Nursing supervisor Mary Prehoden was on the eighth floor of Scripps Mercy Hospital when she heard a man screaming obscenities.

As a supervisor, it was her job to investigate. But when she stepped into the doorway of the patient’s room, a 25-pound chair came flying right at her.

She managed to dodge the four-legged projectile, but it was quickly followed by the man who threw it. He delivered a punch to the side of her head that sent her to the ground, her glasses flying.

“We ended up on the floor face-to-face in an alcove,” Prehoden said. “He had hold of my hair, he bit me, he punched me, he kicked me. I couldn’t open my eyes because he was trying to gouge out my right eye. It took at least nine people to restrain him so that I could get away from him.”


Today, she said, she has a permanent bite mark on her chest and a scarred sense of trust.

The attack last summer occurred on the oncology ward of the Hillcrest hospital. Had it taken place outside the medical center, the jail time served by her attacker likely would have been significantly longer.

“A firefighter, a paramedic, an EMT, a lifeguard, a process server, a dog catcher … if they’re in the course of their work and they get assaulted, that’s an automatic felony,” said Prehoden, who has worked as a nurse for 39 years. “People who work inside of health care facilities, all of us, are not protected by the same law. We need to be treated the same as far as the law goes.”

Others agree.


On Jan. 31, state Assemblyman Freddie Rodriguez, D-Pomona, introduced Assembly Bill 329. The legislation mandates up to one year of jail time and up to $2,000 in fines for anyone who assaults or batters a health care worker inside a hospital. Current law extends those penalties only to doctors and nurses working outside hospitals in emergency situations.

Though the bill has not yet had its first independent state analysis, Scripps Health is already planning to testify on behalf of the legislation in Sacramento as it moves through the hearing process.

Chris Van Gorder, Scripps’ chief executive officer, said Prehoden’s incident is just one example of a rising tide of violence in hospitals that requires action.

“We see violence escalating,” Van Gorder said. “I think we need to increase the penalties to protect our people.”


A retired Los Angeles area police officer injured in the line of duty who worked for a time as a hospital security officer, the executive makes it clear that this is not a new problem. He himself was stabbed in the arm by a patient in the 1970s.

× Legislation mandates up to one year of jail time and up to $2,000 in fines for anyone who assaults or batters a health care worker inside a hospital.

And it’s not the first time that the Legislature has attempted to bolster penalties for hospital workers.

In 2015, a similar bill, also introduced by Rodriguez, was vetoed by then-Gov. Jerry Brown. The governor’s veto message, which expressed “great respect” for health care workers, took an extremely skeptical tone stating: “If there were evidence that an additional six months in county jail would enhance the safety of these workers or serve as a deterrent, I would sign this bill. I doubt that it would do either.”


But Brown is no longer in office. Gov. Gavin Newsom’s first act in office was to expand health care coverage, encouraging a second attempt.

Van Gorder said he is convinced that passing AB 329 will give hospitals meaningful new tools despite the former governor’s skepticism. It would allow, he noted, hospitals to post notices on their walls informing patients that assault is a crime punishable with significant jail time. Under current law, such postings are not allowed.

“I hope that it will create a deterrent,” Van Gorder said. “I also think it sends a message to our people: If you are a health care worker, we are prepared to do everything we possibly can to protect you.”

Van Gorder said he has also decided that some Scripps security officers will be armed with Tasers, the non-lethal weapons capable of subduing attackers with a powerful jolt of electricity. That measure, he said, has been preceded by extensive de-escalation training of all patient-serving staffers.


Today, a new protocol has front-line workers marking the rooms of patients assessed to potentially become violent with peace signs, signaling in a discreet way to all who enter that extra caution is warranted.

A survey of local hospitals showed that Scripps is not the first to arm its security guards.

Both Sharp Grossmont Hospital and UC San Diego Medical Center already use Tasers and those at Palomar Health hospitals in North County can choose to carry pepper spray if they are certified. Tri-City Medical Center in Oceanside and Prime Healthcare, which operates Paradise Valley and Alvarado hospitals, did not respond.

Grossmont, with the busiest emergency department in the region, has been at the forefront of security changes, implementing a similar de-escalation training program about four years ago when it also introduced tasers and the use of metal-detecting wands for most emergency patients and their families.


Chief Executive Officer Scott Evans said the multi-faceted security upgrade has not only stopped weapons such as knives and guns from entering the hospital, but has made staff more pro-active in preventing violence. In 2015, according to Sharp Healthcare, Grossmont saw 67 “combative” injuries compared to just 21 in 2016 and 2017.

Scott noted that violence is not always visited on hospital workers by patients. Family members also throw punches.

“Sometimes, it’s the dynamic within the family itself that explodes over onto the staff,” Evans said.

Across the Scripps system last year, Van Gorder said, 23 assaults by patients on staff were severe enough that they caused an employee to miss work, the litmus test for whether they must be reported to the state Occupational Safety and Health Administration. Sharp reported 70 such incidents to the CalOSHA in 2018. Palomar, which transmits information to CalOSHA on all injuries it records regardless of whether they were severe enough to cause a worker to miss work, tallied 225 worker injuries last year. Kaiser Permanente San Diego, which has not armed its workers, has not recorded any assaults.


The U.S. Bureau of Labor Statistics surveys all workplaces with more than 10 workers every year to gauge overall worker injury rates. In 2017, the most recent year for which data is available, the BLS survey reports 10.7 intentional injuries per 10,000 hospital workers committed by patients. According to BLS records, that number was 7.5 injuries per 10,000 workers in 2007, suggesting that patient-on-caregiver violence is indeed on the rise.

But the movement to stiffen penalties for assaults on health care workers is about protection and justice, Prehoden said.

Her experience, she said, has led her to believe that society should see assaulting workers who are just doing their jobs the same way whether those assaults occur inside or outside of a hospital.

“I didn’t realize the fear that this would cause,” Prehoden said. “It’s life changing. I couldn’t leave my windows open in my house for months. Still, if somebody’s walking too close behind me, I find myself turning my head to see if I can see out the corner of my eye.”


While her assailant was charged with a felony because he used a chair as a weapon and thus did receive a longer sentence than he otherwise would have, the nurse manager said most assaults that are similarly vicious don’t involve a weapon and, because they happen in hospitals, result in little jail time, usually only a few months.

Of course, what happens inside hospitals is complicated. In Prehoden’s case, the man who hurt her so badly had been diagnosed with mental illness in the past.

In 2015, an organization called Legal Services for Prisoners with Children formally opposed the first bill to take up increasing hospital violence penalties, arguing that it was “misguided” because “the vast majority of assaults on health care workers are caused by individuals who are severely mentally ill, suffering from dementia or undergoing significant psychological stress.”

The organization did not respond to a request for more information on whether it intends to oppose AB-329 this year.


Van Gorder said he agrees there are cases where a mental illness can mean a person is not truly responsible for their actions. Those that are truly unavoidable, he said, would not be charged by the local district attorney in the location where the assault occurred.

“I can tell you right now there are a lot of the assaults that take place here (where) the individuals knowingly assaulted the people. It wasn’t that they didn’t know what they were doing,” Van Gorder said.

Prehoden said that her assailant made a decision not to take any of his prescribed medications. That decision, she said, should come with consequences if it results in an injury to another person.

“I think it’s a balance of, at what point is public safety the greater need,” Prehoden said. “His actions that day were willful. He knew very clearly how to fight. I didn’t have any time to defend myself. I didn’t know what was coming until he was already on top of me.”


AB-329 is currently in the legislature’s Public Safety Committee. Its first hearing has not yet been scheduled.

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paul.sisson@sduniontribune.com


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