OLYMPIA — A woman arrested for throwing a cup of juice that splashed on a nurse’s shoulder. A man yelling near the ambulance doors of a hospital booked into jail. A man who spit on a nurse charged with felony assault.

A new report by Disability Rights Washington (DRW) documents the arrest of more than 100 people in a one-year period at seven Seattle health care facilities, highlighting one way people suffering from mental health crises find themselves tumbling into the criminal justice system.

During the year ending June 30, 2019, 78 calls related to patient assault came from Harborview Medical Center, with 52 resulting in arrest. Navos West Seattle, a psychiatric facility, had 34 calls, resulting in 11 arrests. Swedish First Hill had 41 assault-related arrest calls, bringing 18 arrests.

Titled “From Hospital to Handcuffs,” the report by the advocacy organization contends that most of those arrests involved behavioral health issues. In a review of the criminal cases, the report concludes that some alleged assaults did not cause bodily harm, such as the woman who threw a cup of juice and the man who spit on a nurse. It found that sometimes cases were dismissed because the person wasn’t competent to stand trial.

The findings come as Washington lawmakers and officials in recent years have struggled to repair a mental-health system with challenges on many fronts. The state doesn’t have enough treatment beds or crisis centers — meaning patients often wind up at a hospital during a mental-health crisis. Meanwhile, the state has struggled to provide competency exams, meaning people have been held for days or months in jail awaiting an exam.

The report isn’t an attempt to dismiss safety concerns of front-line health care workers, who must sometimes face dangerous situations in hospitals and emergency rooms, said Kimberly Mosolf, a director at DRW. She added, “no one should go to work and be assaulted.”

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But the findings show how gaps in the mental-health system can lead to the criminalization of people with mental-health issues, according to Mosolf, who worked on the report.

“We have just under-resourced our mental-health treatment system to an extent that it is a lot easier to go to an ER and end up in a jail than it should be,” Mosolf said.

The 41-page report offers a host of recommendations for health care facilities, law enforcement and prosecutors to de-escalate situations and avoid arrests. Those include better violence-prevention programs at hospitals, more training for health care workers and encouraging more discretion for law enforcement when it comes to arresting and charging people in hospital settings. The report also calls for the Legislature to roll back a state law that makes an assault on a health care worker a felony.

Spokespeople for four of the seven health care facilities named in the report — Virginia Mason, Harborview Medical Center and UW Medical Center-Northwest, and Navos, which is a subsidiary of MultiCare — said staff are trained to de-escalate situations, but law enforcement must sometimes be called in to potentially dangerous situations.

A spokesperson for the other three facilities named in the report — part of the Swedish medical system — did not offer an immediate response to the report.

“Despite our prevention and intervention efforts, there are situations where the safety of Navos patients and employees is in jeopardy,” according to a statement from MultiCare. “In these circumstances, each staff member or patient that is assaulted has a right to notify police and file a report. We do not influence that decision for the individual.”

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And, “In several situations of severe assault, Navos staff has opted not to press charges out of concern for the patient’s mental health,” the statement added.

Assault-related police calls happened in only a small fraction of the roughly 6,000 annual inpatient and emergency room visits to Harborview Medical Center that involve mental-health issues, according to a spokeswoman there.

“Roughly 1.3% of the psychiatric inpatient and Emergency Department visits seen annually at Harborview Medical Center result in a staff member’s call to the Seattle Police Department due to an assault by a patient,” according to spokeswoman Susan Gregg. “In reviewing the circumstances around these calls, a majority of the calls have been because of significant bodily harm to the employee.”

Virginia Mason has worked hard to create a safe environment for patients, visitors and staffers, wrote hospital spokesman Gale Robinette in an email, but “Threats and aggressive behavior, including physical assault, are not tolerated.”

“Our team members are trained in de-escalation techniques and behaviors, and our hospital security officers are available to respond to threatening situations as needed,” he wrote. “Seattle Police are contacted when our efforts are unsuccessful and there is a continuing safety concern.”

The new report looks only at Seattle health care facilities. But Mosolf said DRW is reviewing police calls from health care facilities in Spokane and Tacoma — and is seeing a similar pattern with assault-related arrests.

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DRW reviewed 275 calls to the Seattle Police Department coded as assaults coming from the seven hospitals between July 1, 2018 and June 30, 2019. It determined 201 of those calls were alleged assaults by patients against hospital staffers or other patients.

Of those, 102 calls resulted in arrests, according to the report. Those arrests included some people who had been involuntarily committed by a civil judge to a psychiatric setting for treatment, according to Mosolf.

DRW then reviewed case information on those incidents from the King County Prosecuting Attorney’s Office (KCPAO) and the Seattle City Attorney’s Office.

The prosecutor’s office handles some of the cases, because state law defines an assault against a health care staffer as a felony. The report contends that 22 of the 101 arrests were referred to that office, which ultimately filed charges in 20 cases.

In five cases, charges were dismissed, according to the report, and people in seven other cases pleaded guilty to lesser charges.

“Many of the KCPAO cases were referred for competency evaluations … raising similar concerns about the patient’s mental health state and overall purpose of prosecution,” according to the report.

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In an email, a spokesman for the office wrote that cases are “carefully reviewed prior to any filing decision being made including referrals where a healthcare worker has been assaulted.”

“Each of these referrals is reviewed on a case-by-case basis and includes an analysis of any behavioral history on the defendant we may be aware of at the time of the referral, spokesman Casey McNerthney wrote.

McNerthney also cited an example of a psychiatrist at Virginia Mason who was attacked by a patient while trying to perform an exam.

“The defendant was there just weeks after assaulting a security guard at Harborview Medical Center,” McNerthney wrote. “In this context, it is the responsibility of the criminal justice system to … reduce the exposure of others to the individual’s violent behavior.”

Meanwhile, Seattle police referred 77 arrests from that one-year period to the Seattle City Attorney’s Office. The office declined to file charges in 13 of those cases, or 17%, which the report contends is a lower rate than for assault charges citywide.

In the 2018 calendar year, the City Attorney’s Office declined to file charges for nearly half of all misdemeanor assault referrals the office received, according to the report.

The office takes “assaults against our healthcare professionals seriously, and the aim in filing a charge is to holistically address a person’s underlying behavioral health issues to ensure an assault never happens again,” spokesman Dan Nolte said in a statement.

Nolte wrote that his office will review the report’s recommendations. McNerthney said the King County prosecutor’s office will reach out to DRW, “to better understand their concerns and to share the many ways we are already meeting the recommendations contained in their report.”