Violence at Israel's hospitals endangers the country's medical care

HEALTH AFFAIRS: "It is not possible for staff members to come to work and provide treatment if they have to fear violent behavior from patients," said Laniado Medical Center CEO Nadav Chen.

 POLICE AT Rambam Health Care Campus in Haifa. (photo credit: RAMBAM HEALTH CARE CAMPUS)
POLICE AT Rambam Health Care Campus in Haifa.

“It is unacceptable that Israeli citizens do not feel safe in the place that should be the safest for them,” President Isaac Herzog said Wednesday during a visit to the Galilee Medical Center. “How can it be that the place we go to receive lifesaving care becomes a life-threatening place?”

His words were especially poignant after a series of violent incidents rattled the country’s hospitals this week, including one incident in which bullets were shot in a hospital parking lot. 

“This crosses a redline, and we demand that vigorous actions be taken to maintain peace in the hospital,” said Dr. Shlomi Kodesh, director-general of Soroka-University Medical Center in Beersheba, where one of the incidents occurred. 

“It is not possible for staff members to come to work and provide treatment if they have to fear violent behavior from patients or those who accompany them,” said Laniado Medical Center CEO Nadav Chen, whose hospital suffered from an assault the week before. 

A massive brawl broke out on Sunday night between two clans in Soroka’s parking lot, during which guns were fired. Four people were injured and 10 people were arrested, the hospital and Israel Police said. It took about an hour from the start of the incident until police managed to restore calm to the area.

Soroka Medical Center in Beersheba (credit: DR. AVISHAI TEICHER/WIKIMEDIA COMMONS)Soroka Medical Center in Beersheba (credit: DR. AVISHAI TEICHER/WIKIMEDIA COMMONS)

Then, on Monday, Rambam Health Care Campus security was forced to call in police after nearly 100 clan and family members attempted to force their way into the hospital’s emergency room where a victim of criminal violence was brought for treatment. 

“Two or three times a week, the hospital turns into a battlefield between warring clans,” said Benny Keller, head of Rambam’s security department. “Shooting near a hospital is unbelievably scary.”

The next day, an angry mob gathered outside Meir Medical Center in Kfar Saba where two shooting victims, one who later succumbed to his wounds, were being treated. The crowd thronged to the hospital from a nearby funeral at a cemetery in Jaljulya, where fire had broken out between the parties. The families managed to push past security guards and enter the facility, until police arrived and restored order. 

Only one week prior, a violent incident took place at Laniado in Netanya which the hospital said could have been worse had the attacker not been stopped by security personnel.

In the early morning, a patient’s visitor verbally assaulted staff and broke a computer screen in the hospital’s emergency department, and then lunged forward to physically assault a nurse, only to be stopped just in time by hospital security staff. 

Two videos were disseminated by the hospital, one that shows a bearded man in a black shirt standing at one of the department’s reception desks shouting at staff. He then yanks an entire computer screen off the desk and crashes it to the ground. The second video shows him running through the department with his arms flailing until he is seized by a security guard.

While according to Dr. Zeev Feldman, chairman of the Association of State Physicians and acting chairman of the Israeli Medical Association, incidents like what occurred at Laniado are more common than the recent clan and family violence being witnessed near hospitals, all of these events have “highlighted the fact that the medical crews in the hospitals are without any kind of protection at all.” 

HOSPITALS ARE a microcosm of society. Every day, thousands of diverse citizens arrive in the country’s emergency rooms to be treated, and they bring with them the pulse from outside the hospital walls. When there is stress and violence on the streets, Feldman explained, this is what enters the hospital.

And the COVID-19 pandemic has made matters worse.

According to Tavor Enoshi, the head of human resources for Samson Assuta Ashdod Hospital, coronavirus has caused an uptick in violence in hospitals due to the stress it has put on society.

“When there is more violence in the community, the violence shows up in hospitals, too,” he said. “People who come to the hospital are inherently stressed, and people act in extreme ways when they are under stress. Hospitals right now are also very crowded, and the staff is stretched thin, and this combination leads to a situation where violence can more easily erupt.

“The more crowded the hospital, the more likely that violence will increase,” he said.

