What happens if you hit the patient back?

[retro]

I work in a big city where it's known for drug addicts, alcoholics, psych patients, homeless, you name it.

Recently, I had a shift where I was slapped on the face by a mentally ill / intox patient.
The slap wasn't enough to knock me out or anything, but it was enough to ruin my shift.

At that moment, I had the urge to hit the patient back, but I somehow managed to hold back.

I guess the rational side of me kicked in, and I started thinking about different scenarios that could ruin my life even more.

I thought this crazy patient who was under arrest had nothing to lose, but I do have some things to lose. So it would be at my best interest to let go of the incident.
I also thought about the hospital camera recording everything, which might complicate things even more.

My question is, what happens if I decide to hit the patient back?
Assuming everything gets recorded in the camera, and patient decides to sue me for this?
Legally speaking, am I at fault for assaulting someone even if I wasn't the one to instigate the fight?
I'd love to hear from anyone with similar experience.

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[always.chillin]

Yes. The argument will be made in favor of the patient, that he was intoxicated/altered and couldn’t control himself while you could. We had a staff member get fired over something like this.

 

[The Knife & Gun Club]

Sounds like a great indication for 500 mg IM ketamine for stat behavioral control +/- Airway management. Safety of yourself and the staff comes first.

 

[Tenk]

Just remember: (Ketamine + foley) > slap.

 

[Siggy]

Sounds like a great indication for 500 mg IM ketamine for stat behavioral control +/- Airway management. Safety of yourself and the staff comes first.

I've yet to hear anyone complain or fight back after receiving roc.

 

[RuralEDDoc]

That’s a no-win situation. Unless their hands are around you neck, or you’re cornered and they are swinging, best move is to walk away.

 

[BoardingDoc]

Hopefully you live in a state where assaulting a health care worker is a felony. If so, press charges.

 

[Apollyon]

I've yet to hear anyone complain or fight back after receiving roc.

That's torture, bro, unless you're sedating them at the same time.

 

[Lexdiamondz]

That's torture, bro, unless you're sedating them at the same time.

Maybe, but

Don't start none won't be none

 

[AlmostAnMD]

Hopefully you live in a state where assaulting a health care worker is a felony. If so, press charges.

Bad advice

Lots of paperwork

Might have to miss a shift due to court stuff

Patient in jail probably gives better food/shelter than being homeless

 

[Rendar5]

Bad advice

Lots of paperwork

Might have to miss a shift due to court stuff

Patient in jail probably gives better food/shelter than being homeless

I did press charges once on a drunk 18 year old who decided to headbutt me. I had to fill out zero paperwork, and I spoke with the district attorney once for five minutes to go over what I felt was appropriate. We both agreed since he was not a serial offender that diversion was reasonable (community service and gets off record if he has no issues for several months), so I do not have to deal with any court issues. The guy missed out on Thanksgiving with his parents and ended up in jail, which I thought was reasonable punishment.

I did not punch him back, but I did shove him in response across the hallway, right into his bed (luckily).

As far as punching someone back, legally I believe you have the right to defend yourself, but not to retaliate. Force has to be proportional and immediate in response, not 20 seconds later. That’s legally speaking. Hospitals might fire you even if you’re legally in the clear.

 

[ScepticSkeksis]

I would press charges on anyone who assaults me and I encourage the nurses to do the same. Assault of any kind on any worker is never acceptablee.

 

[bravotwozero]

Hopefully you live in a state where assaulting a health care worker is a felony. If so, press charges.

Texas just changed the law, so that it is a 3rd degree felony - meaning the assailant can face 2 to 10 years prison plus a $10k fine.

 

[WorkNoteEmergency]

That’s a tough situation. That type of scenario there should be some security muscle around for the overwhelming response but O know some ED’s don’t roll like that.

When I was a resident a drunk patient took a swing at me, missed, walked out of ED and hit someone else. He was arrested and convicted in court.

