Doctors and nurses are being punched and bitten

Plus: Online airport parking rates are going up, too; Lawrence Toppman reviews Three Bone Theatre’s ‘The Lehman Trilogy’; Election notes; PNC bans lawn chairs; Tattoos in York County

Good morning! Today is Monday, November 6, 2023. You’re reading The Charlotte Ledger, a newsletter with smart and original local news.

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As violence against doctors and nurses in hospitals is rising, a new N.C. law aims to help protect them; ‘The public has no idea what we have to endure’

Hospitals are posting signs like these to warn patients about the consequences of verbally or physically abusing workers.

By Michelle Crouch
Co-published with North Carolina Health News

Emergency physician Jennifer Casaletto has been cursed at, shoved, punched, spat on and bitten while trying to do her job. One patient threw a container full of urine at one of her medical residents. Another kicked her when she was pregnant. 

As violent incidents against health care workers have surged, Casaletto said she now tries to work mostly in large hospitals, because they tend to have more security. 

“In large emergency departments, you call security and they are there instantly,” said Casaletto, past president of the North Carolina College of Emergency Physicians.  “Some of the smaller ones have security guards who have been told by the hospital they aren’t allowed to touch anyone. How does that keep us safe?” 

A new N.C. law aims to help address Casaletto’s concern. The legislation requires hospitals with emergency departments to have a law enforcement officer on site at all times, unless they get local authorities to sign off on an exemption. The requirement takes effect in 2025. 

The law also calls for hospitals to report violent incidents to the state, to provide employees with violence-prevention training and to conduct a security risk assessment and create a detailed security plan. 

The legislation is a response to an alarming rise in violence against doctors and nurses in North Carolina and across the country. Federal data show that health care workers are five times more likely to experience workplace violence than workers in other industries, and they accounted for 73% of non-fatal injuries from violence in 2018, the most recent year for which statistics are available. 

The rate of injuries from violent attacks against medical professionals grew by 63% from 2011 to 2018, the data show. 

Emergency departments are particularly dangerous, since staff members are legally required to assess and treat anyone who walks in the door, even a patient who has been violent before. E.R.s also treat patients struggling with psychiatric problems and substance abuse, which can contribute to outbursts. Nationally, 55% of emergency physicians and 70% of emergency nurses report being physically assaulted on the job.

‘The public has no idea what we have to endure’

Violence in hospitals has long been an issue, but the pandemic exacerbated the problem, hospital workers said. It sowed distrust between patients and care providers and contributed to a rise in bad behavior of all kinds. And hospital staffing shortages have contributed to long waits for care and frustrated patients. 

The incidents against healthcare workers often go beyond threats or verbal assaults and result in serious physical harm. For example: 

• In July, a nurse at Atrium Health Carolinas Medical Center in Charlotte was stabbed in the neck with a pen when he tried to help a colleague who was being attacked by a patient, Charlotte-Mecklenburg police said. 

• At Duke Raleigh Hospital in 2022, a patient punched a nurse so hard that he knocked her unconscious and fractured her nose and eye socket. 

• At New Hanover Regional Medical Center in Wilmington, a patient was charged with attempted murder in 2022 after he attacked two emergency room staff members, choking one until she fell unconscious and trying to snap the other’s neck. 

One Charlotte nurse who asked not to be named told The Ledger/N.C. Health News that he “gets abused on a daily basis.” 

“The public has no idea what we have to endure. There is tons of verbal abuse,” he said. “I’ve been attacked by a patient. One of my coworkers was kicked in the face and got knocked out.”

The increase in aggression and violence is driving doctors and nurses to leave health care settings, said Trish Richardson, president of the North Carolina Nurses Association.

“The violence feeds into significant burnout, which leads to staffing shortages, which exacerbates the frustration patients feel that can lead to violence,” she said. “It’s a vicious cycle; one feeds the other.” 

A focus on prevention 

Rep. Timothy Reeder (R-Ayden), a practicing emergency physician at ECU Health in Greenville, said he sponsored the bill because he has seen the effects of violence on hospital staff. “It’s personal for me,” he said.  

Like many other states, North Carolina already had a law making it a felony to assault health care workers on hospital premises. But Reeder said when he investigated, he found that only a small number of people were being prosecuted, and he wanted to do more to protect physicians and nurses. 

David McDonald, president of the North Carolina Emergency Nurses Association, said he is encouraged that the new law focuses on prevention, rather than just tougher penalties for offenders. 

McDonald said nurses who have been assaulted don’t always want to file a police report because they worry about retribution or taking time off to go down to the station. In addition, he has heard that some hospital administrators discourage victims from pressing charges because they think it reflects poorly on the hospital’s public reputation. 

“We are pushing hard on the prevention side to keep nurses from being assaulted in the first place,” he said.

But some advocates for people with mental health issues feel the new law goes too far. 

Corye Dunn, policy director for Disability Rights North Carolina, said that one big problem with bringing the hammer down on this behavior is that in some instances, the behavior stems from an untreated mental health issue. 

“While nobody thinks that violence in a health care setting is appropriate or acceptable, we have to be cautious that we don’t create a system that punishes people for seeking the care they need,” Dunn said. 

