A violent attack in a Pennsylvania hospital in February, resulting in the death of a police officer, has prompted the American Nurses Association (ANA) to ask Congress to pass legislation for a workplace violence prevention standard.
“Workplace violence is a longstanding and unresolved issue in healthcare. It is a growing public health crisis that demands urgent attention,” said Jennifer S. Mensik, the president of the ANA in a February 23 news release. “It worsened during the COVID-19 pandemic, overburdening an already strained healthcare system.”
On February 22, 49-year-old Diogenes Archangel-Ortiz entered UPMC Memorial Hospital in Pennsylvania with a firearm and shot a doctor, a nurse, a custodian, and three police officers. The previous evening, hospital staff had removed Archangel-Ortiz from the premises after he became highly agitated upon learning there was no further treatment available for his terminally ill wife.
Archangel-Ortiz returned the next morning with a backpack containing a firearm, zip ties, and duct tape. He took staff members hostage before being killed in a shootout with police. One of the police officers died from his gunshot wounds.
Weeks after the Pennsylvania attack in March, an employee of Corewell Health Beaumont Troy Hospital in Troy, Michigan, was arrested after shooting a coworker in the hospital garage, striking the person twice in the arm.
Health Care Worker Deaths
In a review of large medical databases, an analysis in eClinical Medicine in June 2024 found about 3,197 citations by searching “workplace violence” and “health care.” A deeper look into the papers revealed 156 health care workers were killed at their workplaces between 2011 and 2018 in the United States, about 20 deaths a year.
A 2023 study found the frequency of workplace violence against health care workers between January 2020 and March 2022 to be 1.2 percent. About 72 percent of the incidents reported were verbal, and 28.1 percent were physical. In terms of workplace violence exposure, doctors accounted for 62.3 percent of the incidents, nurses, 20 percent, and administrative workers, 7.4 percent.
The analysis found most incidents occurred in outpatient clinics (34.8 percent), followed by emergency departments (25.9 percent). Among the main reasons identified for workplace violence against health care workers were health care workers not following expected procedures (49.6 percent), problematic communication (27.4 percent), and dissatisfaction (23.1 percent).
Soft Targets
The current increase in health-care-related violence mirrors previous times of societal stress, says Merrill Matthews, Ph.D., a resident scholar with the Institute for Policy Innovation
“Hospital shootings appear to increase during times of economic stress: the dot.com crash, the 2007-09 [economic contraction] and for a few years after, and the COVID recession all saw increases in hospital shootings,” said Matthews.
“It’s likely that hospital shootings are taking the place of school shootings, since schools have increasingly stepped-up security, taken steps to harden the facilities, and have security guards or armed employees available,” said Matthews.
“Hospitals became the next soft target,” said Matthews. “They are often large buildings filled with vulnerable people, most of the employees are women, and there have been few efforts to monitor those who enter. Plus, with the rise of violent gangs, hospitals make it easy to retaliate against a gang-member patient or to take out some other form of retribution.”
System Strains
Stress in the health care system could also be partly to blame, says health care economist Devon Herrick, Ph.D.
“Violence in hospitals has increased markedly since COVID-19,” said Herrick. “Hospital emergency departments are the most vulnerable. There are various theories about why violence and verbal abuse have risen, but long waits for physician appointments, understaffed emergency rooms, and dissatisfaction with the health care system are the most likely reasons.”
Another factor is the shortage of primary care physicians, says Herrick.
“It forces some Americans to seek care in an emergency room,” said Herrick. “Staffing of emergency departments has been taken over by private equity investors, who reduce staff to save money. It is easy to understand how long waits in the ER lead to dissatisfied customers.”
Relationship Problems
The growing resentment could also stem from the third-party payment system, says Chad Savage, M.D., founder of YourChoice Direct Care and a policy advisor to The Heartland Institute, which co-publishes Health Care News.
“This issue can, at least in part, be traced back to the payment system,” said Savage. “In the past, doctors worked directly for their patients. That model rewarded physicians who delivered the kind of care that patients valued. Doctors who took time, built trust, and formed strong therapeutic relationships tended to thrive.
That changed when the payment model shifted to third-party payers, says Savage.
“Doctors began to adapt their practice styles to align with what was most financially rewarding under that system: high volume, rushed visits,” said Savage. “Unfortunately, that environment isn’t conducive to fostering meaningful doctor-patient relationships.”
Contentious lawsuits show the hostility the payment disconnect can lead to.
“Research has shown that patients who have strong relationships with their physicians are less likely to sue, even when mistakes occur,” said Savage. “Conversely, patients who lack that connection are more likely to pursue legal action. It stands to reason that if a patient is willing to cause financial harm to a physician they don’t trust, they might also be more likely to consider physical harm.”
Unhealthy Attitudes
Problems outside the doctor-patient relationship can also cause conflict within care facilities, says Savage.
“I’ve seen countless instances over the years where patients direct anger at medical staff for issues unrelated to the actual care—confusion over deductibles or frustration with insurance coverage decisions,” said Savage.
The 2023 study found some cases could be linked to patients’ unrealistic expectations, impatience with hospital rules, inadequate patient management, unclear communication, and excessive staff workloads. The researchers recommended evaluating the frequency and affecting factors of workplace violence before developing policies and interventions.
Kevin Stone ([email protected]) writes from Arlington, Texas.
