Attack on nurses points to growing risk of Minnesota hospital violence

St. John's Hospital
Still image from the surveillance video from St. John's Hospital in Maplewood, Minn., Nov. 2, 2014.
Courtesy of KARE 11 News

An attack by a patient on nurses at a Maplewood hospital over the weekend highlights an issue many Minnesota healthcare workers say they deal with almost daily -- the increasing risk of violence.

Authorities say Charles Logan, Sr., of St. Paul, hit four nurses with a metal bar early Sunday at St. John's Hospital in Maplewood. Security video released Thursday shows Logan running at nurses carrying the bar, which he took from his hospital bed.

Maplewood police and Ramsey County sheriff's deputies later found Logan still holding the bar about three blocks from the hospital, where deputies tried to subdue him with a Taser.

According to the Bureau of Criminal Apprehension, Logan became unresponsive after deputies pulled him to the ground and handcuffed him. Deputies and paramedics tried to revive him with CPR, Maplewood Police said, but he was pronounced dead at St. John's Hospital.

• KARE 11 Video: More on risks of violence in hospitals

The incident at St. John's highlights the potential danger of what can happen inside hospital walls. Hospitals statewide tightening security and training staff members in an effort to keep patients, visitors and employees safe.

At Hennepin County Medical Center, in the heart of downtown Minneapolis, healthcare workers recently took part in an active shooter simulation exercise. A video of the drill shows a man with a gun entering a makeshift hospital emergency triage area. The situation soon becomes its own emergency as the man starts to shoot.

The gun is loaded with paintballs, but the drill - now a video HCMC workers can watch if they choose - is an example of how healthcare workers are preparing to respond to an ever-increasing risk of violence.

"We deal with real life and death here every day," said Scott Wordelman, HCMC's vice president of ambulatory administration. "It's one of, I think, the realities of what we need to be prepared for."

The fake active shooter event became a little too real last August when an incident outside HCMC that had nothing to do with the hospital led to a shooting. Bullets broke emergency room windows.

Today, a network of surveillance cameras keeps watch over every corner of HCMC and a newly-installed alert system keeps workers informed. HCMC has also built new security desks. Hennepin County sheriff's deputies patrol the grounds and just one hospital entrance is open in the evenings and on weekends.

"We may have a perception of safety at HCMC," Wordelman said. "What I want to tell the public is this is a safe place." But what happens when patients or visitors lash out?

HCMC employees reported close to 100 assaults from patients last year. The assaults included everything from spitting to kicking. However, violent crime overall at HCMC is going down according to Wordelman, bucking what appears to be a national trend.

Doctors, nurses and mental healthcare workers are more likely than other workers to be assaulted on the job according to federal workplace injury data.

At hospitals around the country, physical attacks against workers have been on the rise. A recent national survey of hundreds of U.S. hospitals by the International Security and Safety Foundation found a spike in reported incidents and an upturn in violent crime.

Minnesota's office of the Occupational Health and Safety Administration reports workplace injury claims for assaults and violent acts in hospitals going up year over year since 2012.

The issue is so concerning for Minnesota's healthcare community, the Minnesota Department of Health formed a statewide task force and launched a safety campaign on preventing and responding to violence. Today, 90 healthcare facilities have signed up to be part of the campaign.

"We heard stories about the toll that everyday violence can take on healthcare workers," said Diane Rydrych, director of the department's health policy division. "We have some of the best places to receive care in the world in Minnesota. But healthcare workers are at a greater risk for violence."

Frontline workers may be most at risk.

"Violence unfortunately happens more than you would ever know working in healthcare," said Becky Puzel, an emergency room nurse at St. Cloud Hospital. Puzel and fellow emergency room nurses have been yelled at, hit, threatened and worse.

"Thrown again the wall from a patient," she said.

Puzel considers such encounters an occupational hazard, as nurses deal with patients and visitors during stressful times. Most emergency room personnel never report incidents. "Unless it's something big and traumatic I usually don't report," Puzel said.

Three serious incidents in 2010, including one where a patient threatened to harm other patients, prompted St. Cloud Hospital to take a stand against violence in the healthcare workplace.

"I think a hospital is an unconventional setting where people don't necessarily think that violence occurs," said Joy Plamann, care center director for St. Cloud Hospital and CentraCare Health System. Plamann said violence is not limited to the emergency room or mental health unit anymore. Incidents are occurring in oncology and even maternity wards, for example.

To respond to safety concerns, the hospital launched a training program. Since then, CentraCare has trained more than 3,000 workers system-wide on how to de-escalate tense situations. "The biggest change is that people are now talking about this as an issue," Plamann said.

Frontline workers have access to a checklist to help identify patient risk factors. CentraCare also created a behavioral team to be deployed when workers need extra help with patients.

Plamann said assaults against CentraCare workers have increased in the last two years, from 182 incidents to 237. However, she attributes that increase to more awareness, better reporting and a clear message from hospital administrators that violence is not part of the job.

"Not every encounter we have is a bad encounter," Puzel said. "We want to care for people. We want to cure people and that's why we keep coming back."

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