She pointed out that frequently people who are involuntarily committed to psychiatric treatment will languish in emergency departments for days and sometimes weeks, which can create an explosive situation.

Can law enforcement make a difference?

While some large North Carolina hospitals already have law enforcement officers on their campuses, Reeder said most rely on non-certified security guards or have no security at all. 

To comply with the law, hospitals can hire off-duty law enforcement officers, contract with the county sheriff or the city police department to provide officers or create their own special police force, said Eddie Caldwell, executive vice president and general counsel of the North Carolina Sheriffs’ Association.

In Charlotte, Atrium Health said it has increased its security staffing in recent years, including adding armed guards with firearms and/or tasers. “Many have prior law enforcement experience or a military background,” the hospital said in a statement. 

The guards would not meet the new law’s requirements, however, because they aren’t law enforcement officers with arrest powers. 

Suzanna Fox, senior vice president and deputy chief physician executive for Atrium Health, said in a statement, “We know health care professionals work around the clock to provide quality care to everyone who needs it and they deserve to be protected from violence while they do it … We look forward to working with law enforcement in the communities we serve, as well as ongoing collaboration with lawmakers, to achieve greater safety for our teammates, patients and visitors at our facilities.”

Novant Health said it uses armed public safety officers as well as law enforcement officers on its hospital campuses. The system is still determining whether it will need to make changes to its current model, a spokeswoman said.

Hospitals beef up security

Like other hospitals across the state, Atrium and Novant have already amped up their security to address the rising violence. Both have installed metal detectors in their E.R.s. They also provide workers with violence prevention training and have posted signs in their facilities warning patients about the consequences of assaulting hospital workers.

Novant said it established a standing workplace violence committee in 2019. In contrast to national trends, the system said it has observed a “year-over-year downward trend in workplace violence, which we attribute to our robust training and safety measures.”

Atrium, meanwhile, said in a statement that it has increased its security staffing and provided its workers with personal panic devices, among other steps. 

The hospital has also “been working more closely with law enforcement, prosecutors and magistrates to reach a common understanding of what types of circumstances can be most successfully prosecuted and diligently pursuing those in court, and it’s working.” (Click here to see the specific steps Atrium, Novant and a few other N.C. hospital systems have taken to protect their workers.)

Making the E.R. safe for everyone

Casaletto, who went to the U.S. Capitol in 2022 to talk about the need for federal legislation to protect hospital workers, said she’s heartened that more hospitals are taking steps they were reluctant to take just a few years ago, such as installing metal detectors and pressing charges.  

Next, she said she wants to see more district attorneys prosecuting those who assault health care workers to the full extent of the law. 

“These incidents aren’t just affecting emergency physicians and nurses,” Casaletto said. “They’re taking us away from our patients, and that makes everyone in the emergency department less safe.”

Michelle Crouch covers health care. If you have tips or ideas for her, please shoot her an email at mcrouch@northcarolinahealthnews.org.

This article is part of a partnership between The Ledger and North Carolina Health News to produce original health care reporting focused on the Charlotte area. For more information, or to support this effort with a tax-free gift, click here.

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Today’s supporting sponsor is Landon A. Dunn, attorney-at-law in Matthews:

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Turns out online reservations for airport parking are now more expensive, too

You probably saw that Charlotte’s airport announced a couple weeks ago that it is hiking the rates for airport parking, effective today.

At the time, the airport took pains to emphasize that the new rates — $12 a day for long-term, $20 a day for daily as well as increases in the other lots — applied only to fliers who showed up without online reservations. Its press release was titled “Drive-Up Parking Rates Increasing Nov. 6,” and it said on social media, “The price increase is for drive-up only.” Local media also described the changes as affecting “drive-up parking rates.”

Lo and behold, it turns out that those online reservation prices are now higher, too. The “drive-up” rate for daily was announced as increasing from $12 to $20. On Sunday, on the airport’s online reservations system, the price for a one-day reservation that starts today (Monday) was listed at $19.99, which is (obviously) higher than the previous $12-a-day rate for those decks.

Same goes for long-term lots, for which the “drive-up” rates went from $10 a day to $12 a day. The online reservations system on Sunday was selling a three-day reservation for this week for $35.99, which is 1 cent short of $12 a day — higher than the previous $10-a-day rate.

The airport says the higher rates are needed to pay for expanded parking as the number of travelers grows. It says the least expensive rates can be found by booking online ahead of time. —TM

Related Ledger article:

• “Airport raises parking rates again” (Oct. 30)

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Taking Stock, sponsored by Topsail Wealth Management

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How local stocks of note fared last week (through Friday’s close), and year to date:

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🎭 Theater review: Three Bone Theatre’s ‘The Lehman Trilogy’ aptly captures one family’s money hungry arc, with 3 actors and 3 acts

Ledger arts critic Lawrence Toppman took in Saturday night’s performance of “The Lehman Trilogy” by Three Bone Theatre. (It runs through Nov. 18 at the Arts Factory.) 

