(Image courtesy of American College of Emergency Physicians)

The overwhelming majority of emergency department (ED)physicians across the country have experienced, witnessed or been subjected to threats, abuse, assault and injury during their shifts, said Dr. Melisa Lai-Becker, chief of Mass General Brigham Community Emergency Medicine. Under existing law, a nurse can be punched and kicked by a patient or visitor and the crime is classified as simple assault, which is a misdemeanor, rather than a felony charge of assault and battery with a dangerous weapon, she said.

"There are, unfortunately, many people who have come at us, who knowingly and willingly have assaulted us and our staff, and they are our patients, and they have committed only a misdemeanor," Lai-Becker said. "And we call the police, and the police are just as frustrated. Our partners in law enforcement, they also tell us, 'I am sorry, this is a misdemeanor, I am not allowed to take them away, I can't take them into custody.'"

Instead, Lai-Becker said, violent patients end up staying at the hospital and taunting health care workers, whose colleagues may be admitted for care themselves after an attack.

Emergency physicians looking to strengthen safety protections for health care workers and stiffen penalties for assault charges had a powerful ally on hand during their Beacon Hill lobby day Thursday.

"I don't sponsor many bills because I'm the majority leader, but this bill was important to me," House Majority Leader Michael Moran said about his bid to crack down on violence in health care settings as he described learning about the issue from advocates. "We have a few months left in this session. It is my hope that we get this out of Health Care Finance -- which I believe is the committee it's in right now; it was reported to that committee from Public Safety -- and see if we can get this across the line between now and the end of July."

Moran's bill (H 2381) was reported favorably out of the Joint Committee on Public Safety and Homeland Security on May 22 and sent to the Joint Committee on Health Care Financing. It would create standards for hospitals to evaluate security risks, require hospitals to develop violence prevention plans, implement mandatory and protected reporting protocols tied to safety incidents, and classify assaults against health care providers and first responders as a felony.

Doctors and residents with the Massachusetts College of Emergency Physicians are also prioritizing their advocacy around overhauling the involuntary commitment landscape for individuals grappling with alcohol and substance use disorders, and establishing a 10-year pilot program for overdose prevention centers to stem the tide of opioid-related overdose deaths. Those proposals have gained some traction among legislators, but still need key committee votes to advance to the floor for debate before the end of formal sessions next month.

Physicians made their requests to lawmakers against the backdrop of deteriorating health care conditions, including the protracted emergency room boarding crisis that's leading to poorer outcomes for patients, avoidable deaths, burnout for providers and a worsening workforce shortage. The circumstances are making physicians feel like they are doing a "terrible" job and that the health care system is collapsing, said Dr. Joseph Kopp, an emergency physician at Faulkner Hospital and Brigham and Women's Hospital.

"It is at a breaking point. We can't solve the issues that we're having right now when we're trying to see patients in the waiting room," Kopp said. "Hospitals are trying different innovative ways to do this; whether it's hallway care upstairs or early discharges, there's lots of things that they can do. But quite frankly, it's going to take the government and legislative processes to actually fix this issue."

During their legislative briefing, MACEP advocates also sought to generate momentum for an involuntary commitment reform bill from Rep. Ruth Balser (H 1966), which is accompanied by a similar proposal from Sen. Cindy Friedman (S 1247). The legislation, which has been in the House Ways and Means Committee since mid-April, would block the state from sending men to correctional facilities when they are committed for alcohol and substance use disorder treatment.

The overhaul to what's known as Section 35, which physicians said is often seen as a last resort for families looking to keep their loved ones safe, would require men instead to go to treatment facilities administered by the Department of Public Health and the Department of Mental Health. Advocates said officials rely on prison beds when there's a shortage of space in more appropriate treatment settings, though Balser's bill would require the state to maintain an adequate bed supply for men under Section 35.

Women who are involuntarily committed under Section 35 stopped being sent to prisons in 2016, advocates said.

"Massachusetts is the only state in the country that sends individuals to carceral facilities -- the only one that will send them to jails to have this treatment. No other state does this," Dr. Scott Weiner, an emergency physician at Brigham and Women's Hospital, said.

"It's not the best place to be treated for this disease," Weiner continued. "Does it work? Short answer: No. Systematic reviews show that there's no evidence of benefit, and we know that when people get out of a carceral facility, their risk of overdose markedly increases."

Focusing on prevention strategies to tackle the opioid epidemic, emergency physicians support controversial bills to establish overdose prevention centers, where trained professionals are available and can intervene in overdose situations.

Proposals from Reps. Dylan Fernandes and Marjorie Decker and Sen. Julian Cyr (H 1981 / S 1242) that pave a path for the centers, also known as supervised injection sites, have been lodged in the House and Senate Ways and Means committees for months.

Boston could save $4 million annually if the city had an overdose prevention center, by cutting costs from ambulance rides, emergency department visits and hospitalizations, Weiner said, referencing a past study.

"Large studies have shown that there's no harm in using safe injection facilities. In fact, there are reductions in morbidity and mortality, improvement in harm reduction behaviors, there's more access to addiction treatment programs," Weiner said.

Cities and towns that want to open safe injection sites would still need approval from their local boards of health under the bills.

"It's not a mandate. There's a ton of requirements about what they need to provide to patients," Weiner told advocates ahead of their meetings with lawmakers. "We hope that people in this room to influence policy will help move it forward."

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Emergency Docs at "Breaking Point" -- Demand Action - Franklin Observer