
American Emergency Rooms Confront a Crisis of Violence - jseliger
https://www.city-journal.org/violence-in-americas-emergency-rooms
======
olivermarks
It's not just emergency rooms, example of a food store in San Francisco:

'...When I sit down with Desaulniers, he's tired and stressed and the deep
creases between his brow are furrowed.

In our brief meeting, I get an up-close look at how much he's juggling by the
number of people who approach him as we're talking at one of the tables in the
grocery store's cafe.

For starters, there's the worker who has arrived to fix the $4,000 broken
window due to a robbery early that morning. There's also an investigator from
the District Attorney's office who drops by to share that a customer who bit
Desaulniers in the arm is being subpoenaed (This is the second customer who
bit him). And there's the employee who asks him to deal with an uncontrollable
customer who is shoplifting and hollering that he needs to use the bathroom'.

[https://www.sfgate.com/bayarea/article/SoMa-San-Francisco-
Ha...](https://www.sfgate.com/bayarea/article/SoMa-San-Francisco-Harvest-
Urban-Market-drugs-14450121.php)

------
Animats
The US used to have places to send those people. Santa Clara, CA had "The
Great Asylum for the Insane".[1] Later "Agnews State Mental Hospital", then
"Agnews Developmental Center", and finally demolished for a Sun Microsystems
facility. It was the classic "funny farm" in a rural area, with impressive
architecture.

This was the early 20th century solution to homeless crazies. Was it better
than what we have now?

[1]
[https://en.wikipedia.org/wiki/Agnews_Developmental_Center](https://en.wikipedia.org/wiki/Agnews_Developmental_Center)

~~~
cmiles74
The "state hospital" in my area was shut down in the eighties. It turns out
that many of their treatments were ineffective and inhumane. I believe there
is still a support group for former patients that is active.

~~~
randogogogo
I don't know how much truth there is to it, but people I've known that worked
in metal health institutions have complained that they're systemically being
shut down with no where for the patients to go. They say that often patients
end up being handled by police, EMTs, and medical workers. None of which are
particularly expert in dealing with mental health issues.

~~~
Animats
That happened in the US a long time ago, starting in the 1960s.[1] "By 2000,
the number of state psychiatric hospital beds per 100,000 people was 22, down
from 339 in 1955." During this period, prison populations went way up.

[1] [https://www.uniteforsight.org/mental-
health/module2](https://www.uniteforsight.org/mental-health/module2)

------
omfgwhat
This isn't limited to ERs. I have a close friend that works as a nurse at
Stanford (not in the ER) and the treatment they have to endure there is
insane. Patients have punched her, spit on her, asked her for sexual favors,
massages, and the list goes on. Worse, Stanford wants their nurses to treat
patients like hotel guests which makes matters worse. The staff has no
recourse when patients act this way. Seeing all of the sexual harassment
backlash in Silicon Valley makes me wonder why it hasn't applied to places
like hospitals - it's as if this treatment is expected and hospitals are
immune because they're seen as a last resort for sick people. Where else do
you send them?

~~~
cm2187
Presumably the people making those offenses aren’t educated computer science
students (referring to the parallel with the Sillicon Valley).

------
cyberferret
The one thing that I find hard to believe in our society these days is the
amount of violence shown to medical teams in hospital emergency rooms and also
first responders and paramedics who are trying to save lives in the field. It
is endemic here in Australia too, not just the US.

I grew up in South East Asia, where I and my friends were taught to pretty
much revere the people in this line of work. I guess it is still that way in
those countries too, highlighted by a recent video of the protests in Hong
Kong where huge crowds of protesters would willingly make way for ambulances
to get to casualties in the crowd.

Is it something that we need to ingrain to our kids as they are growing up, so
that they have more empathy? It astounds me that a paramedic friend of mine
was recently kicked and punched by 2 "friends" of an unconscious person as she
tried to save his life on the street. She says it is a really common thing
nowadays. Where is your mindset at when you try to prevent someone from saving
your friend's life?

------
booleandilemma
_“I have seen a colleague kicked in the face; I’ve seen a nurse kicked in the
chest and have to get medical treatment. I’ve seen patients spit on people and
throw urine across the room,” he added_

Why is our society so tolerant of this? Why should anyone, let alone an
educated, working professional have to put up with this?

~~~
tristanstcyr
What solution do you propose?

~~~
nordsieck
> What solution do you propose?

Ban those people from emergency services.

~~~
TheGallopedHigh
This would not be a good measure of society.

~~~
austincheney
The best measure of society is compromise and social valor. Those who have
neither deserve none.

~~~
happytoexplain
I can't tolerate the concept that people don't "deserve" basic things like
health treatment based on their behavior. It's sick to me, and a hallmark of a
sick society.

~~~
thrower123
Health treatment isn't really a basic thing. I find it really bizarre how
people keep trying to write in more and more luxury goods as god-given rights.

