Michigan moves to protect health workers from assault, leaves a giant loophole

• Health care workers report facing increasing workplace violence, particularly since the pandemic 
• The Legislature passed bills that would boost fines for assaulting health care workers 
• And there’s an odd carveout: Patients are exempt from the larger fines

Those who lash out at Michigan’s health care workers could soon face tougher penalties.

But some workers — including those who have been slapped, punched, bitten, spat at — say it doesn’t go far enough in an industry that reports some of the highest rates of workplace violence in the country.

The legislation — passed with bipartisan support and now awaiting Gov. Gretchen Whitmer’s signature — carves out one significant exception: Patients who attack health workers are exempt from higher fines.
That’s drawn some pushback, particularly from some nurses, who were more than twice as likely to face physical violence than physicians during the pandemic. 

Steven Knopp, a registered nurse at McLaren Bay Region hospital in Bay City, still bears scars across his chest from a run-in with an angry patient.

“If you remove the patients from the equation,” he said, “who's really going to be at fault?” 

Rep. Mike Mueller, R-Linden, who sponsored one of the bills, said lawmakers were reluctant to toughen penalties for patients who lash out during a mental health or substance abuse crisis.

“It’s kind of hard to charge a patient sometimes if they’re under the influence of something or in a mental breakdown,” Mueller said during a hearing in June before the House Criminal Justice Committee.

The two bills don’t increase incarceration for assaults on health workers, but they double fines:  

• For simple assault, which carries up to 93 days in jail, fines were doubled to $1,000
• For aggravated assault (“inflicts serious or aggravated injury”), which carries up to a year in jail, fines doubled to $2,000 
• For assault with a “gun, revolver, pistol, knife, iron bar, club, brass knuckles, or other dangerous weapon,” which carries up to a four-year prison term, fines doubled to $4,000

Once signed into law, the bills will require Michigan health facilities to post signs in prominent locations describing the enhanced penalty.

The higher fines probably won’t stop somebody from throwing a punch, said Knopp, who began his health care career as a security guard: “If it’s in their character to harm you, they're not going to worry about monetary loss.” 

Still, he said, the bills are a crucial “start of the conversation.”

Gov. Gretchen Whitmer’s spokesperson Stacey LaRouche said the governor is expected to sign both measures this week.

Just last week, Whitmer signed into law penalties that begin with 93 days in jail and a $500 fine for those who intimidate or otherwise threaten election workers in an attempt to stop them from performing their duties. However, the health care worker bill boosts existing penalties.

How many attacks? Hard to know  

It’s unclear how many health workers are assaulted physically or verbally in Michigan hospitals, doctors offices, nursing homes and health clinics each year.

The Michigan Occupational Safety and Health Administration tracks workplace injuries, but doesn’t break out which are due to assault. And MIOSHA only focuses on the most serious injuries — those that require an amputation or hospitalization for example, as opposed to, say, a push or a punch in the gut, according to a spokesperson.

The U.S. Bureau of Labor Statistics estimates that 4-in-5 injuries (1,870 of 2,310) inflicted by others in privately-run Michigan workplaces occurred in health facilities and social assistance settings, such as child care settings and social welfare offices.

And government-run nursing facilities report some of the highest nonfatal injury rates with 9.1 injuries for every 10,000 workers reported in 2022, according to another Labor Statistics report. That data also is imperfect; it doesn’t specify which injuries were caused by other people versus, say, a sprained back from moving a patient. 

Health workers say that, beyond physical attacks, verbal assaults and threats have also taken a toll. Supporters of enhanced penalties say the legislation is about more than protecting workers from harm; it’s also about keeping nurses, aides, doctors and others from fleeing a critical profession. 

“When people are assaulted, they don't want to work in that type of environment,” said Dr. Michael Fill, an emergency physician at Henry Ford Jackson Hospital, who spoke in support of the bills in June. “People are leaving the emergency department, which means that there’s less people to care for the patients, which means that patients and family get more upset because of longer wait times.” 

Michelle Peña, chief nursing officer at Trinity Health Grand Rapids, testified about colleagues who missed work from “concussions, internal bleeding of a pregnant woman, a fractured jaw, dislocated shoulders, (and) severe anxiety from assault.”

Kim Chapman-Hitchcock, a trauma and emergency nurse in Macomb County, told lawmakers that colleagues have been “verbally abused, hit, bitten, slapped, choked, punched and, like me, bones being broken.”

