Andrew Kimball-Mirzaie had been working at Butler Hospital less than two months when he was attacked by a patient.
At 30, Kimball-Mirzaie has the athletic build of someone who looks like he could defend himself if he had to. But he had no reason to think he might be in danger one afternoon in February of last year when was sent in alone to a room with a young male patient who was waiting to be admitted to the psychiatric hospital on Providence’s East Side.
Kimball-Mirzaie had brought the patient a sandwich and a drink, and was seated near him as they were watching a Knicks basketball game on TV. Suddenly, he said, the patient stood up and punched him, repeatedly, in the face.
“I have never experienced anything like that,’’ he said. “It was really traumatic.’’
The assault left Kimball-Mirzaie with a concussion, a broken nose and a deviated septum.
In hospitals, a combative or violent patient, known as a “code gray,” can be so spontaneous and unpredictable that it’s impossible to prevent. But the risk of violence increases when hospitals are understaffed or employees are insufficiently trained or experienced to manage patients they are assigned to care for, according to interviews with employees and industry researchers, and an examination of inspection reports by The Public’s Radio.
Now, roughly 800 unionized workers at Butler Hospital are in the eleventh week of a strike. And their demands for better pay and benefits, union leaders and labor researchers said, are part of a larger effort to ensure workers have the staffing and resources needed to safely care for their patients.
“Hospitals are among the most dangerous workplaces in terms of violence,” said Rachel Odes, an assistant professor at the University of Wisconsin-Madison School of Nursing who worked for years in psychiatric hospitals. Labor unions and professional organizations like the American Nurses Association “have tried to make a big point of shifting the culture, which is that this is not an acceptable problem, this is not part of the job.’’
During the last two years, episodes of violence reported by Butler’s nurses, CNAs and unlicensed staff like mental health workers jumped 40%, from 168 incidents in 2022 to 236 incidents in 2024, according to the hospital’s incident logs released by the Service Employees International Union Local 1199 New England.
The staffing shortage and higher staff turnover rates, workers said, also have left some employees working without proper training, which can endanger patients as well as staff.
State inspections in 2022 and 2023 revealed instances in which Butler Hospital employees didn’t do the required 5-minute observation checks on high-risk patients; used physical restraints on patients without the proper training; kept patients in seclusion and, in one case, strapped into a chair used to transport patients without assessing the patients at the required intervals. Inspectors cited these deficiencies as part of a review for the federal Centers for Medicare & Medicaid Services, or CMS, which oversees health inspections.
In response, Butler Hospital disciplined one employee, instituted random spot checks by nurse directors on their respective units, and revamped its training on deescalation, including assessing competency on the use of restraints and seclusion, according to the reports.
Training is critical, but so is experience. In the 2 ½ years since Katie Bradley started working as a nurse at Butler Hospital, she said that she’s often been forced to take on more responsibility than she feels she can safely manage.
“A lot of times, especially on the evening shift,’’ Bradley, 25, said, “I will be the most senior nurse, and that can be a lot.’’
She was the nurse in charge in April when two patients got into a shouting argument during dinner. One of them began flipping over tables and throwing chairs. Bradley shouted “code gray!” to alert staff to the combative patient.
“I could feel my legs shaking,’’ she said, “and I could feel my voice kind of wavering.’’
Since the strike began, a June 17 inspection for compliance with CMS revealed the hospital allowed an unlicensed medical assistant to insert an intravenous catheter into three patients, in violation of state regulations and hospital policy.
“Butler Hospital takes patient and healthcare worker safety very seriously,’’ Mike Raia, a spokesman for Butler Hospital, which is operated by Care New England, said in a statement. “We strive to provide our psychiatric and behavioral health patients with high-quality care in a safe environment.”
The “uptick in violent episodes at Butler in recent years,’’ Raia said, “is part of a larger trend of increased violence against healthcare workers across the nation.” The hospital, in collaboration with the union during a previous bargaining session, he said, created a Health and Safety Committee Charter. The group meets monthly to review critical incidents and adapt strategies to reduce risk, including training in de-escalation and violence prevention.
At the start of the strike, Butler Hospital had more than 100 full-time, part-time and per diem openings. As of Thursday, the hospital had posted more than 380 job openings on its careers website.
