Merianne Lero was working a Christmas Eve shift as a nurse at a psychiatric hospital last year when a ranting patient sunk his teeth into her right hand.
It wasn’t the first time Lero was attacked by a patient. Just was one of the worst.
“The wound was bad enough that my employer wanted it checked out,” Lero said. “The patient had been screaming, ‘I have AIDS, I have AIDS, I have AIDS,’ and then (he) bit me.”
Lero later had to testify in court against her attacker. He tested negative for HIV.
“As far as I know,” Lero said, “it was just part of the psychosis.”
Lero, who now works in the Belton Regional Medical Center emergency room, is one of about 1,000 Missouri health workers receiving training provided by the Missouri Hospital Association that they hope will prevent such attacks. She and about three dozen hospital workers stood in a circle around some wrestling mats in a vacant wing of Research Medical Center last month watching security professionals demonstrate ways to safely subdue an assailant.
It’s becoming a necessary job skill.
A study by the Occupational Safety and Health Administration found health care workers nationwide are four times more likely to be victims of serious workplace violence than people in private industry as a whole. Of the workplace violence against health care workers, 80 percent came from patients.
Those are just the serious incidents — ones that cause injuries severe enough to require time off.
The study authors said the true numbers are much higher because minor assaults on health care workers are considered “just part of the job.” An article published in April 2016 in the New England Journal of Medicine also concluded that violence against health care workers is seriously underreported.
The OSHA study cited a 2014 survey in which 21 percent of nurses or nursing students said they had been physically assaulted on the job in the past year.
Dave Dillon, the vice president of public and media relations for the Missouri Hospital Association, said the danger to health care workers isn’t new, but it seems to be increasing.
“It’s become a profound issue, instead of just an issue” Dillon said.
The hospital association is using federal funding to offer Missouri workers training from Mitigation Dynamics Inc., a Lee’s Summit security firm. Twenty hospitals — most of them outside the Kansas City metro area — are participating. Some larger hospitals have their own training.
Keith Payne, the director of operations for Mitigation Dynamics, said his training emphasizes toning down situations when patients become belligerent. Nine times out of 10, he said, those situations can be resolved without physical contact if workers spot the signs of threatening body language early and talk someone down. For instance, health workers are advised to “listen to hear, not to respond.”
“If it becomes escalated, we give them the tangible tools to be able to de-escalate them,” Payne said. “We do not want to go hands-on unless we have to, but we need the tools in case we do.”
After watching the professionals demonstrate how to corral people and bring them to the ground safely, the health care workers took their turn on the mats.
“I’ve been through several trainings before (where) you were bored and you also didn’t feel like you were walking away with skills that were truly helpful,” Lero said. “This is very interactive, it’s very engaging, and I’ve already learned a few things I’m really excited to have as a tool.”
In addition to the training, some health care workers are seeking greater legal protections.
The Boston Globe reported this month that a 73-year-old nurse in Massachusetts, herself a victim of patient assaults, has formed a nonprofit called Stop Healthcare Violence that is lobbying for stiffer penalties for assaults on health care workers.
Thirty-two states, including Missouri, have laws that make such assaults felonies. Kansas does not. A bill that would have made them high-level misdemeanors in the state died in committee last year, despite support from the Kansas Nurses Association.
An assault on an emergency room nurse at Lawrence Memorial Hospital last year became a rallying point for workers who want stiffer penalties.
But it also drew attention to the state’s mental health system after the perpetrator, who was convicted of misdemeanor battery and sentenced to two days in jail, apologized for the attack and said it was due to an untreated bipolar disorder.
The OSHA study pointed to psychosis as one of the main sources of assaults on health care workers nationwide.
“Because of reduced funding for mental health services, severely ill patients with violent tendencies are increasingly using emergency departments rather than more specialized facilities for treatment,” the study said.
Hospital officials in Kansas and Missouri say that fits with what they’re seeing.
Staff at Lawrence Memorial and other Kansas hospitals said last year that their facilities were forced to hold people undergoing psychiatric crisis for days at a time because of reduced bed space at Osawatomie State Hospital, one of two mental health institutions run by the state of Kansas.
Sarah Willson, the vice president of clinical and regulatory affairs for the Missouri Hospital Association, said Medicaid mental health patients spent the equivalent of 14.4 years in Missouri hospitals in 2016.
“In Missouri, we have a significant issue with the boarding of behavioral health patients,” Willson said.
It’s one of the reasons the hospital association is offering the training.
Payne, the former head of security for a West Coast hospital chain, watched closely last month as his colleagues prepared health workers for the next angry or psychotic patient they face.
“People in health care will endure a lot,” Payne said. “Because they believe in what they do.”