Sam Demers, a nurse in the Emergency Department at the University of Vermont Medical Center in Burlington, on Wednesday, August 5, 2026. Photo by Glenn Russell/VTDigger On the afternoon of Aug. 29, 2025, 24-year-old Destiny Hubbell was in a Morrisville emergency room for a mental health emergenc y examination, when she grew angry and agitated. She started spitting at healthcare workers, on their faces and in their eyes, court documents show.  “Now you’re infected!” she repeated as she spit. Hubbell threatened to strangle Elizabeth Couto, a registered nurse at the hospital, who knew Hubbell from repeat visits to the ED, according to court documents.  The incident led Hubbell to be charged with four counts of assault with bodily fluids on a protected professional — a category healthcare workers, who cannot refuse to engage with a patient, fall into. She also had one charge of threatening a healthcare worker.  Nearly a year later, in June, a Lamoille County judge found her guilty on all five counts and sentenced her to 3.5-10 years. The sentencing is rare, but the issue of repeat violence against healthcare workers is not. Verbal and physical attacks on healthcare workers have become so prevalent that they’ve become the “daily reality of emergency care,” one emergency nurse told VTDigger. It’s a reality that’s become so normalized that it often goes underreported and unaddressed. Many nurses told VTDigger that the lack of any real consequences has acted as a deterrent for hospital workers to report violent incidents. Now, the recent Lamoille County sentencing has opened up a broader concern about how to help individuals with extreme mental health needs access appropriate care while also protecting those tasked with caring for them.  “It has been really challenging to navigate accountability in the court system with patients that have been deemed to lack the capacity to stand trial,” said Couto, who spoke with VTDigger in her capacity as the director of the Vermont Emergency Nurse Association, “but also protect the individuals that are expected to be there and care for them, as well as every other patient in that setting.” “There needs to be some sort of balance between healthcare and the judicial system to support both ends of these really challenging situations,” she added.  There are frustratingly few options to genuinely address the underlying needs of those who commit these acts of violence against healthcare workers, according to Aliena Gerhard, the Lamoille County state’s attorney who prosecuted the case against Hubbell. If a judge finds a person incompetent to stand trial, as one might due to mental illness, the state cannot prosecute the case.   “A lot of states have laws that permit some sort of resolution that protects the victim while acknowledging that the defendant might be incompetent or going through a mental health crisis,” Gerhard said, pointing to the mental health courts that other states have. There, a multidisciplinary team of attorneys, case managers, mental health representatives and others meet to devise a plan that balances treatment, community support and accountability.  “But here we have nothing,” she added. Instead, Vermont primarily uses orders of non-hospitalization, court orders that put the defendant in the custody of the state Department of Mental Health and guide a treatment plan for them. But a patient has to willingly engage in their care, and in the cases where a patient does not follow the order’s guidelines, there is little the state can do to enforce compliance. “(Orders of non-hospitalization) do literally nothing to protect our victims,” Gerhard said. “We need to do better for the defendants. We need to do better for the families. We need to do better for our communities.” “It’s not always doing someone a service to have them in a non-secure facility,” she continued. “Should they be in jail? No, absolutely not. They shouldn’t be in jail, but they need to be in a safe place, and Vermont is not providing that.” Resources such as better housing facilities, mental health specialists embedded in police departments and more collaboration between defense attorneys and prosecutors could help law enforcement identify what a person is struggling with and how to better connect them to the services they need, Gerhard said. Samuel Demers, a staff nurse in the UVMMC’s emergency department, argued that investing in social services that assist someone before they land in the ED is essential to helping patients and also protecting healthcare workers from this kind of violence. Long wait times, unmet behavioral health needs, intoxication and prolonged warehousing while awaiting psychiatric placement all feed the likelihood of violence, he said.   “There can be an over-reliance on the ED as a last resort safety net when community systems do not meet the needs of the population,” he told VTDigger. “We will always provide compassionate care to everyone who comes to us for emergency care, but our capacity is limited.” Rep. Anne Donahue, I-Northfield, has long been a staunch advocate for better mental health care and for the rights of people struggling with their mental health. She thinks that much of the violence in emergency departments could be stemmed by expanding access to alternative settings.  Mental health urgent care clinics, for instance, can be a much more appropriate place for a person in crisis to be seen by a clinician or talk with a peer support volunteer, she said. READ MORE “I think it’s a serious problem that we don’t have enough availability of alternative resources, and I think that’s one of the struggles,” she said.  She also suggested training hospital staff in trauma-informed care, allowing clinicians to feel better equipped to navigate situations that might unknowingly trigger a patient. It’s particularly difficult when a patient arrives in the emergency room with a court order for an emergency psychiatric evaluation and requires treatment at a high-level psychiatric facility, explained Kristen Schieman, the emergency department nurse manager for Central Vermont Medical Center. There are only four hospitals in Vermont with this type of high-level psychiatric unit — and CVMC is not one of them. High-need psychiatric patients can spend days in the emergency department, Schieman said, waiting for a bed to open up or for transportation to a high-level psych unit. The week she spoke with VTDigger, she said, two patients at CVMC needed to wait four to five days for placement. Couto sees some glimmers of hope in recent legislation that creates a treatment facility for those who have been found not competent to stand trial or not guilty by reason of insanity when charged with extreme criminal offenses. The law seeks to stand up the program, called a forensic facility, in one of Vermont’s prisons. Though this year’s legislation carves out eligibility for a small subset of individuals charged with extreme offenses, Couto said she thinks it sets an important foundation for helping people in psychological distress get care while also protecting hospital workers from the ongoing threats of violence. “In the past, it’s really felt like the judicial system works in their own silo, and the healthcare system works in their own silo, and the legislature is trying to figure out what to do to blend all of that,” she said.  The forensic facility legislation is just one part in a series of recent laws that have sought to address the intersection of violence against clinicians and people in mental health crises.   In 2023, lawmakers increased the penalties for threatening healthcare workers and made it easier for law enforcement to arrest people who assault healthcare workers. Last summer a new law went into effect requiring the state’s hospitals to develop a reporting system to track workplace violence, including data on the number of incidents reported to law enforcement. It also requires that hospitals use that data to create security plans aimed at reducing violence.  Already, some hospitals have seen decreases in workplace violence. At UVM Medical Center in Burlington, violence in the emergency department has fallen 64% between 2022 and 2026, according to Demers. The department now has around-the-clock security staff, metal detectors, and screening policies for patients and visitors. Still, it’s a decrease in a much larger, national increase: the last 15 years have yielded unprecedented heights of violence in healthcare settings. To Couto, having healthcare workers involved in the legislative and judicial processes has been essential in producing these modest wins.  “When we see how the system as a whole can work to be successful to support reduction of workplace violence in healthcare, as well as patients’ needs,” she said, “it’s validating.” Read the story on VTDigger here: For emergency department staff, violence at work is a dangerous and demoralizing reality. ...read more read less