Health care workers at risk
Health care workers in hospitals have long had among the highest violent injury rates nationwide of any workers, and the problem seems to be getting worse. The strain of the pandemic drove many health care workers to quit or retire. That has left hospitals relying on fewer and less experienced workers, increasing the risk of injuries.
The frequency of violence in hospitals has increased significantly over the past decade, according to a report released in June by the American Hospital Association. More than three quarters of health care workers have reported experiencing violence, with over 80% experiencing verbal violence and 33% experiencing physical violence.
The rise in violence toward health care workers has sparked protests across the country. In Palm Beach, Florida, earlier this year medical professionals held a rally after a nurse was brutally attacked by a psychiatric patient. In California, staffing and workplace violence were among the reasons nurses at three hospitals held a one-day strike in late-May. Minnesota nurses picketed last month calling on administrators to address what they described as understaffing and unsafe conditions. In Ohio, employees at Ohio State University Wexner Medical Center protested the university’s board of trustees meeting in May, demanding better staffing and workplace safety.
Nationwide, health care workers are nearly five times as likely to experience workplace violence as other workers, according to federal data. Massachusetts’ rate of workplace violence among health care workers in 2021-2022 was 6.1 per 10,000 full-time workers, among the highest in the country. Rhode Island’s workplace violence rate is not tracked; it’s one of nine states that do not perform an annual survey of occupational injury and illnesses.
Last May, hundreds of striking Butler Hospital workers joined a State House protest where they spoke out about workplace safety. Some workers held up graphic, poster-sized photographs of their injuries, including puncture wounds, a swollen eye, a broken nose and a bloody scalp.
Among them was Liz Paradis, a 28-year-old registered nurse who had been working in the adult inpatient unit at Butler Hospital.
In an interview, Paradis said that she was taking a patient’s blood sugar one afternoon in mid-May of 2023 when she glanced up and noticed a male patient with a history of violence making a beeline for her.
This was the same patient, Paradis said, who she and her co-worker, Anthony Manzi, 45, had written up three days earlier for making inappropriate and threatening remarks about Paradis.
“It felt like I was prey,’’ she said, “like I was being stalked.”
Just then, Manzi stepped into the hallway and saw the patient coming up behind his co-worker, eyes “locked on her.”
Trying to protect his co-worker, Manzi said, he approached the patient and tried talking to him.
The patient mumbled something inaudible, Manzi said, and pointed in the distance. Manzi said he kept his eyes on the patient, who he suspected was trying to distract him.
“I asked what he was doing near that nurse,” Manzi said, “[and] he tackled me.”
Paradis recalled “seeing and hearing Anthony’s head hit the nurse’s station door…and this patient is screaming [at him], ‘I’m going to kill f- – – – -g you!’’’
Manzi was diagnosed with a concussion and post-traumatic stress disorder, or PTSD. He was out of work for about 4 ½ months.
Paradis was hit in the head while trying to restrain the patient. She also had a concussion and PTSD and was out of work for almost 5 months.
To this day, Manzi and Paradis said, they still don’t know why a patient who had threatened violence was allowed to wander the halls unsupervised.
Discussions about how to balance safety with staffing constraints were frequent and heated during safety committee meetings, said Ben Degnan, a mental health worker at Butler Hospital and committee member.
“We’ve had a joint union-hospital safety committee that was meeting once a month to talk about…what we can do to make improvements,” Degnan said. “They ended up being kind of just these contentious meetings. And there wasn’t enough real hard change to, what are we going to do about this?’’
Since he began working at Butler Hospital 23 years ago, Degnan said, the hospital has more acutely ill patients and fewer staff with the experience to manage them.
“When the majority of the staff working on a unit are brand new and inexperienced,’’ Degnan said, “it is a recipe for people getting hurt.”
Kimball-Mirzaie, the mental health worker who was attacked by a patient after he’d been on the job at Butler Hospital less than two months, said he doesn’t blame the patient, who was very ill at the time.
“I understand that there is an inherent danger with the job,’’ Kimball-Mirzaie said. He said he wasn’t trained properly to work on the intake unit, and would likely never have been there that day if it wasn’t “due to short staffing.”