A family member of one patient told a nurse that “if anything happens to” the patient “I will f---ing kill you,” Chapman-Hitchcock told the committee.

“That nurse had to be escorted out of the hospital under guard (and) was terrified for months afterwards to come back to work.”

After another harrowing incident, the hospital installed metal detectors at the ER entrance, and “our security officers are confiscating an average of 150 to 200 weapons a week from patients and visitors,” she said, “150 to 200 weapons.” 

On her LinkedIn page, Chapman-Hitchcock says she’s “at a place in my career where I am ready to move away from the stress and craziness of ER/Trauma and into a position that will help me find fulfillment and less stress as I head into my last couple of decades of nursing.”

A pandemic surge 

The health field was rife with workplace violence even before the pandemic. But the level of assaults and abuse surged when COVID hit, and rose further as the pandemic dragged on. 

As the conflict worsened, health workers said they became more vocal in reporting abuse. 

“I was never one, in my early career, to call the police, to press charges,” said Knopp, the Bay City nurse. “If somebody spit in my face, I would just say ‘Oh, well. It's just a (workplace) hazard.’ 

“Now, I am 100 percent tired of it,” he said.

One Michigan doctor made national headlines during the pandemic after recounting the angry pushback he and his colleagues were receiving based on misinformation and conspiracy theories relating to COVID.

About 43 percent of health workers experienced some kind of verbal or physical assault during COVID, according to a review of 38 studies of workplace violence. Published earlier this year, the review drew from data that involved more than 63,000 workers.

And those numbers are likely a vast undercount, according to workers who spoke with Bridge Michigan. 

Fill, then-president-elect of the Michigan College of Emergency Physicians, said health workers are sometimes discouraged from reporting abuse. 

“The last time I was assaulted, I called the police and I was told by the police officers, ‘That's just part of your job,’” he told the Criminal Justice Committee, as it weighed the bills introduced by Mueller and Rep. Kelly Breen, D-Novi. 

Small wonder, then, that the health field has suffered an exodus of workers or workers thinking of leaving. 

Violence and short-staffing are part of a “vicious cycle,” Fill said.

In a recent survey of more than 5,400 health workers in 79 countries — more than half said they were the victims of workplace violence; 1-in-4 said they were willing to quit their jobs because of it.

Which patients to hold accountable?

Certainly, many patients may not be in control of their behavior — driven by dementia, psychosis or severe injuries — and shouldn’t be held criminally accountable, health care workers told Bridge.

Indeed, most violent episodes happen in psychiatric departments, emergency services and geriatric units. 

The patient who lunged at Knopp, ripping through his scrubs and digging into the flesh on his chest, was in a behavioral health crisis. Knopp said he didn’t bother filing a police report, though the hospital documented it.

“It’s one of those situations in a tricky area: If a person is in a behavioral health crisis, you’re not going to take them out in handcuffs,” he said.

In contrast, assault charges were filed earlier this year when a 27-year-old patient was discharged without the painkillers he’d sought for injuries to his “ribs, hip and shoulder.”

According to health workers, he became disruptive, slamming the door in Knopp’s face and shoving another McLaren worker. 

The man later blamed his outburst on being in pain. “I told the doctor that the Ibuprofen wouldn’t work … I used Ibuprofen last night and that didn’t help at all,” according to a police report.

Peña, at Trinity, said a years-long review of thousands of cases of violence at the health system revealed roughly 1-in-4 patients who assaulted Trinity workers had the cognitive ability to control their behavior. They are people, she said, who are “committing these violent acts willfully.”

In response to rising aggression, hospital leaders say they are encouraging workers to report such incidents so health systems can get a better sense of the scope and nature of the violence to better prevent it. 

That may explain why the number of recorded assaults doubled at Sparrow Hospital in Lansing — from 303 incidents in 2015 to 597 last year. Through October this year, there were already 650 reports filed at Sparrow. 

That’s “approaching a rate of two events per day just at Sparrow Hospital alone,” Sparrow’s chief medical officer, Dr. Denny Martin, told lawmakers.

Trinity Health Grand Rapids last year launched a program with four dogs — two Dutch Shepherds and two Belgian Malinois Shepherds — to support patients, de-escalate tense situations and deter violence.

McLaren in Bay City created a workplace violence committee last year.

Patient care and healing should be the focus for McLaren workers, said Stacey Klump, the hospital’s chief nursing officer. 

“It is not part of our job to be in situations where we have to protect ourselves from violence.”