Fatal shooting at Pa. hospital renews calls for legislation to enhance security

A deadly shooting at a hospital in Pennsylvania prompted additional calls for steps to increase the security of healthcare settings.

On Feb. 22, a gunman took hostages in the ICU at UPMC Memorial Hospital in York, Pa. During the standoff, local police officer Andrew Duarte was shot and killed, while three hospital staff members and two other officers were wounded and were in stable condition as of Feb. 24. The gunman was killed.

The wounded hospital employees included a physician, a nurse and a custodian. A fourth staff member suffered a non-shooting injury.

According to reports, the perpetrator specifically targeted the hospital’s ICU. Subsequent reports indicated he was distraught about his wife, who had been on life support in the ICU for a terminal illness.

An increasing threat

In 2021-22, with the COVID-19 pandemic generally still taking a toll on the healthcare industry, workplace violence in healthcare settings accounted for 14 nonfatal injuries involving days away from work per 10,000 FTEs, according to data from the Bureau of Labor Statistics. That rate was more than triple the average among all industries.

Healthcare workers comprised 10% of the workforce yet experienced 48% of nonfatal injuries due to workplace violence.

“Hospitals are sanctuaries of healing, where dedicated nurses, physicians and other team members work tirelessly to care for patients,” Rick Pollack, president and CEO of the American Hospital Association (AHA), said as part of a written statement issued after the Pennsylvania incident. “We cannot allow these types of violent acts to persist. As a nation, we must unite and take decisive action to end this relentless cycle of violence.”

Recent legislative activity

In the 118^th Congress (2023-24), the House considered a bill that would have required the Department of Labor to establish regulations mandating that healthcare and social service employers take actions to protect staff. A companion bill was introduced in the Senate.

Neither got any traction at the committee level, even though a similar bill had passed the House in 2021 with support from Democrats and a minority of Republicans before a companion bill stalled in the Senate. The AHA advocated against passage of the 2021 version of the bill, saying it would impose costly regulatory mandates that would not lead to worthwhile improvements.

Hospital associations instead have supported a bill that was introduced in 2022 and would have provided options for prosecuting an assault or threat against hospital staff in the same manner as such acts against airport and airline workers. Other provisions in the bill would have authorized grants to fund programs such as training for hospital workers in de-escalation techniques and responses to metal health crises. Grant funding also would have gone toward installation of access-control technologies such as video surveillance.

The bill was reintroduced in both chambers two years ago during the 118^th Congress but did not receive a vote even at the committee level, in part because of concerns over costs. The Senate version of the bill excluded the grant funding that was part of the House bill and thus might have a better chance of being legislated in the current Congress.

In the absence of legislation, CMS issued a 2022 memo putting the impetus on hospitals to protect their workers, advising steps such as identifying patients at risk of committing harm to themselves or others, identifying environmental safety risks for those patients, and providing education and training for staff and volunteers.

States take up the cause

Legislation to protect healthcare workers has been consummated at the state level. According to a 2024 report (login required) in JAMA, roughly 40 states have adopted laws to strengthen sentencing against individuals who commit assaults against healthcare workers.

In addition, a dozen or so states require provider organizations to plan and execute workplace violence prevention programs. The programs typically must include staff training and worksite risk assessments.

Almost 30 states have passed or are considering laws that allow healthcare facilities to designate hospital security personnel as an independent police force, thereby authorizing the security team to carry firearms and make arrests.

“These laws often arise as a result of healthcare workers’ demands,” states the JAMA report.

A related concern

While not pertaining to healthcare workplace violence, legislation to enhance mental health and wellness for healthcare workers became law in 2022 but was not reauthorized at the end of 2024. Reauthorization initially was part of a bipartisan continuing resolution but ultimately was left out when Republicans pushed for a leaner bill.

A five-year reauthorization was drafted in the Senate in January, and advocates hope it will receive consideration as part of the ongoing FY25 budget reconciliation process.