Bernice Troy, a geriatric nursing assistant in Baltimore for the past 20 years, has been spat on and cursed, scratched and punched on the job. A patient once slammed Jo Samrow, a nurse in Southern Maryland, into a wall so violently that she developed a large hematoma on the back of her head.
In recent weeks, these nurses and other health care workers have shared their stories before lawmakers in Annapolis with one goal in mind — reducing assaults in Maryland health care facilities.
"All I want is for my facility to care about my safety," Troy told the House Economic Matters Committee during a recent hearing on a proposed bill that would bolster violence prevention standards at health facilities across the state.
The problem has come under a spotlight recently, with problems identified in state and private facilities. A consultant's report on Spring Grove Hospital Center, a state mental hospital in Catonsville, found that attacks on staff were common, and state statistics show that in the 12-month period ending in September there were 66 assaults on staff members that required medical attention.
A January report by a coalition of employees, workers' rights advocates and others found that 62 percent of workplace violence in 2010 involved health workers, who made up just 16 percent of the state's workforce. Between 2008 and 2010, health care and social workers were the victims of 74 percent of workplace violence requiring employee time off, the report found.
The legislation being discussed in Annapolis — versions have been filed in both the House of Delegates and the state Senate — would require public and private facilities to improve safety by establishing violence-prevention committees consisting of management and employees; establish a violence-prevention program; produce annual violence assessments and provide regular workplace violence training for employees.
"I think everybody agrees on the need," said Del. Tom Hucker, a Montgomery County Democrat who is sponsoring the House bill. "We just need to have more discussion over the implementation."
Sen. Katherine Klausmeier, a Baltimore County Democrat sponsoring the bill in the Senate, said the language of the legislation might need to be tweaked to address concerns from some stakeholders, but finding an appropriate compromise is critical.
"I want to see the employers working with the employees and getting a good product, and most of all getting everybody as safe as possible," she said. A hearing on the Senate bill is scheduled for Thursday.
Many groups — including the American Federation of State, County and Municipal Employees, the Service Employees International Union, the Alzheimer's Association and the Maryland Hospital Association — support the legislation, though some have suggested amendments. The hospital association has said that many of the requirements in the bill are mandated at private hospitals under federal and state regulations.
Dori Henry, a state health department spokeswoman, said the legislation "largely mirrors" policies the agency began implementing with AFSCME in its facilities, including Spring Grove, last year.
Some groups — including the Health Facilities Association of Maryland, which represents skilled nursing and rehabilitation centers, and LifeSpan, which represents nursing care and assisted-living facilities — have outwardly opposed the new legislation.
The groups have said the bill would use a broad brush to force vastly different facilities — from large systems such as Johns Hopkins to individual assisted-living facilities — to adhere to the same protocols for dealing with and mitigating workplace violence.
"Our opposition does not diminish our commitment to workplace safety," said Danna Kauffman, LifeSpan's vice president of public policy. "However, we do believe there are different approaches."
Many facilities that largely serve individuals with Alzheimer's disease, for instance, already craft individual safety plans for patients or residents, and they would not be better served by the more uniform approach outlined in the bill, Kauffman said.
Joseph DeMattos, president of the Health Facilities Association of Maryland, said the organization has similar standards for assessing patients on an individual basis, and isn't convinced the approach outlined in the bill would improve its violence-prevention efforts. The association is always looking for ways to improve its care, but the bill as proposed would force a streamlined approach where nuance is often more effective, he said.
"We'd like to be able to support this bill, but we do oppose it from experience," DeMattos said. "Now the challenge is, let's roll up our sleeves and let's look at the data and let's look at what's the same and what's different across the various [health care] settings, and work to put in policies that work."
Kauffman and DeMattos said resources would be strained if the bill were to become law, but the organizations' reasons for opposing it have more to do with safety strategy than budgeting.
Klausmeier said she has heard similar concerns about the bill, and that concerns about small assisted-living homes with two or three residents facing the same reporting standards as large hospitals would be addressed before the bill is finalized.
"You're going to see a lot of changes in that bill," she said. "I'm just trying to get some kind of consensus."
Kim Perkins, an emergency room nurse in Prince George's County, said in testimony before the House committee last week — when she and other speakers avoided naming their employers — that many health workers want the same.
Perkins often deals on the job with patients who are high on PCP, and she accepts that it can be dangerous, she said. But she gets frustrated when the violence isn't addressed.
"All we are asking for is a plan and to be involved in that plan, because we are the ones experiencing workplace violence every day," she said.
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