Legislation aims to curb violence against health care workers in emergency settings

Wed, 06/28/2023 - 6:00pm

    A bill that would expand the scope of Maine’s criminal code for assaults against an emergency care provider passed easily in both chambers last week but advocates say there is still more to be done to protect health care workers.

    Maine law currently states that a person who commits assault against an “emergency medical care provider” while the provider is administering emergency medical care is a Class C crime and carries a punishment of up to five years in prison and a $5,000 fine.

    While the crime carries a harsher penalty than assault against another person, a legislative task force studying violence against health care workers said in its final report in December that the law’s “scope is too limited to be an effective deterrent to violence against health care workers.”

    LD 1119 would amend the law to say “a person is guilty of assault on an emergency medical services person if that person intentionally, knowingly or recklessly causes bodily injury” to any person licensed under the Maine Emergency Medical Services Act of 1982, “regardless of where the emergency medical care is provided.”

    The bill would also add a new section to the law that would make it a Class C crime — a felony — to commit assault to a “person employed or contracted by a hospital…if the injury occurs in the hospital’s designated emergency room.”

    Expanding the scope of the law would solve an issue in the current statute, the task force report said, in which a person is not guilty of a felony if they injure a person working in an emergency department who is not directly providing care to the person and/or not in an emergency medical situation.

    The broader law would, for example, make it a felony to injure a nurse working in an emergency department, even if that nurse is not directly providing care to the person who committed the assault. It would also make it a felony to injure any nonmedical staff, such as custodial, security or administrative staff, in an emergency department.

    The bill’s sponsor, Sen. Richard Bennett, R-Oxford, also served on the task force.

    Following a 105-38 vote in the House in favor, the bill was placed on the Special Appropriations Table on a motion by Sen. Peggy Rotundo, D-Lewiston.

    Because there is a fiscal note attached to L.D. 1119, it must go through the Special Appropriations Table to receive funding from the Appropriations and Financial Affairs Committee.

    Bennett said late Friday afternoon that he believes his bill should be taken off the table since there is no funding request attached, especially since “now there seems to be a practice of letting bills just die” there.

    Fiscal notes are preliminary estimates of the financial impact on the stage budget. The note attached to this bill does not request funding but does estimate a minor increase to revenues as the result of higher fines associated with Class C crimes.

    However, the note does say that the current average cost to incarcerate one individual for a single year is $55,203.

    As of Friday afternoon, there were more than 250 bills, including L.D. 1119, still on the table.

    Should the bill get the appropriations committee’s OK and make it to Gov. Janet Mills’ desk for her signature, “It’s one modest step. It absolutely should be done,” said Maine Hospital Association’s vice president of government affairs and communications.

    “But it is not a solution,” Jeff Austin said in an email.

    While the bill is a “very important clarification” to current law, it is limited to emergency care, Katie Fullam Harris, chief government affairs officer for MaineHealth, said Wednesday.

    Harris said that she and others advocated to expand the law to all health care workers, regardless of the department where the assault occurs but “were not successful in that effort.”

    From January 2021 to May of this year, there were a total of 6,305 reported violent incidents across all departments at MaineHealth’s flagship hospital, Maine Medical Center in Portland, according to data provided by the health system.

    Across Northern Light Health’s network, which includes Eastern Maine Medical Center in Bangor, the “current average” is 88 “disruptive patients events” per month, according to a spokesperson.

    These events tend to be concentrated in hospital emergency departments where one of the primary challenges over the past few years has been the “boarding behavioral health patients in the emergency department for extended periods,” Lisa Harvey-McPherson, Northern Light’s vice president of government relations, said.

    These patients are often stuck in an emergency department for weeks or months waiting for a bed at an inpatient psychiatric unit or residential care facility to open up. The situation is particularly acute when it comes to children who end up in emergency departments while awaiting behavioral health services, Harris and Harvey-McPherson said.

    In May, there were 623 children or youths in Maine on a waitlist for home and community-based treatment. These services “offer strategies to help the children and family manage mental health symptoms, function better in home, school and community, and prevent hospitalization,” according to DHHS. Together, these children had been on the waitlist an average of 194 days.

    “That’s a stressor in the emergency department and they’re there for days and some of these kids have been there for weeks and months,” Harvey-McPherson said. “And then that stressor, you know, challenges everyone in the emergency department environment.”

    “Violence is usually not an outcome of mental illness. It is a result of uncontrolled and misplaced aggression,” she said.

    Some mental health advocates and criminal defense attorneys warned lawmakers expanding the criminal code could have a disproportionate impact on people with mental illness.

    “Emergency rooms are places where people go because they are having an emergency medical or psychological situation that requires immediate care,” Augusta attorney Walter McKee said in testimony on behalf of the Maine Association of Criminal Defense Lawyers, which opposed LD 1119.

    “You are never in your best state of mind, and your behavior will sometimes present itself in a way that you would never imagine. Making a person’s actions on that day result in their being a convicted felon forever is a terrible idea,” he said.

    Harris said that it is “never our intent” to have someone experiencing a psychiatric episode or whose actions are the result of a behavioral health condition arrested and prosecuted.

    “We only call for those circumstances in which a patient or visitor makes a conscious and deliberate decision to attempt to harm us,” Nancijean Goudey, director of emergency services at MMC, said in testimony in support of LD 1119.

    Miranda Chadbourne, program manager for workplace violence prevention at MMC, told lawmakers in April that a survey of 277 incidents that took place in MMC’s Emergency Department during the first three months of the year found that “only 18 events (were) committed by individuals who did not have medical capacity.”

    Still, Harris, Harvey-McPherson and Austin agreed there is much more to be done on the prevention side.

    “I can’t say strongly enough that the single most important thing that we can do from a public policy perspective is to build a comprehensive behavioral health system that meets the needs of individuals who have mental health and substance use issues or developmental disability that ensures that they are provided with the right level of care in the right place at the right time,” Harris said.