In his review for The Ledger, Toppman writes: 

Until I watched “The Lehman Trilogy” Saturday night, I could not conceive of a three-hour drama in which nobody spoke the word “love.” Or “pity,” “charity,” “kindness,” “tenderness,” “mercy” or “forgiveness.” (“Hate” gets tossed around freely, especially in act 3.)

One emotion prevails in the 2022 Tony-winner for best play: fear. Fear of being poor, no matter how rich one becomes. Of failing to outrun or outpunch business competitors. Of failing to expand eternally, like the universe. Of being the mythical shark which, if it stops moving for an instant, dies. Watching this coldly fascinating work, expertly produced at the Arts Factory by Three Bone Theatre, is like watching feeding time in a zoo populated by bankers and stock traders.

Check out Toppman’s full review, with information if you want to go: 

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🇺🇸 Election Notes: Tomorrow is Election Day; Stephanie Hand responds to Ledger report on airport experience; Early voting analysis

Now through Election Day, The Ledger will round up tidbits of election news to help you make an informed choice. For unbiased election information that’s free to all, with no ads, check out The Ledger’s Election Hub, with candidate questionnaires, videos and links to other reputable sources on city elections, school board elections and the school bond vote.

◼️ Tomorrow is the big day: Polls are open 6:30 a.m. to 7:30 p.m. On the ballot: Charlotte City Council and mayor races, 3 CMS school board seats and the $2.5B school construction bond.

We’ve got all the info you need at our Charlotte Ledger Election Hub, with links to resources and other credible outlets, videos of candidates, endorsement updates and short podcasts. One satisfied reader told us: “Reading up on my Charlotte Ledger voters guide. It is so helpful!!!” and added: “I can’t believe some of the people who are running for the school board.”

◼️ Hand responds to Ledger report: Charlotte City Council candidate Stephanie Hand, a Democrat running to unseat incumbent Republican Tariq Bokhari in south Charlotte District 6, has responded to a reporter who asked her about her airport experience. Sort of.

The Ledger reported last week that despite Hand’s statements that she has “run airports,” it appears that her experience is with airport concessions vendor HMSHost. Hand didn’t reply to our inquiries, but WFAE’s Steve Harrison reported on Friday in his “Inside Politics” newsletter: “When Inside Politics asked Hand why she wasn’t more clear about her resume, she did not directly answer. Instead, she noted that she was an executive at a Fortune 500 company and was the executive operations manager at Charlotte Douglas and other venues along the East Coast.”

Bokhari has sought to make an issue out of Hand’s resume, including with radio ads on WBT and with a mailer last week that depicts Hand dressed as an airline pilot above the words “Not who she says she is.” Hand said in an ad Sunday that “It’s time to vote for responsive, compassionate, positive change.”

◼️ Early voting analysis: Speaking of the District 6 race, WFAE’s Steve Harrison examined the early voting numbers and says they suggest another close race and also that “there are warning signs for Bokhari, as the share of Republicans who have voted early is lagging.”

Hand appears to have the edge in early voting, Harrison writes, with a higher share of Democrats turning out than in last year’s race between the two. Republicans tend to turn out more on Election Day, and last year, “the larger number of people who voted on the final day gave [Bokhari] a narrow win.”

Bokhari won last year by 357 votes, or less than 2 percentage points. You can read the full analysis here.

◼️ Programming note: Ledger contributor Sucharita Kodali, who researched and wrote much of the material for our Election Hub, is scheduled to appear as a guest today at 9 a.m. on WFAE’s “Charlotte Talks with Mike Collins” to discuss the school board election and school bonds.

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You might be interested in these Charlotte events

Events submitted by readers to The Ledger’s events board:

• WEDNESDAY: Topgolf Tournament and Fundraiser, 9 a.m. - 1 p.m., Topgolf Charlotte University, 9110 Drivers Way. Join the Charlotte Area Chamber of Commerce for an afternoon filled with networking, food, drinks and fun! Grab your team — colleagues, clients, prospects or friends — sign up and get ready to network with your peers in a relaxed, fun environment. Individual player: $125; Team of 6: $625.

◼️ Check out the full Ledger events board.

➡️ List your event on the Ledger events board.

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In brief:

• Music venue bans lawn chairs: PNC Music Pavilion said in a Facebook post that it will no longer allow personal lawn chairs. It said lawn chairs will be available to reserve ahead of time and that it was making the move “to improve venue entry and for security purposes.” (hat tip: WBTV)

• Fellow Republican blasts House speaker: Shortly after news emerged last week that N.C. House Speaker Tim Moore is running for a Charlotte-area congressional seat, his Republican opponent, Pat Harrigan, released a statement that said: “Let’s be clear: Tim Moore carries a legacy of corruption, from being bought and paid for by the casino and gambling bosses, to taxpayer-funded sexual escapades.” (Raleigh News & Observer)

• Future of SouthPark: SouthPark Community Partners is asking residents to complete a survey that will be used to help shape the future of the SouthPark area. Details here.

• S.C. tattoos: York County, S.C. is getting its first tattoo parlor, 20 years after the state legalized them. (Rock Hill Herald)

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Executive editor: Tony Mecia; Managing editor: Cristina Bolling; Staff writer: Lindsey Banks; Business manager: Brie Chrisman, BC Creative