Fatal Attack Renews Calls for Healthcare Workplace Safety

Cynthia Barraca Palomata, RN, died last week after she was attacked and struck in the head with a lamp by a prisoner she was treating at the Martinez Detention Facility in Contra Costa County, CA.

Palomata was a veteran nurse who'd worked in San Francisco-area hospitals for more than 20 years. She joined Contra Costa Health Services in 2005 and had worked in the Martinez Detention Facility since then.

"She was a well respected member of our nursing staff and our hearts go out to her
family during this incredibly difficult time," says William Walker, MD, director of Contra Costa Health Services. "Staff safety is the highest priority and we continue to work closely with the Sheriff's Office to evaluate safety procedures."

Palomata was attacked in the intake area of the jail by a burglary suspect who police said had no previous history of violent behavior and who allegedly picked up the lamp and struck the nurse "without provocation or warning," even though sheriff's deputies were in the area. The inmate faces murder charges.

Regular HealthLeaders Media readers know we've touch upon the subject of workplace violence numerous times. The topic doesn't get old for us, because the incidents of violence won't go away. Bureau of Labor Statistics data for 2008—the latest figures available—show 2,890 work-related assaults at hospitals. That doesn't tell the whole story, because the data reflect only assaults that are serious enough to inflict injury and force the victim to miss at least one day of work. Other BLS data show that for every 10,000 hospital workers, there were eight workplace assaults that resulted in missed work days. By comparison, in the overall private sector, there were only 1.7 workplace assaults resulting in missed work for every 10,000 workers. Last year, more than half of the 3,465 respondents to an Emergency Nurses Association online survey said they've been spit on, hit, pushed, shoved, scratched, or kicked while on the job.

The public is becoming aware of the issue, and they're getting angry, thanks to high-profile media reports of attacks like the one that killed Palomata. The publicity is a good thing. People need to know about the extent of the problem.

In the wake of Palomata's murder, there have been calls to re-examine enhanced criminal penalties for assaults against healthcare workers. California enacted a law in 1993 requiring hospitals to have a security plan in place for general acute-care hospitals, but the law did not cover prisons and jails. There is now a call to amend the law to include correctional facilities.

The California Nurses Association has weighed in too, and it's completely appropriate that they do. CNA represents the nurses at the Contra Costa Health Services, which contracts to provide inmate healthcare services. The union says its members had repeatedly called for stronger security measures, but that the health system has indicated it is not responsible for security at the detention center, and has ignored requests for security upgrades in the main hospital to include 24-hour guards, metal detectors and other security devices in the ER and psychiatric unit.   

"We can no longer tolerate inadequate security measures which threaten not only RNs and other staff, but also put families and other patients at risk," said Kay McVay, RN, CAN's president emeritus, and a long-time resident of Contra Costa County.

CNA is correct to raise these concerns. So far, it's not clear what—if anything—could have been done to prevent Palomata's murder. Perhaps it was an isolated, tragic instance. However, there are just too many of these "isolated" incidents going on across the nation, and hospitals must be compelled to evaluate their security measures to ensure a safe workplace for their frontline healthcare workers.

Many will note that Palomata was killed in a jail, not a hospital. That point is irrelevant for Palomata's family and colleagues, however, and it should be for the rest of us as well. There shouldn't be a tacit lowering of standards for safety and security for healthcare providers depending upon where they practice their profession. Any hospital or health system that provides healthcare beyond the campus should make every effort to ensure that their employees are as safe there as they would be in the C suite. 

"Prevention is essential for creating a safe and therapeutic environment for patients and a safer workplace for healthcare workers, and to reduce the loss of experienced staff who leave because of assaults and threats of violence," McVay said.

The CNA is right on this one folks.