A few years later I got in the face of a drunk patient. I’m generally pretty good at ignoring the crap and even de-escalating a lot of tense situations with my “hey, mellow guy here, what’s with all the fuss” routine, but this was a drunk girl with an ugly ankle fracture dislocation that needed a quick reduction. Staff was getting everything together and this girl was screaming and dropping f bombs at the top of her lungs, insulting everyone in the room and getting everyone on edge. It finally pushed the button in me and I got in her face and shouted at her to shut the eff up or I was going to put her ankle back without any meds. That got everyone in the room real quiet. I was so pissed I might have slapped her if it got worse.

 

[JacobMcCandles]

I would also press charges but, unless, you feel that your life is truly in danger then fighting back probably isn't the best choice (and I wholeheartedly disagree with this). You have much more to lose than the patient in this scenario.

 

[skougess]

I would also press charges but, unless, you feel that your life is truly in danger then fighting back probably isn't the best choice (and I wholeheartedly disagree with this). You have much more to lose than the patient in this scenario.

Agreed. Either intubate or discharge immediately (depending on the patient) and move on.

 

[GassYous]

dc to jc

 

[Siggy]

That's torture, bro, unless you're sedating them at the same time.

Yes, I agree... don't paralyze patients without sedation. I wish anesthesiology gets this memo...

...however maybe I still haven't heard anyone complain while paralyzed. /s

 

[Birdstrike]

I work in a big city where it's known for drug addicts, alcoholics, psych patients, homeless, you name it.

Recently, I had a shift where I was slapped on the face by a mentally ill / intox patient.
The slap wasn't enough to knock me out or anything, but it was enough to ruin my shift.

At that moment, I had the urge to hit the patient back, but I somehow managed to hold back.

I guess the rational side of me kicked in, and I started thinking about different scenarios that could ruin my life even more.

I thought this crazy patient who was under arrest had nothing to lose, but I do have some things to lose. So it would be at my best interest to let go of the incident.
I also thought about the hospital camera recording everything, which might complicate things even more.

My question is, what happens if I decide to hit the patient back?
Assuming everything gets recorded in the camera, and patient decides to sue me for this?
Legally speaking, am I at fault for assaulting someone even if I wasn't the one to instigate the fight?
I'd love to hear from anyone with similar experience.

If you act in self defense, you should be protected. Unfortunately, attorneys can make a court case out of arguing what constitutes self defense, whether the defensive response appropriate for the threat, etc. It sounds like you made a decision you’re comfortable with.

 

[Fpg1245]

Hopefully you live in a state where assaulting a health care worker is a felony. If so, press charges.

Isn’t assaulting anybody a felony?
I mean I’ve been trying to figure out all the “reminders” in the ED waiting area letting people know it’s a crime to assault the staff.

 

[CajunMedic]

Dealing with this now after being attacked by someone that had already been violent with family and other staff, and defending myself.

Thrown under bus by admin.
Drug in front of every hospital committee and privileges suspended. Now have a laundry list of things to do to get them back.
Had to self-report to medical board, lawyer up, and meet with investigators-outcome pending me completing everything the hospital wants me to do.
In process of joining Navy Reserves and dealing with it in my security clearance interview.

 

[Janders]

As far as punching someone back, legally I believe you have the right to defend yourself, but not to retaliate. Force has to be proportional and immediate in response, not 20 seconds later. That’s legally speaking. Hospitals might fire you even if you’re legally in the clear.

This is the advice I would give you. If you have time to think "should I be punching?" then you shouldn't be punching.

If someone has you cornered, making multiple swings at you, has a weapon, etc... this is life or death and you need to live. Damn the torpedos.

If someone backhands you and stands there, it will be hard to defend winding up and slugging them.

 

[Brigade4Radiant]

Dealing with this now after being attacked by someone that had already been violent with family and other staff, and defending myself.

Thrown under bus by admin.
Drug in front of every hospital committee and privileges suspended. Now have a laundry list of things to do to get them back.
Had to self-report to medical board, lawyer up, and meet with investigators-outcome pending me completing everything the hospital wants me to do.
In process of joining Navy Reserves and dealing with it in my security clearance interview.

Yeah it's often not worth it being a doctor a patient is heavily protected while just the investigation process can do real harm for a physician

 

[TooMuchResearch]

Dealing with this now after being attacked by someone that had already been violent with family and other staff, and defending myself.

