders from across the state are working with our federal delegation and local lawmakers on legislation aimed at reducing workplace violence. Here in Vermont, a bill will be introduced this session that would allow law enforcement to immediately remove perpetrators who threaten or commit violence that interferes with providing care. Additionally, we have to invest in more long-term care and inpatient mental health beds to reduce wait times and overcrowding and get patients the right care in the right care settings. This not a nice-to-have; it’s a must do. If we don’t act, we will see the problems in our emergency departments and on our floors worsen despite all of the measures mentioned above.
We did not get to this unfortunate reality overnight. Violence in health care settings was a major issue before COVID. Like so many challenges, the pandemic has made it far worse. It will take time to stop this downward spiral happening in our society and spilling over into our emergency departments. None of us is to blame for the suffering and instability that is causing this violence to occur, but we all have a role to play in making it stop. So, we must act now, and we must work together.
And one more thing: if you see doctors, nurses or other hospital staff members in your
travels, you might take a minute to smile their way or say thank you for continuing to show up to work and endure the fear and violence to care for us when we and our loved ones need them. They continue to show courage and compassion in these really challenging times.
|
|
Devon Green, VP of Government Relations
Part of my job is looking at each issue from every angle—what will the state say, what will this stakeholder say, where is this legislator coming from? For years, I’ve looked at workplace violence from every angle. It’s an extremely difficult conversation. How do you protect health care providers from getting injured while they are caring for hurt people? How do you ensure that the conversation does not break down into an us-against-them mentality and alienate patients? How can you get more resources to address this issue when you’re in a workforce shortage?
We worked on this issue from all the angles. We had a multidisciplinary task force and developed a toolkit. We tried a public service campaign. However, after the health care provider stories piled up and health care providers themselves despaired that nothing would happen until someone was killed, I can only look at the issue from one angle—we need to do something now. We will not be able care for Vermonters if health care providers are going to work worried about getting assaulted or subjected to hateful threats. We have asked too much of our health care workers. They need immediate relief.
VAHHS is proposing that workplace violence, and the threat of workplace violence, against health care workers result in immediate removal of the perpetrator from the facility by law enforcement. What we need now is help in removing individuals who are violent from hospitals so that trauma to health care providers and patients is mitigated as much as possible. This provision will not solve workplace violence. It will not apply to individuals who need emergency care for stabilization. Law enforcement doesn’t have the resources to carry out this directive every time. And, the question of where those individuals go remains up in the air. But, the issue is clear—we need help caring for those who provide care. And, we need it now.
|
|
A lack of resources': Brattleboro man's multiple altercations at local hospital highlight need for mental health services |
|
Brattleboro Reformer
A 22-year-old man accused of causing multiple altercations at Brattleboro Memorial Hospital was arraigned Friday and released on the condition he receive another mental health evaluation.
In October 2022, Kyle Hamilton, of Brattleboro, received a no trespass order after an incident in which he made threats toward hospital staff and had to be forcibly removed from the property.
Between then and Jan. 5, when Hamilton was taken into custody after another incident at the hospital, he has been back to the hospital causing problems “about 10 times,” said Deputy State’s Attorney David Gartenstein during Hamilton’s arraignment on Friday.
|
|
Dr. Dan Barkhuff: Just send ‘them’ all to the ED, and let the ED figure it out |
|
VTDigger
“Yeah, I know him,” I say to the off-going attending physician during signout, the 30 minutes-or-so period in between shifts at the University of Vermont emergency department where we discuss patients who — either through time of check-in to the emergency department, medical complexity, or, most commonly, lack of inpatient psychiatric beds — require multiple 8-10 hour chunks of care.
“What’s going on today?”
Sometimes, with the psychiatric patient population, the issue is a recent suicide attempt, or a gesture, or pervasive thoughts. Sometimes they’re manic. Sometimes they’re awaiting a consult from our overbooked CRISIS team of caseworkers.
|
|
Dr. Ben Smith: Health care ‘data’ startlingly divorced from the realities |
|
VTDigger
As an emergency doctor and the director of a small Vermont emergency department, I am glad to see some of Vermont’s health policy thinkers embracing investment in outpatient services like primary care, mental health, home health, and in the social determinants of health.
The hallways of emergency departments nationwide, including here in Vermont, are a vivid, gut-punch tutorial in the social determinants of health and the paucity of outpatient care. These investments are desperately needed, as are major investments in nursing home care.
Worth questioning, though, is the notion that any of these investments can be made simply by reallocating money from emergency and hospital care, which is often characterized as “avoidable” and “low-value.”
|
|
6 weeks, 1 bed, 10 lives: A Newport recovery center provides space for hope in the opioid crisis |
|
VTDigger
The furniture is not fancy — a single bed bumps up to a leather recliner just steps from a small desk. But sunlight pours in from a large window, and friends are there.
The small room is part of the Journey to Recovery Community Center in Newport, located in a woodsided office building, across the street from North Country Hospital and a short walk from the eastern shore of Lake Memphremagog. The space opened six weeks ago to provide an option for short-term, 24-hour peer support for people in crisis from substance use who want to begin their recovery. The first day was, so far, the busiest.
“It was the day after Thanksgiving,” said Lila Bennett, the center’s executive director since 2020. “We had one person in the bed and three people in the emergency room.”
|
|
Top Biden official joins Welch in Rutland to talk prescription drug and opiods |
|
WCAX
Making your medication cheaper and battling addiction-- that was the focus of top Biden administration officials who visited Rutland Monday.
Health and Human Services Secretary Xavier Becerra highlighted last fall’s Inflation Reduction Act along with now-U.S. Sen. Peter Welch.
“The federal government has never been there to advocate for consumers against price gouging,” said Welch, D-Vermont.
The law, in part, allows the feds to negotiate directly with drug manufacturers, a move they say will bring down the price of your medication. It also caps the price of insulin at $35 a month.
“Why is it that made-in-America drugs cost made-in-America Americans more money than they cost in France, England, Italy, Japan? Why do we have to pay a better price?” Becerra said.
|
|
|
|
|
|
|
