Former Ore. Paramedic Aims to Change ER Assault Laws

The World, Coos Bay, Ore.

On the day before Valentine's Day 2018, Southern Coos Hospital and Health Center emergency room nurse Pam Lewis might have been expecting flowers or candy from her husband of 46 years, or something special from one or more of her 11 children. Maybe a sweet treat from the hospital's cafeteria.

What she wasn't expecting was a punch in the face.

But that's what happened to the 63-year-old Coquille resident when an irate patient took out his aggression on Lewis during his visit to the Bandon ER.

Being hit in the face was bad enough. It caused bruising and she needed stitches, but Lewis was all right. She took one day off and returned to work. But what happened with the patient who attacked her was a more painful blow.

He was charged with a Class C Misdemeanor and a year later still has not been prosecuted for his crime, which would likely result in probation and a fine. Lewis wants to protect all healthcare workers from attacks in hospitals or other places where they are performing official duties by adding wording to current legislation to make such assaults a Class C Felony.

It was a busy day in the ER, just like almost every day. A familiar older patient walked in about 5 p.m. complaining of pain. A diabetic, the patient had been seen the previous December after a severe burn. Lewis treated his burn and advised him to go regularly to wound care appointments. The man did not follow through, so his burn got infected, Lewis said. The man ended up coming in again in January, where he was transported to Portland for skin grafts. He came in again on Feb. 13 for outpatient services, but his condition was such that he was brought to the ER and put into a small room. His infection now warranted IV antibiotics.

"I said, 'So we meet again,'" Lewis said.

The man was starting to get agitated. Lewis was called away to a different emergency and when she came back 20 minutes later, she said the man was screaming at a certified nursing assistant and getting belligerent.

"He was yelling at the CNA 2 regarding a phone call she made on his behalf," Lewis said. "He yelled that he wanted her out of the room and the IV out of his arm. He was completely volatile."

Lewis stepped into the room and closed the door. She said she tried to reason with the patient and pleaded with him not to pull out his IV. At that point, Lewis's paramedic training kicked in and she reached behind her for the door handle while talking to the man and maintaining eye contact. She couldn't find the handle, so turned her head briefly. When she turned back around, she said the man punched her in the face.

"I was shocked," Lewis said. "I found my glasses, then realized I was bleeding. I looked at him and said, 'Really?' then went out of the room and asked for help."

Another hospital employee had already called the police and Lewis was told they were on their way. Someone called her husband Keith. She was then treated by the physician on shift. Lewis needed stitches inside her mouth.

The staff was going to admit the patient because he still needed IV antibiotics, but the director of nursing on call refused.
"No one else needs to get hurt," she told others in the ER.

The police came and arrested the suspect, but on the way to Coquille, he complained of pain again, so was taken to Coquille Valley Hospital. Lewis called to warn them. The doctor there did an assessment of the suspect and said he was fine to go to jail.

The next day, Lewis went to a victim's assistance program to see what she could do. Bandon Police Officer Cory Dhillion came to talk to her a couple days later and that's when she found out the assault was a misdemeanor and there wasn't much the Bandon Police could do.

Medical professionals are not fully protected by the law because the law states if the assault occurs in the ER, it's considered outpatient care, not pre-hospital care. If a patient assaults a medical professional or others there working, it's a Class C Misdemeanor.

"If you're a firefighter or paramedic, it's a Class C Felony," Lewis said. "But if you're a caregiver in a hospital or clinic, it's a misdemeanor."

"That's the law throughout Oregon," Lewis added. "I went to a workplace violence seminar and it said 80-85 percent of violence in hospitals happens in the ER, yet ER workers are not protected."

That's when Lewis knew she needed to work to change the law.

"We all need to be protected by the law, from the janitor to people working in admitting or discharging. All of them," she said.

Lewis grew up in Coquille and married her high school sweetheart. They had two children together and adopted nine African-American children after being told they couldn't adopt children of color because they live in a "lily white county."
After arguing with the State of Oregon Department of Human Services that 95 percent of children available for adoption are African-American, the Lewis's decided to go out of state to adopt. Their first was a 4-month-old from Oklahoma who's 32 years old now. More children followed.

During this time, Lewis earned her emergency medical technician certification in 1986 and worked for Coquille Valley Ambulance for 30 years. She's worked as an emergency room nurse for 11 years, at Coquille Valley Hospital and at Southern Coos.

In all those years, she's faced irate people before. Some were dementia patients or people having mental health issues. Some were on drugs.

"I got assaulted today," Lewis said during a recent interview. "It's every day—it's verbal and I get pinched and maybe on a good day, patients will only cuss at me or stomp out of the ER."

When she found out her attacker would likely only be fined, Lewis went into warrior mode. With the blessing of then-CEO JoDee Tittle and her nursing supervisor, Lewis sent letters to local representatives, senators, congressman, the governor and the Oregon State Board of Nursing and made follow-up calls to those who didn't respond. The Board of Nursing said they couldn't help her. Some responded and advised her to contact others. Only State Sen. Dallas Heard, R-Roseburg, responded with an offer of help. Heard represents Oregon Senate District 1 which includes Bandon.

Heard has introduced new wording for a draft Legislative Concept, which is what a draft bill is called before it is filed with the Secretary of State and assigned a bill number.

"At this point we have no comment on it," said Nikolas Ruiz Anderson, chief of staff for Sen. Heard. "As for a timeline, we are still sorting out our approach to this issue and working with the chair of the committee we believe it will be going into to make sure that we can have their support on it."

LC 2176, the draft legislation, "expands the crime of assault in the third degree to include physical injury to licensed healthcare providers performing official duties. The crime would be punished by a maximum of five years in prison, a $125,000 fine, or both."

It's a long process, but Lewis will not give up. She's encouraging all her nurse friends and others in the medical field to attend the hearing the day it goes to the Senate floor, which is still undetermined. The current session began Jan. 22 and runs through June 30.

Since the assault, Lewis said the suspect hasn't shown up for any of his hearings. She's upset that he hasn't been pursued, though she knows under the current legislation, he won't suffer many consequences.

Protocol at Southern Coos Hospital changed after that incident. And Tittle tried to get a security guard for the entrance to the ER, but the hospital found it wasn't a sustainable practice.

Lewis took another self-defense class and is urging other nurses and doctors to do the same.

"The mayor contacted Chief (Bob) Webb and he did come down and we met with him on how they can be supportive," Lewis said. "But there's some things they can't do. They can't charge a suspect with a felony."

Those who work in the ER are trained to treat emergent health concerns, not perform self-defense, Lewis added.
"I've got a straight shooting personality," she said. "But when you're sick, you want me."