Punched, kicked and hit: How violence in hospitals is becoming the norm

“I’ve been called everything under the sun,” said Dr Kate Porges, Area Director Emergency Services for Central Coast LHD. “I’ve been kicked, hit, threatened.”

Dr Porges explained that, sadly, most doctors in emergency departments are becoming numb to violence and aggression.

“If someone in the community called me an f’ing so and so I might be upset. But it happens so often in my workplace that I hardly even notice,” she says. “It’s easier to laugh it off, but if you’re laughing it off, you’re not going to report it.”

Health Minister Brad Hazzard tasked former police and health minister Peter Anderson to conduct a review into hospital security in November 2018.

The review follows an incident at Nepean Hospital in October last year, when a 54-year-old man was shot and tasered by police officers after wielding two knives. Nepean Hospital was also the site where NSW Police Sergeant Luke Warburton almost lost his life after being shot twice in the leg in early 2016. The police officer was trying to restrain a drug-affected patient who was holding a doctor captive with scissors held to her neck.

Mr Anderson consulted with stakeholders and visited major hospitals in each of the eight local health districts in Sydney metropolitan, Central Coast and Illawarra regions, plus the two specialist networks. “It was disturbing, to say the least, to hear during my hospital visits from experienced doctors and nurses about the increase in aggressive and violent behaviour that they are experiencing, and the apprehension this brings,” he said.

After consultation with stakeholders, Mr Anderson released an Interim Report with 48 recommendations, including changing the culture of under-reporting of security-type incidents.

Dr Porges said there are several barriers to reporting these incidents. Not only is it time consuming, but staff are reluctant to become involved in the criminal justice process as a witness, particularly when no actions are taken against offenders by the courts. As well, many clinicians excuse bad behaviour by attributing it to the offender’s physical or mental illness, or drugs and/or alcohol.

As Dr Porges explained, in most other workplaces if someone were to come in and act aggressively to staff, they’d be shown the door. But in a hospital, you can’t do that.

“You have to give them the benefit of the doubt that they are somehow drug-affected or unwell, because if you make the wrong judgement and discharge them and something happens to them out the front of the hospital you’ve potentially breached your duty of care. Not only will you personally feel terrible, but you will worry about the outcome for that patient.

“So you always presume illness until you’ve proven it beyond doubt, and in that process you put yourself at risk, and other people at risk.”

Increases in aggressive and violent incidents are also being attributed to record-breaking ED presentations and the inevitable impact on wait times.

“When you’ve got an overcrowded emergency department, where you’ve got staff who are overwhelmed by the volume of patients and they are getting increasingly busy, you can’t give the time needed to that individual patient who is getting agitated. You don’t have the time to talk them down, you don’t even really have the time to observe them to notice when they are getting agitated and step in to settle them. So, I think ED overcrowding and the increasing workload of staff in those EDs is absolutely a contributing factor to the increasing agitation which then becomes violence,” Dr Porges said.

The latest figures from the Bureau of Health Information show nearly three quarters of a million people attended NSW emergency departments in the last three months of 2018. This is an all-time record for ED attendances and continues a rising trend that’s been observed since the BHI started keeping records 10 years ago.

The first fourth quarter report released by BHI back in 2010 showed 535,790 patients attended emergency departments, at the end of last year it had ballooned to 749,504.

Dr Porges suggested it’s not just emergency departments that are dealing with the after effects of record-breaking patient numbers.

“I think it’s the same on the wards as well,” Dr Porges said. Medical and nursing staff are being squeezed tighter and tighter – a patient is no sooner out of a bed then a new patient is in the bed and there’s push, push, push to get them out as soon as possible. There’s less and less opportunity to sit down and talk to a patient, calm the patient, and develop that relationship so they don’t become agitated. So, I think that’s all contributing.”