Thrown under bus by admin.
Drug in front of every hospital committee and privileges suspended. Now have a laundry list of things to do to get them back.
Had to self-report to medical board, lawyer up, and meet with investigators-outcome pending me completing everything the hospital wants me to do.
In process of joining Navy Reserves and dealing with it in my security clearance interview.

Wtf. Were you in actual danger and this is just another case of **** hospital and **** state medical board?

 

[BoardingDoc]

Isn’t assaulting anybody a felony?
I mean I’ve been trying to figure out all the “reminders” in the ED waiting area letting people know it’s a crime to assault the staff.

No. Simple assault and battery is a misdemeanor in most cases.

 

[Pudortu]

If you act in self defense, you should be protected. Unfortunately, attorneys can make a court case out of arguing what constitutes self defense, whether the defensive response appropriate for the threat, etc. It sounds like you made a decision you’re comfortable with.

Yeah attorneys can manipulate any situation.

Had a mentor who a patient pulled a gun on him for narcotics. Nurse kicked the gun out of the patients hand. Nurse sued for assault. Luckily it got dropped. This was 10+ years ago.

 

[Birdstrike]

Dealing with this now after being attacked by someone that had already been violent with family and other staff, and defending myself.

Thrown under bus by admin.
Drug in front of every hospital committee and privileges suspended. Now have a laundry list of things to do to get them back.
Had to self-report to medical board, lawyer up, and meet with investigators-outcome pending me completing everything the hospital wants me to do.
In process of joining Navy Reserves and dealing with it in my security clearance interview.

Some states have tremendous protections for wrongful termination. Keep that in mind, if necessary.

 

[dozitgetchahi]

This is the advice I would give you. If you have time to think "should I be punching?" then you shouldn't be punching.

If someone has you cornered, making multiple swings at you, has a weapon, etc... this is life or death and you need to live. Damn the torpedos.

If someone backhands you and stands there, it will be hard to defend winding up and slugging them.

I fully agree. These are always hard situations.

In medical school, I had a med student friend who was rushed by a crazed hospital patient who was detoxing off benzos. What this patient didn’t know was that my friend was a past state champion wrestler, and trained MMA fighter. My friend basically just took this guy to the floor and held him there until security showed up, which I think was smart. He didn’t strike the guy or anything and there wasn’t a scratch on him afterwards. Nothing really happened to my friend and he was actually complimented by admin for keeping the situation from turning into something worse.

In most situations, you don’t want to strike back. However, if your life is threatened, it becomes a “rather be judged by 12 than carried by 6” situation. You need to live to fight everything another day. There are medical professionals who have been seriously injured, paralyzed, even killed in these situations. I’m not letting that happen to me. But I also wouldn’t hit back if someone slapped me.

 

[ScepticSkeksis]

I stay 6+ feet away from any drunk/belligerent patients. I don't do any physical on them unless there's something (like a lac or fracture) that needs to be examined. Always stay out of swinging/kicking range, and make sure you have a clear exit path.

 

[Kryptocoin]

Most state courts are useless, lazy and hate going to trial (unless it's a murder charge). So a 3rd degree assault felony charge will get pleaded down to misdemeanor with no jail time. Criminals rejoice.

The only thing criminals fear are (1) federal charges or (2) state charges with mandatory jail minimums (aka RICO). So unless assaulting a healthcare workers becomes a federal crime or has a mandatory jail time in state prisons, I don't see this stopping.

 

[ShockIndex]

As far as punching someone back, legally I believe you have the right to defend yourself, but not to retaliate. Force has to be proportional and immediate in response, not 20 seconds later. That’s legally speaking. Hospitals might fire you even if you’re legally in the clear.

This pretty much sums it up. There are 2 issues: your criminal liability and your employment.