Whenever I think of rights, it is things that society and other people must
_not_ do, rather than something that other people must provide for me.

~~~
kwhitefoot
Think of it as a duty. Love thy neighbour and all that.

------
cmiles74
This article fails to mention that ER departments tend to be underfunded;
hospitals typically do not generate much revenue through ER departments and
they are often blamed for losing money. There are many articles out there,
this is just the first one I grabbed.

[https://www.beckershospitalreview.com/finance/7-things-to-
kn...](https://www.beckershospitalreview.com/finance/7-things-to-know-about-
emergency-department-profitability.html)

[https://www.commonwealthfund.org/publications/newsletter-
art...](https://www.commonwealthfund.org/publications/newsletter-
article/emergency-rooms-labeled-biggest-crisis-american-health-care)

With little motivation to staff up, this seems like the predictable outcome.

~~~
creato
Why is this relevant at all? Why is violence in an ER a predictable outcome of
understaffing? That makes no sense.

~~~
cmiles74
Less staff means higher wait times, long wait times lead to frustrated and
angry patients. People with mental health issues might be less able to manage
a longer and more stressful visit. Exhausted providers might me less effective
managing upset patients. And so on.

This article calls out people with mental health or drug addiciton
specifically.

"As doctors and nurses administer care, they risk physical assaults from drug-
addicted or emotionally disturbed persons"

~~~
brippalcharrid
Mental illness exacerbated by drug use that leads to ER visits is a pretty
disordered state of affairs to begin with.

There are plenty of legitimate reasons that would make sense for a person to
wait an hour or so in an ER once they have been stablised/triaged, such a for
observation, further diagnostic tests, or the attention of a particular
specialist.

An otherwise-healthy person can generally deal with this without getting
violent, even if they're feeling a bit stressed, but if someone's tripping
balls and being chased by robotic dinosaurs, then it's no wonder that people
are acting out and behaving in ways that transgress social norms.

------
agumonkey
Similar issues in France right now

~~~
epiphanitus
Is France also dealing with an opiod crisis? That might explain it

~~~
agumonkey
No the underlying causes are different. Social tensions, budget cuts,
inadequate management... all these leads to delays and mishaps in emergency
rooms. To a level we've never seen before (forgotten elder died after too many
hours unattended).

------
patientplatypus
Well...doctors and nurses are some of the highest paid people in the US and
these problems are directly caused by a lack of a social safety net and mental
health care. It's like they took the Hippocratic oath and didn't think it
applied to not bankrupting people for getting sick.

Color me completely unsympathetic.

~~~
el_dev_hell
You're "completely unsympathetic" that ER nurses (making a little over minimum
wage in some cases) and on-call doctors are getting assaulted at work?

~~~
HarryHirsch
A few years back, my wife had to go to the ER due to sudden life-threatening
illness. They were getting ready to stabilize her (barely) and turf her out
because of an issue with health insurance (my employer was happy enough to
take the premium out of the paycheck but never informed the insurance). It
took a lot of pleading to keep her that night. A young black guy might well
have been arrested.

Right now I am dealing with fantasy bills from an ER visit a few months ago.

The whole medical-industrial complex can die right now. I have no sympathies
for anyone in it. If they get assaulted in the course of work, they earned it
many times over.

~~~
mikeash
I can totally see being upset with the people in administration and billing.
But how can you be that upset with the doctors and nurses, when your whole
complaint is that you wanted _more_ of their attention?

~~~
HarryHirsch
The physicians and nurses are the public face of the healthcare mess. It's
only natural that they would attract ire. You go to the physician and you know
they'll overbill you. It's sickening. You get angry the moment you walk
through the door.

~~~
mikeash
You could stay home instead.

~~~
stallmanite
Yes stay home witha severe injury. Why does no one think of that? Are you even
being serious or just making antagonistic posts?

~~~
mikeash
The dude hates doctors and nurses so much that he thinks they deserve to be
physically attacked. And yet he is desperate for their services. This is a
contradiction. I’m attempting to point this out.

~~~
HarryHirsch
You can look at it the other way: you need physicians and nurses, and because
you have no alternative they fleece you by any means possible, and the rule of
law doesn't apply to them.

A couple of years ago I fell for the high-complexity drug testing scam at the
intake visit. It goes like this: you pee in a jar, and they send it to an out-
of-network lab. A few weeks later the 4.5 kUSD bill arrives, which isn't
covered by insurance. Everyone denies responsibility: the physician says you
gave us the sample, the insurance says out-of-network, and the lab says
services rendered. The charges eventually went away, after several afternoons
on the phone.

Civil society offers no solution. It's no surprise that people give way to
their anger. There isn't even a contradiction.

~~~
stallmanite
Ridiculous. The best part about paying for a drug test is that it literally
offers no benefit to the patient. He or she knows firsthand whether they took
any drugs. (Excepting cases where something is slipped into a drink but that
accounts for ~0% of tests performed.)

