Published March 14, 2022
Physicians, public health officials, and other health care workers face a crisis of workplace violence, a persistent problem which has intensified amidst the ongoing COVID-19 pandemic. The politicization of the pandemic, including the need for vaccination, masking and social distancing, has led to a dramatic increase in threats and violence targeting these individuals, many of whom are on the frontlines of caring for patients. Both the federal government and the states, in varying degrees, have taken some steps to address this problem but more needs to be done. ACP has developed this toolkit to assist chapters in outreach to their state governors and legislatures urging greater protections under state law for physicians and all health care workers from such threats and violence in the workplace.
According to the Bureau of Labor Statistics, workers in the health care and social service sectors experience the most violence of any industry. A 2018 analysis found that health care and social service workers were five times as likely to experience workplace violence than workers overall, and that health care workers specifically made up 73 percent of all nonfatal workplace injuries and illness due to violence. While comprehensive data during the ongoing pandemic is not yet available, widespread reporting and early evidence clearly indicate that the pandemic has exacerbated violence against health care workers. For example, an August 2021 article in the journal Workplace Health and Safety on a survey of registered nurses found that 44 percent and 68 percent of nurses reported experiencing physical violence and verbal abuse, respectively, between February and June 2020. Rising violence against physicians and other health care workers is a global problem, which the World Medical Association labeled “an international emergency” that “undermines the very foundations of health systems and ultimately impacts critically on patients’ health.”
A survey of local health departments across the country found over 1,500 incidents of harassment and violence against “public health” workers between March 2020 and January 2021. Public health officials at every level of government have seen increased threats to their safety, and threats have often extended to officials’ families, with many targeting workers based on race, gender, religion, or sexual orientation. This violence has taken a profound toll on our country’s public health capacity and has contributed to an alarming rate of staff departures from state and local health agencies. Although no comprehensive data exists, media outlets including the Associated Press and the New York Times have attempted to quantify staff departures, with the Times reporting in October 2021 that they had identified at least 500 top health officials who left their jobs since the beginning of the pandemic. Crucially, this data only describes top-level staff departures, not those of lower-level staff who are also critical to public health. Reporting indicates these departures have affected over 20 percent of Americans. Furthermore, the U.S. Centers for Disease Control and Prevention (CDC), in a December 2021 report, surveyed 26,000 public health workers to evaluate the mental health of the country’s public health workforce. Among these respondents, 26 percent reported experiencing work-related stigma or discrimination, 23.4 percent reported feeling bullied, threatened, or harassed because of work since March 2020, and 11 percent reported receiving job-related threats because of work during that same period. Respondents who reported those experiences were nearly twice as likely to report symptoms of PTSD.
ACP policy states that no one should be subject to harassment, physical, or verbal violence at their place of work, and has repeatedly spoken out to condemn violence against physicians and other health care workers. In September 2021, ACP adopted policy on Promoting Policy Standards for Workplace Violence Prevention and Management. That policy recognizes the harm violence causes, calls for additional research to better understand workplace violence and the most effective interventions, and supports legislative efforts to reduce and prevent instances of workplace violence and bolster workplace safety.
At this time, the Occupational Safety and Health Administration (OSHA) does not require employers to implement workplace violence prevention programs, though it does offer voluntary guidelines. ACP policy calls on OSHA and other relevant federal agencies to develop, implement, and enforce a national standard for preventing violence in the health care setting.
In April 2021, the U.S. House of Representatives passed H.R. 1195, the Workplace Violence Prevention for Health Care and Social Service Workers Act, bipartisan legislation that would direct OSHA to implement standards requiring health and social service employers to have comprehensive workplace violence prevention plans and annually report violent incidents to the Department of Labor. That legislation is currently pending in the U.S. Senate.
The American Rescue Plan Act, enacted in March 2021, contained $7.44 billion in funding to hire and train public health workers. The legislation did not address the rising violence targeting public health officials.
In October 2021, the National Association of County and City Health Officials (NACCHO) wrote a letter to U.S. Attorney General Merrick Garland asking that he also include public health officials in a recent Department of Justice policy responding to increasing harassment of school board members.
Many states, but not all, have taken varying steps to address this growing crisis, and that has resulted in a patchwork of state initiatives and laws that offer some protection for certain individuals against threats and violence in the workplace. In some states, those legal protections cover health care workers including physicians, while in other states, protections may apply to public health officials specifically. Some states may also have employer requirements for workplace violence prevention programs.
- Legal Protections for Physicians and Other Health Care Workers
Thirty-eight states have established or increased criminal penalties for the assault of health care workers. In eight of those states, legal protections only apply to certain types of health care workers, like emergency department or mental health personnel, who experience violence at higher rates.
- Legal Protections for Public Health Officials
According to the Network for Public Health Law, 35 states and the District of Columbia have existing laws that prohibit impeding a public official’s duties through violence, threats, and harassment. In these states, existing statutes protect public health officials and should be enforced.
Three states -- Illinois, North Carolina, and Vermont -- have similar laws covering some public officials, but do not extend those protections to public “health” workers. Twelve states have no laws providing legal protections to public health workers.
Some states have taken additional action to protect public health officials by protecting their privacy. California expanded its Safe at Home program to allow public health officials to confidentially protect their addresses. In 2021, Colorado outlawed doxxing, or sharing personal information online with the intent to harass or intimidate, of public health workers and their families.
- Employer Requirements for Workplace Violence Prevention
In the absence of a national standard for the prevention of workplace violence in health care, some states have created their own requirements. Ten states have adopted laws of this kind establishing workplace violence prevention standards for health care employers, and though laws vary somewhat across states, generally, these laws require employers to implement workplace violence prevention programs, and to track and report violent incidents.
ACP urges chapters to advocate with their state governors/legislatures to pass legislation to protect health care workers, including physicians, and public health officials from harassment and violence in the workplace using the customizable sample letters, as provided below, based on a given state’s circumstances.
|Letter One||AL, AZ, AR, CO, DE, HI, IA, ID, KS, KY, LA, MS, MO, NE, NM, OH, OK, SD, TX, UT, WV|
|Letter Two||MN, NJ, WA|
|Letter Three||AK, FL, GA, MA, NC, RI, SC, TN, VT, VA, WI|
|Letter Four||DC, IN, ME, MI, MT, NC, NH, PA|
|Existing state laws are adequate||CA, NV, NY, OR, CT, IL|
- ‘Are You Going to Keep Me Safe?’ Hospital Workers Sound Alarm on Rising Violence | Kaiser Health News (khn.org)
- Violence against healthcare workers rising, state lawmakers told | (capitol-beat.org)
- Lawmakers move to better protect healthcare workers from violence, assault (beckershospitalreview.com)
- Workplace Violence | The American Nurses Association (nursingworld.org)
- Covid-19 and laws for workplace violence in healthcare | The BMJ
- The Persistent Pandemic of Violence Against Health Care Workers (ajmc.com)
- Protecting Health-care Workers: A Summary of Laws in Our Members’ States | Physicians Insurance (phyins.com)