Israel shelved 2017 plan to fight violence in hospitals

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The Israeli government has failed to implement recommendations made in 2017 for countering violence in hospital even though a committee that discussed implementing the suggestions convened just two months ago.

Health care personnel contend with violence on a daily basis, with thousands of instances reported annually to the Health Ministry. Many cases also go unreported, including incidents of verbal violence, threats, damage to equipment, and physical violence.

For example, two days ago the father of a boy in an intensive care unit lashed out at the medical team, threatening to kill them. “Security guards took control of the situation, but the team was in shock,” a hospital official said. The incident was not reported to the media.

A few hours earlier, in an incident that was widely covered in the media, dozens of family members tried to forcefully enter the trauma ward at a hospital in Nahariya and assaulted staff after they were informed of the death of a relative who was killed in an accident.

The 2017 committee, headed by Prof. Shlomo Mor-Yosef, was appointed by then-Minister of Health Yaakov Litzman, after a nurse was murdered by a patient at a health clinic. The 23 members of the committee were asked to study the characteristics of violence within the health system; to identify circumstances and early warning signs leading to violence against medical staff and patients; examine ways of combating the phenomenon and recommend courses of action – both systematically and on an individual level. The committee was also asked to discuss the allocation of resources for dealing with the issue.

The recommendation’s include installing cameras linked to security guard stations, expanding the authority of the guards, imposing harsher penalties, having police officers permanently stationed in hospitals, increasing cooperation with police, and providing more support to victims of violence.

Doctors striking on Thursday demanded that the state finally implement these recommendations.

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The recommendations have been shelved since they were submitted. The chairman of the newly established implementation committee, Health Ministry’s deputy director-general Dr. Yosef Mendelovich, could not explain why they hadn’t been implemented. “Apparently, like everything that requires hefty budgets, more urgent things come first,” he said in an interview. “Dealing with violence is complex and requires changes in infrastructure.

“The committee’s job is to make sure that both immediate and long-term recommendations are implemented. It’s clear that violence against medical staff won’t go away and will only increase. Every day, gunshot victims come in with 30 people who are banging down doors. We can’t give in, and it’s our duty to make our staff feel protected, so they can deal with medical issues.”

Committee member Dr. Zeev Feldman, the head of Israel’s Medical Association, says that none of the recommendations were implemented substantively. “Things are stuck at the administrative or budget level.” Regarding police presence, Feldman says that “there is a police presence at [state hospitals] Rambam, Sheba and Shamir. Some of them have around-the-clock police presence. Health fund hospitals have no police presence, because it’s expensive. There were attempts to post officers in emergency wards, but it was cut because of lack of funds.”

Feldman noted the recommendation of installing cameras, and said that it was not widely implemented. “Each hospital has done what it could. They also recommended increasing penalties for assaulting emergency healthcare workers – but that only includes first responders and emergency ward staff. The implementations committee will try to expand the definition to include other staff as well.”

The Knesset Health Committee discussed the matter in November 2021. Committee members called to bolster police presence in hospitals, expedite the legal process in cases of violence against medical staff, and impose harsher penalties. Hospital directors noted a severe shortage in security guards, which makes it difficult to contend with violent incidents. During one of the meetings, Dr. Mendelovich, a former deputy director of the Shaare Zedek Medical Center, said that “everyone on the ground in a hospital experiences violence. It’s intolerable that it has become routine. Last year, we had to smuggle physicians out of the hospital to save them from assaults by patients’ family members.”

The head of security at the Health Ministry said at the Knesset meetings that violence against doctors is treated with horrifying triviality. “It has become a societal norm, and it must change. Security guards come to work every day knowing that they will have to deal with serious violence.”

The implementation committee is trying to find ways of expanding the authority of security guards, so they can use force and handcuff visitors when required. The committee wants to define the job as “preferred work” for demobilized soldiers, in an attempt to recruit more guards.

The Health Ministry wants to make it easier for assaulted staff to file complaints, with police trained to gather testimony on site, rather than making staff go to police stations to testify. Another idea is to allow for administrative fines to be imposed immediately on offenders.

A further problem is security at health clinics, where it is often absent. The ministry hopes to establish mobile security units, for example, guards on motorcycles, who could respond quickly when violence occurs. A smartphone application with virtual distress buttons is also being considered, so that staff can call for help without relying on physical buttons, which are often inaccessible.