For your employment’s sake, I strongly recommend that you not strike anyone in the hospital unless you are trying to defend yourself or others from an ongoing attack that poses serious bodily harm. Hitting a patient who struck you once but is otherwise in the process of being subdued or not continuing their assault might be crossing some admin’s line into the retribution realm. I recall a nurse who was fired for punching a patient who had gotten loose from their restrains and struck them. The nurse just snapped in the moment and landed a closed fist strike to the face punctuated by a “motherf’er” just a second after security had regained control of the patient’s extremities rendering them relatively subdued the moment the nurse’s punch landed. Gone.

Remember, your license and employability are likely among your most valuable assets. Getting fired for hitting a patient gets reported on every medical license and privileges application.

 

[bravotwozero]

Most state courts are useless, lazy and hate going to trial (unless it's a murder charge). So a 3rd degree assault felony charge will get pleaded down to misdemeanor with no jail time. Criminals rejoice.

The only thing criminals fear are (1) federal charges or (2) state charges with mandatory jail minimums (aka RICO). So unless assaulting a healthcare workers becomes a federal crime or has a mandatory jail time in state prisons, I don't see this stopping.

Don’t care, still pressing charges if attacked. Watching a-holes leaving the ED in cuffs is still incentive enough.

 

[southerndoc]

Most state courts are useless, lazy and hate going to trial (unless it's a murder charge). So a 3rd degree assault felony charge will get pleaded down to misdemeanor with no jail time. Criminals rejoice.

The only thing criminals fear are (1) federal charges or (2) state charges with mandatory jail minimums (aka RICO). So unless assaulting a healthcare workers becomes a federal crime or has a mandatory jail time in state prisons, I don't see this stopping.

At least in Georgia you get from 3 years (simple battery) to 20 years (aggravated battery/assault) if you assault a healthcare worker. I was told by a police officer that they are mandatory sentences. Someone got arrested for throwing a phone charger at a nurse.

 

[bravotwozero]

At least in Georgia you get from 3 years (simple battery) to 20 years (aggravated battery/assault) if you assault a healthcare worker. I was told by a police officer that they are mandatory sentences. Someone got arrested for throwing a phone charger at a nurse.

I suspect it will boil down to partisan lines, red states having harsher sentences than blue states.

 

[carbonizedeyesockets]

It sucks. And I'm sorry it happened. But, you don't have justification if you are able to make a hasty exit. Within reason you can defend yourself, but you're gonna have to exhausted all other options. You are not held to (very very low) standards of a cop who would easily get away with hitting someone back because they have no integrity and their "brothers" will lie to protect you even when you're in the wrong.

You did the right thing. You remained calm and collected and you used your head. YOU were the better person. If this patient was in police custody, then the police should be charging the patient.

 

[ScepticSkeksis]

It sucks. And I'm sorry it happened. But, you don't have justification if you are able to make a hasty exit. Within reason you can defend yourself, but you're gonna have to exhausted all other options. You are not held to (very very low) standards of a cop who would easily get away with hitting someone back because they have no integrity and their "brothers" will lie to protect you even when you're in the wrong.

You did the right thing. You remained calm and collected and you used your head. YOU were the better person. If this patient was in police custody, then the police should be charging the patient.

Cops have "no integrity"??? I agree there are bad cops out there, and that they are human too. But most of my police interactions have been good.

 

[CajunMedic]

Wtf. Were you in actual danger and this is just another case of **** hospital and **** state medical board?

They had attacked their family when they got there and had gotten Geodon from the doc in that pod. After they were signed out to me for the rest of my overnight, they spit in the tech's face in an attempt to deliberately give them Covid. Was running around that side of the department, yelling at nurses and other patients, trying to go in their "rooms" (walls on 3 sides with a curtain-no door). Woefully inadequate security never showed up. I have a zero tolerance policy on free-range psych patients. Got him corralled back in his room and when we went to sedate him, he swung on the nurse first, then me, got shoved back in the bed by my forearm, tried to headbutt me, tried to bite me, all while swinging and kicking at the other staff while I'm pinned between the bed and the wall. 2 blows to the top of the head. Stopped the attack and went nighty-night for the rest of the shift. Security wandered through about 30 mins later. Hospital pissed PD off at some point in time and they usually don't show up until it's too late. If we called them early in a patient interaction that could get violent, they'd just stand there and go "what do you want us to do?"

