Spotlight on the Workplace Violence Bill: More punishment does not equal more safety

Healthcare workers deserve meaningful protection from workplace violence. The question is whether increasing criminal penalties actually provides it.

Across the country, legislators have repeatedly answered violence against healthcare workers by creating special criminal offenses, increasing sentences, or converting conduct that would ordinarily be a misdemeanor into a felony. Massachusetts lawmakers are now considering doing the same.

As described in the previous article, the House version of the Massachusetts workplace-violence bill would allow an assault on a healthcare worker to be prosecuted as a felony carrying up to five years in state prison for bodily injury and 10 years for serious bodily injury. The Senate rejected that provision but expanded the circumstances in which police could make a warrantless arrest.

These approaches may communicate that violence against healthcare workers will be taken seriously. That is not the same as demonstrating that they prevent it.

What deterrence research actually says

To serve as an effective deterrent, we must assume that someone will consider the possible punishment before acting and decide that the consequences are not worth it.

That assumption is questionable in many healthcare encounters. Someone who is delirious, terrified, cognitively impaired, intoxicated, experiencing psychosis, reacting to trauma, or attempting to escape unwanted physical force may not be calmly weighing the difference between a misdemeanor and a felony.

More broadly, decades of criminal-justice research have consistently found that the certainty of a consequence generally matters more than its severity. The National Institute of Justice summarizes the evidence plainly: increasing the severity of punishment does little to deter crime, while longer prison sentences produce, at most, a modest additional deterrent effect. People frequently do not know the precise penalties attached to an offense—even when they are posted around a facility on angry red signs.

There is little reason to believe that a person in an emergency room—much less someone in psychiatric crisis—knows whether grabbing, pushing, spitting, or striking a worker carries one possible sentence or another.

A harsher penalty imposed afterward cannot retroactively make an understaffed unit safer. It cannot shorten an eight-hour wait, provide an interpreter, relieve someone’s pain, give workers time to listen, or prevent an encounter from escalating.

States have passed penalty laws without proving that they work

A recent 50-state review published in Health Affairs Scholar examined healthcare workplace-violence laws in effect as of June 2024. It found that 45 states had enacted penalty laws, but only 27 had adopted prevention laws and only 23 had adopted measures involving remediation, worker support, or data collection.

Only one state’s law expressly required evaluation of its violence-prevention program.

After decades of penalty enhancements, researchers still have not established that making these offenses felonies—or otherwise increasing their punishment—causes workplace violence to decline.

Indeed, the authors of the 2026 fifty-state review noted that it remains unclear whether the growing shift toward prevention and remediation reflects recognition that penalty-focused laws have been ineffective, while emphasizing the need for research comparing whether different legislative approaches actually reduce workplace violence.

That does not prove that no enhanced penalty could ever affect anyone’s behavior. It does mean proponents cannot honestly describe this as an evidence-based violence-prevention strategy.

Without consistent data or meaningful evaluation, states can tell us how many people were arrested or prosecuted. That measures use of the law—not safety produced by it.

Massachusetts’s existing healthcare-worker assault law

Often left out of the conversation is the fact that Massachusetts already imposes special penalties for assaulting certain healthcare workers while they are treating or transporting a patient: 90 days to 2½ years in a house of correction, a fine of $500 to $5,000, or both.

Yet the law has no required evaluation component, so we do not know whether it has reduced violence. The apparent lack of public awareness of the law also undermines one of the basic assumptions behind deterrence: People cannot alter their behavior in response to a penalty they do not know exists.

Neither H.4767 nor S.3184 would correct this problem. The bills require facilities to assess risks and report incidents, and the Senate version calls for a one-time governmental report on alternative pathways for certain groups. But neither appears to require an ongoing, substantive evaluation of whether the legislation reduces violence—or of whom its criminal-enforcement provisions arrest, prosecute, and harm.

Washington State’s data should be front and center

Washington State has had a felony law covering assaults on healthcare workers since 1997. Conduct such as spitting or slapping that might otherwise receive a lesser charge can become a felony when directed at a healthcare worker.

In 2024, The Marshall Project and The Seattle Times examined 151 cases filed under that law in King County between 2018 and 2022.

They found that:

76% involved people identified as showing signs of emotional or mental distress, including people who had been involuntarily committed, were in emergency rooms for psychiatric evaluations, or had received an emergency response to what was viewed as a psychiatric crisis.
Competency to stand trial was questioned in nearly 40% of the cases.
More than one-third of the people charged were unhoused.
Forty percent were described as Black in police reports, although Black people made up approximately 7% of the county’s population.

In 2023 alone, at least 206 felony cases were filed statewide. Competency was questioned in 28% of them.

These findings should serve as a warning about who is actually prosecuted when such a law is put into practice.

Kevin’s story

Kevin Page was brought to an emergency room during a psychiatric crisis. He described being strapped to a hospital bed, surrounded by hands, and unable to understand why he was being held. Panicked and feeling as though he could not breathe, he spat at nurses.

Police removed him from the hospital and took him to jail, where he faced felony charges.

The law did not prevent that encounter. But it certainly changed what happened to Kevin after it.

Others examined by the reporters were also removed from healthcare facilities, jailed, and left waiting for psychiatric evaluation or competency services.

King County’s prosecuting attorney acknowledged that charges were sometimes filed in the hope that the criminal system would connect people with services. But that promise rarely bore fruit.

Of more than 150 cases reviewed, only 12 people appear to have entered either available program: six were accepted into the county’s LINC diversion program, while six others had their cases handled through mental-health court. The investigation did not establish whether those 12 people received lasting support. Meanwhile, others deteriorated in jail, waited months for competency services, or had existing housing and stability placed at risk by prosecution.

That is not violence prevention. It is using arrest and prosecution to compensate for failures of the healthcare and social-service systems—and sometimes interrupting healthcare in the process.

Accountability and prevention are not interchangeable

Workers who are harmed deserve support and accountability. That does not mean every form of punishment makes them safer.

The harshest provisions do not apply only to the catastrophic attacks most likely to appear in testimony and news coverage. A felony prosecution may grow out of a relatively minor physical interaction, a trauma response, an attempt to escape forced treatment, or conduct by someone unable to understand what is happening.

Once imposed, a felony can affect housing, employment, education, benefits, immigration status, family relationships, and access to the very stability that can reduce future crises.

Meanwhile, the conditions that may have contributed to the incident—dangerous staffing levels, overcrowding, inadequate training, delayed care, inaccessible communication, lack of accountability for poor employee performance, or an institutional reliance on force—may remain untouched.

Healthcare workers deserve more than a law that acts after they have already been hurt. They deserve adequately staffed facilities, enforceable prevention plans, useful training, reliable reporting, post-incident support, and employers that can be held accountable for preventable hazards.

Increasing punishment is politically visible. Prevention is harder.

If the goal is safety rather than symbolism, lawmakers should be required to show that their policies are likely to reduce harm—not merely increase the harm imposed afterward.