The patient was drunk, naked and covered in blood when he burst out of his emergency room cubicle around 2 a.m., brandishing scissors. He lunged at two nurses and began chasing them.
It took two police officers and three zaps from a Taser to subdue him.
Rattled by this attempted stabbing in 2009 and other attacks at Ventura County Medical Center, emergency room nurse Lorraine Sandoval began keeping count of every time a colleague was assaulted or threatened by patients. On average, she found, it was once or twice a day.
"We should not have to wait until a nurse, doctor or EMT or patient is seriously injured or killed before something is done," Sandoval recalled telling her bosses, who later installed an armed officer in the emergency room.
Although nearly invisible to the public except in extreme cases, violence against nurses and other hospital caregivers is commonplace in California and around the nation, according to surveys, state records and interviews with hospital employees and industry experts.
Some workers, especially in emergency rooms, say they experience some level of assault -- biting, hitting, kicking and chasing -- so often they consider it an unavoidable part of the job. Most attacks don't result in serious injury, but hundreds have resulted in workers' compensation claims in California alone in recent years, according to a Times review.
Nearly 40% of employees in California emergency rooms said they had been assaulted on the job in the previous year, according to a survey by UC San Francisco and other researchers in 2007. More than one in 10 emergency room nurses surveyed in 2010 said they had been attacked in the previous week, according to the Emergency Nurses Assn., which represents 40,000 emergency room nurses nationally.
Many industry experts and hospital staffers say they believe violence by patients and visitors is rising but can't say for sure because it hasn't been rigorously tracked over time. The issue has recently gained attention, however, as hospital employee unions, including the California Nurses Assn., have begun pushing for broader protections and more reporting by hospitals.
The violence flares most often in emergency rooms and psychiatric wards, say staffers, researchers and security officials. In emergency rooms, waiting times have grown as increasing numbers of unemployed and uninsured patients seek basic care they can't afford to pay for in doctors' offices.
"We have a lot of men who have lost their jobs, lost their homes, 50-year-old men who have worked their whole lives," said Colleen Sichley, a 17-year nurse at Antelope Valley Hospital in Lancaster and a union representative. "They're angry. Just between the cursing and the bad language, and the physical stuff, and it's anybody" who can lash out, she said.
Staffers are obligated by law to evaluate anyone who goes for treatment, said Michael B. Jackson, an emergency room nurse at UC San Diego Medical Center. He said that whether they be gang members, drug users, psychotic patients or just "people that get frustrated with wait times," they might act out.
Acutely ill mental patients are landing in general hospitals because many lack consistent outpatient care that might keep them from deteriorating.
Hospitals sometimes blame employees for mishandling violence rather than reporting and investigating it, said Kathleen McPhaul, an assistant professor at the University of Maryland School of Nursing who has written about hospital violence and believes it is rising. "Even if the staff did something wrong," she said, "the employer needs to take responsibility and get to the bottom of it and train the staff."
Jan Emerson-Shea, vice president for external affairs for the California Hospital Assn., said that hospitals "generally are very safe places," and that most have specific protocols to follow if trouble arises.
Every so often, a high-profile tragedy prompts hospitals to rethink their security plans. In 1993, a mentally disturbed gunman opened fire in the emergency room at Los Angeles County-USC Medical Center, wounding three doctors. Since then, County-USC and other major urban hospitals have installed metal detectors and posted armed police officers in emergency rooms.
But smaller hospitals have not always gone to the same lengths. Even facilities with armed guards don't tend to station them in private treatment areas. Assaults can be difficult to predict, and guards sometimes arrive too late.
Jackson, a former Marine, said some people give an indication that they may turn violent, such as pacing, yelling or making threats; "other times it just happens."