 

[carbonizedeyesockets]

Cops have "no integrity"??? I agree there are bad cops out there, and that they are human too. But most of my police interactions have been good.

I don't doubt that your interactions have largely been good, but if i were a betting man, I'd bet that your are more likely to lick their boots than most folks. Most of my interactions are forgettable. Not particularly bad or good. But when they stand out, it is rarely for good.

I've been threatened at work and reported it only to have the officer completely blow it off. I've personally witnessed an officer threaten to burn down a house. I've seen an officer threaten to pistol whip someone. Ive seen an officer, in the ER, walk up to a patient who was in the process of being restrained by staff and start punching them. The officers help was not summoned and nor was the pt in police custody. The officer then had the audacity to yell at the doc who told him to stop.

We see time and time and time and time again, police officers acting without integrity. If one were to say integrity is doing the right thing when no one is watching - they fail miserably far too often. And then their "brothers and sisters" cover up for them. No longer is it a few bad apples when other become accomplices in cover ups. This is all well known. It's how they EARNED their reputation.

The most recent incident is the Seattle officer who killed a young woman with his car, and his superior, on camera, dismissing it and acknowledging that essentially there will be no repercussions for the police - the city will just write a check. It's now being suggested that he was mocking the city, but it still stands that the striking officer is unlikely to face an real consequences for his reckless behavior. Speeding at 74mph to an overdose? Not even EMS is going to reach those speed in a city and they are the ones who are going to treat it.

 

[ShockIndex]

I've personally witnessed an officer threaten to burn down a house. I've seen an officer threaten to pistol whip someone. Ive seen an officer, in the ER, walk up to a patient who was in the process of being restrained by staff and start punching them. The officers help was not summoned and nor was the pt in police custody. The officer then had the audacity to yell at the doc who told him to stop.

…and you did what to address these crimes that you witnessed?

 

[Rendar5]

…and you did what to address these crimes that you witnessed?

Sorry did u want him to call the police on the police? They would typically try to cover up for each other. I know I would.

Btw I’ve witnessed only 2 ridiculous police interactions in 8 years out of several hundred interactions with my local pd and sheriffs. I didn’t report either because no one was injured and I didn’t have names or badge numbers. Luckily we’ve got largely professional police in my area. Not all areas have reasonable police. There can be a huge variance in culture from one department to the next.

 

[BulgeDaTwine]

I don't doubt that your interactions have largely been good, but if i were a betting man, I'd bet that your are more likely to lick their boots than most folks. Most of my interactions are forgettable. Not particularly bad or good. But when they stand out, it is rarely for good.

I've been threatened at work and reported it only to have the officer completely blow it off. I've personally witnessed an officer threaten to burn down a house. I've seen an officer threaten to pistol whip someone. Ive seen an officer, in the ER, walk up to a patient who was in the process of being restrained by staff and start punching them. The officers help was not summoned and nor was the pt in police custody. The officer then had the audacity to yell at the doc who told him to stop.

We see time and time and time and time again, police officers acting without integrity. If one were to say integrity is doing the right thing when no one is watching - they fail miserably far too often. And then their "brothers and sisters" cover up for them. No longer is it a few bad apples when other become accomplices in cover ups. This is all well known. It's how they EARNED their reputation.

The most recent incident is the Seattle officer who killed a young woman with his car, and his superior, on camera, dismissing it and acknowledging that essentially there will be no repercussions for the police - the city will just write a check. It's now being suggested that he was mocking the city, but it still stands that the striking officer is unlikely to face an real consequences for his reckless behavior. Speeding at 74mph to an overdose? Not even EMS is going to reach those speed in a city and they are the ones who are going to treat it.

I’d love to hear the other side of these fantastical stories (or at least some credible corroboration).

I know exaggeration and fiction prose when I read it.

 

[sloh]

Please don’t derail the thread.

 

[Birdstrike]

No patient is worth me having to get fired, arrested or brought before the medical board.

 

[TooMuchResearch]

Cops have "no integrity"??? I agree there are bad cops out there, and that they are human too. But most of my police interactions have been good.

