Claims Case Study: Threats and Violence

Acts of violence in health care settings is an under-reported and under-recognized problem—but one that physicians and medical practices must be prepared to deal with. The statistics tell a grim story: Almost 75% of workplace assaults between 2011 and 2013 took place in health care settings, and 78% of emergency department physicians report being the target of workplace violence in the past year. As Dr. James Phillips, author of a recent study on the subject in the New England Journal of Medicine, told Medscape Medical News, “Healthcare providers … seem to be unaware of the extent of the violence.” The following case studies, drawn from the recent experience of Curi member practices, help illustrate the nature of the risk.

A 58-year-old man was referred to a gastroenterology practice for management and treatment of his Crohn’s disease. The patient kept his appointments, but refused to have his vital signs taken, ignored requests and directions from staff, communicated abruptly, and often used profanity. One day, when he had been waiting fifteen minutes after his appointment time, he walked behind the reception area into a clearly marked “Staff Only” area, slapped his hand on the desk, and loudly asked, “Who in the hell do I have to yell at around here to get in to my appointment on time? You better see me now or there’s going to be hell to pay!”

In another case, a patient had recently undergone a knee arthroscopy in an orthopedic outpatient surgery center. He repeatedly told various staff members, “I’m still having problems, and you aren’t helping me.” The patient’s wife also left several messages on the treating physician’s voice mail, stating, “My husband can’t get around and do the things he did before you messed his knee up in surgery. Now, I’m getting bills from your office? Are you kidding me? You’ll be sorry you ever became a surgeon after I’m done with you. If you can’t fix this, then I’ll find someone who can, and you’ll hear from me!”

While the practices in both of these cases were fortunate enough to avoid actual acts of violence, it is important to note that many attacks in health care settings escalate quickly from verbal abuse like that described here. These are warning signs that providers need to be aware of and prepared to respond to.

Key Risk Management Takeaways

Curi’s Risk Management department frequently receives inquiries on how to handle difficult and potentially violent patients. Above all, we stress that the safety of patients and staff is the first priority. If anybody at the practice feels that patients, providers, or staff are in imminent danger, they must not hesitate to contact local law enforcement (911).

The following resources offer guidance in managing these difficult and potentially dangerous situations:

• Managing Patient Complaints Toolkit: This toolkit provides resources for dealing with abusive patients, handling complaints that cannot be resolved, and educating staff about these issues.
• Managing Patient Complaints Webinette: This short instructive video addresses the subject of difficult patients and offers guidance on how to deal with them.
• State-Specific Risk Management Handbooks: These tools contain information on the steps needed to terminate a patient from a practice. Recommendations include how to handle patients who are in active treatment, such as those in the examples above.

For further guidance, Curi members are encouraged to contact our Risk Management Department at 800.662.7917.