Keller said that this kind of stress is difficult on the doctors, nurses and other health staff. He said it throws them off balance and makes it challenging for them to do their jobs. 

He cited a recent example from Rambam where a man who was suffering from COVID-19 deteriorated and the doctor believed he needed to be intubated. The doctor approached the elderly man’s sons to consult with them and “they went crazy and tried to beat up the doctor.” 

The next day, the man died, and the doctor was afraid to deliver the news to his family. Keller said that the hospital called on its security personnel and police to accompany the doctor to deliver the news to ensure he was not harmed. 

Hospital overcrowding and a shortage of doctors and nurses is the result of decades of neglect by the government of the healthcare system, Feldman pointed out. Yet, he said that visitors often blame the medical staff, who are on the front lines, for the “negligence of the government toward the healthcare system,” by lashing out when things do not go right. 

“We need to be protected... so we can concentrate on delivering our knowledge and know-how to treat patients, and not on dealing with public discontent or being the targets of physical or verbal attacks,” he stressed.

Feldman said that the Israeli Medical Association requested information from the police as to how many attacks have taken place against medical crews in hospitals, and was told that they do not track that specific information. However, the Health Ministry was able to provide a snapshot of violent incidents against workers, which it shared with The Jerusalem Post on Wednesday night.

According to the data, in 2018, there were 272 acts of physical violence against medical personnel, compared to 333 in 2019, 306 in 2020 and so far, 252 between January and October 2021. The decrease in 2020, the ministry said, is likely due to the lockdowns, during which fewer people sought medical assistance.

Threats were also relatively steady at 169 in 2018, 216 in 2019, 128 in 2020 and, so far, 115 recorded threats in 2021.

Finally, verbal violence and damage to property numbers are similar, too. There were 270 incidents in 2018, 312 in 2019, 225 in 2020 and, so far, 121 in 2021. 

In addition, there were around 5,300 incidents of disruption of order in hospitals in 2020, compared to 4,631 so far this year. 

But Keller said in his hospital they are definitely feeling a rise. 

“If you compare January to October 2020 to the same period this year, there were 1,000 incidents of disruption of order in the hospital in 2020 compared to already more than 1,500 in 2021,” Keller said. 

He noted that hiring security guards has become more challenging than ever in his 30 years at the hospital. He said that hospital guards receive only NIS 36 per hour, and they are required to work 12-hour shifts, from 7 a.m. to 7 p.m. or 7 p.m. to 7 a.m. 

“We place them at the bottom of the totem pole, and they work very hard and do very dangerous work,” Keller said. “There are many other places that hire security guards to work less hard and for higher salaries.”

He said that he is calling on the government to raise the salaries of the guards, which are set by the state, and to start prioritizing them.

Feldman said that the government should provide the hospitals with more police presence because “once a person sees a policeman, he will think twice about whether he wants to be verbally or physically violent.” 

“The violent incident that took place... on the grounds of Soroka hospital, in the capital of the Negev, is a crossing of redlines and a resounding warning sign to the Health and Public Security ministries,” stressed Prof. Zion Hagay, chairman of the Israeli Medical Association. “It is not possible for patients and medical staff to be abandoned. 

“We must not wait for miracles,” he said. 

PRIME MINISTER Naftali Bennett said that the country is starting to crack down on crime and violence and working to seize illegal weapons, something that he said had been neglected in the last decade.

Speaking at a meeting of the Ministerial Committee to Combat Violence in Arab Society on Monday, he said that the reservoir of illegal weapons has “grown and swelled for many years” and that it “needs to be emptied.”

“Friends, we are working,” he said. “Our task is not to take our foot off the gas, but to continue with all our might. Another operation and another operation, keep pressing until the task is completed.”

Coalition Chairwoman and Health Committee chairwoman MK Idit Silman visited Laniado this week, where she said that “we will examine the possibility of advancing legislation to increase punishment against those who attack medical staff.”

“Our staff are at the forefront every day, around the clock. It is time for an attack on medical staff to be equivalent to an assault on a police officer in the line of duty, including a minimum punishment,” Chen told Silman during the visit.

But something must be done to immediately stop the violence, Feldman stressed, otherwise healthcare could suffer.

“We want to be able to treat the public without any fear or restrictions,” he said.•