My interactions with the police are fine, but I know cops (outside of work) who do some fairly terrible and illegal things strictly because they are police officers and know that they were caught or pulled over or suspected of being intoxicated while working, it would get covered up or ignored.

 

[TooMuchResearch]

They had attacked their family when they got there and had gotten Geodon from the doc in that pod. After they were signed out to me for the rest of my overnight, they spit in the tech's face in an attempt to deliberately give them Covid. Was running around that side of the department, yelling at nurses and other patients, trying to go in their "rooms" (walls on 3 sides with a curtain-no door). Woefully inadequate security never showed up. I have a zero tolerance policy on free-range psych patients. Got him corralled back in his room and when we went to sedate him, he swung on the nurse first, then me, got shoved back in the bed by my forearm, tried to headbutt me, tried to bite me, all while swinging and kicking at the other staff while I'm pinned between the bed and the wall. 2 blows to the top of the head. Stopped the attack and went nighty-night for the rest of the shift. Security wandered through about 30 mins later. Hospital pissed PD off at some point in time and they usually don't show up until it's too late. If we called them early in a patient interaction that could get violent, they'd just stand there and go "what do you want us to do?"

I hope your medical board gets completely replaced.

 

[ScepticSkeksis]

They had attacked their family when they got there and had gotten Geodon from the doc in that pod. After they were signed out to me for the rest of my overnight, they spit in the tech's face in an attempt to deliberately give them Covid. Was running around that side of the department, yelling at nurses and other patients, trying to go in their "rooms" (walls on 3 sides with a curtain-no door). Woefully inadequate security never showed up. I have a zero tolerance policy on free-range psych patients. Got him corralled back in his room and when we went to sedate him, he swung on the nurse first, then me, got shoved back in the bed by my forearm, tried to headbutt me, tried to bite me, all while swinging and kicking at the other staff while I'm pinned between the bed and the wall. 2 blows to the top of the head. Stopped the attack and went nighty-night for the rest of the shift. Security wandered through about 30 mins later. Hospital pissed PD off at some point in time and they usually don't show up until it's too late. If we called them early in a patient interaction that could get violent, they'd just stand there and go "what do you want us to do?"

I sympthatize with your situation, but why did you go anywhere near an agitated psych patient? We are not trained in "takedowns" nor should it be part of our job description. You should always stay out of punching/kicking distance. Theoretically there are people trained to deal with crazies. If they leave property, it's not on me to stop them.

 

[CajunMedic]

I sympthatize with your situation, but why did you go anywhere near an agitated psych patient? We are not trained in "takedowns" nor should it be part of our job description. You should always stay out of punching/kicking distance. Theoretically there are people trained to deal with crazies. If they leave property, it's not on me to stop them.

I initially went in to try and defuse the situation. But when the fight started, I was the closest one with the physical ability to take him down. I'm 6'2", 250 lbs and train Brazilian Jiu-Jitsu to have the skill to safely use takedowns, armbars, etc. as needed. "Security" was a joke, there was no way to even call them when it went down. Their response would have been "Stop, or ill say stop again. Sir, please stop assaulting the staff." If he had tried to leave, I would have gladly let him go.

This was not the first time in my tenure there I had to go "hands-on" with a violent psych patient. We'd had staff assaulted, one tried to steal out of another patient's room, even had one barge in to the resuscitation of a critically ill 5 year old. I dutifully reported every one of them up the chain, even safety reported it, and still no change in security, policy, extra duty PD, nothing. Residents even reported it on their ACGME surveys.

 

[RustedFox]

Yeah... "security" at my place is a soft Boomer armed with a stern look and zero biceps.

If things get wild on a nightshift at my one shop, it's me and an all-female nursing staff; most of which are new RN grads so you know what that means.

 

[GassYous]

Yeah... "security" at my place is a soft Boomer armed with a stern look and zero biceps.

If things get wild on a nightshift at my one shop, it's me and an all-female nursing staff; most of which are new RN grads so you know what that means.

Awww yeah

 

[RustedFox]

Awww yeah

No, not that.

It means they're too dumb to recognize danger, and too soft to do anything about it.