Violence rises at hospital
Toolbox
By Thatcher Moats Staff Writer - Published: February 7, 2010
BERLIN – Almost all the people who pass through Central Vermont Medical Center behave themselves, but an increasing number are being aggressive and violent toward hospital staff, according to the hospital's top administrator.
The increase in aggressive behavior in recent months has prompted hospital leaders to consider beefing up security by adding in-house security staff, more surveillance cameras and rooms where they can seclude disruptive people.
According to President and CEO Judy Tarr, the problem of increased aggression by patients and others at the hospital is not unique to Central Vermont Medical Center and is a disturbing trend hospitals nationwide have been dealing with in recent years.
"This is a nationwide phenomenon," Tarr said Friday. "And it's caused us to take a step back and see what we're going to do to enhance the security we provide here."
A nurse who works in the emergency department at the hospital, David DeRosia, said that in his 17 years there, no patient has ever been injured by another patient. Instead, it's those who work at the medical center who have borne the brunt of assaults, including DeRosia, who said he had to wear a cast for six weeks after one assault.
In fiscal year 2009, there have been 52 "Code Green" incidents, which are defined as nonmedical emergencies, and usually mean someone is being violent or aggressive. The year before, there were 32 such situations, which is about average compared to the three years before that.
There are several reasons for the increase, officials believe, hinting at broader problems in society.
In general, drugs and alcohol play a factor, DeRosia said, including situations where "drug seekers" – people who don't have a physical problem but want prescription drugs — come to the hospital.
They can get unruly "when they don't get what they're looking for," said DeRosia. "And we see spikes when there's been a drug bust in the area and the supply goes down."
Another factor is the problems with Vermont's mental health system, Tarr contends.
The medical center has a 14-bed psychiatric ward, but it's not meant for the "most unstable, violent and acute mental-health patients," which is what the Vermont State Hospital in Waterbury is designed for, she said.
The problem is the Vermont State Hospital consistently has been full, meaning the Berlin medical center sometimes houses certain patients longer than it should. It also means the emergency room has become something of an entry point into the system for people with mental health issues, Tarr said.
"I think that the mental health crisis has been discussed a lot in recent years, and this is an issue for the entire state: the appropriate placement of psychiatric patients," she said.
In Code Green situations, staff members who are trained to de-escalate tense situations converge at the scene in a "show of force" and try to calm things down.
"When there's 15 people standing behind you … it's very likely to de-escalate the situation," DeRosia said.
The situations typically calm down, but in about half of the 52 Code Greens in 2009, there was some kind of physical contact, DeRosia said.
It's a small percentage of the Code Green incidents that amount to serious assaults, officials said. And the hospital rarely pursues criminal charges against people, though a woman who kicked and punched two nurses last fall was arrested.
That's because workers at the hospital often are dealing with the mentally ill or people in a lot of pain.
"These guys are very good at differentiating between what's intentional versus what's unintentional aggressive behavior," Tarr said.
DeRosia agreed. "So much is forgiven in the emergency department because people are not at their best when they're ill or injured or their family member is ill or injured," he said. "It's a tense kind of environment."
A member of the in-house security staff at Fletcher Allen Health Care said the hospital in Burlington hasn't seen the same problems. Its incidents, known as Code 8 incidents, dropped in 2009 compared to 2008, said Jack Conry, director of security at the hospital.
The Berlin hospital has had an officer from the Berlin Police Department there seven days a week from 7 p.m. to 3 a.m. for roughly the last three years. But it's likely time for greater security measures, Tarr said.
It's her role to protect the staff, she said, one of the reasons for the possibility of increased security.
"We have taken a very strong position that we won't tolerate any form of harassment or abuse or threats against our staff," she said.
She also said a higher level of aggression from some patients and other people who come to the hospital may be the reality going forward.
"We don't see this issue going away," Tarr said.
thatcher.moats@timesargus.com
21