When patients and visitors walk through the entrance at Milford Regional Medical Center they’re met with a warning: If “unwelcome” words and actions are expressed, future care may be denied.

The hospital’s code of conduct is printed on a large sign in the lobby and on smaller signs sprinkled throughout the 148-bed facility, outlining how “words or actions that are disrespectful, racist, discriminatory, hostile or harassing are not welcome and will not be tolerated.”

Officials at the full-service, community and regional teaching hospital outside of Worcester implemented the code of conduct earlier this month, a measure they say is in “response to the growing number of acts of violence and aggressive behavior toward healthcare workers across the state and throughout the nation.”

The code has made national and international headlines, with critics taking exception to how future care may be denied if the hospital believes a patient or visitor violated it by expressing “unwelcome words or actions.”

Examples include refusing to see a clinician or other staff member based on personal traits, aggressive or intimidating behavior, physical or verbal threats and assaults, sexual or vulgar words or actions, and disrupting another patient’s care or experience.

“Some violations of this Code may lead to patients being asked to make other plans for their care,” it reads. “For serious or repeated violations, future non-emergency care and visitation rights at Milford Regional may require review, though we expect this to be rare.”

Christina Buxton, a registered nurse on the hospital’s IV team, told the Herald that in the past, healthcare workers were never encouraged to speak out when patients and visitors acted poorly, and this is the first time the conversation has made it out to the public.

“People are taking it the wrong way,” Buxton said Friday. “We have never denied care for these behaviors in the past and there’s no plan to deny someone. If somebody comes in, and they have an infection, I’m giving them antibiotics, and they start swearing at me, I’m not not going to give them their antibiotics. Now I can say ‘This behavior is not acceptable in the hospital,’ and the hospital is going to back me.”

The code came to the limelight on social media last week when the Libs of TikTok posted a video of Milford Regional Chief Medical Officer Peter Smulowitz explaining the policy on X, formerly known as Twitter.

Libs of TikTok called the code “dystopian” before Aaron Terr, director of public advocacy for the Foundation for Individual Rights and Expression, slammed it Friday for being “ridiculous.”

“FIRE has seen nebulous terms like ‘disrespectful’ and ‘offensive’ twisted to punish all manner of expression,” Terr wrote, “but censoring individuals coping with their own health and mortality — and punishing them by denying care — is a symptom of a larger societal disease.”

What’s happening at Milford Regional is nothing new in Massachusetts.

The code has nearly identical wording as the one implemented at Mass General Brigham, the first hospital system in the state to adopt a set of rules for patients and visitors, in November 2022.

That came months before the Massachusetts Health & Hospital Association’s Board of Trustees voted for all 56 hospitals in its membership “to align their codes with the United Code of Conduct principles.”

Healthcare workers across the state say they’ve seen an uptick in workplace violence at healthcare facilities since the COVID-19 pandemic, as backed by a report the MHA released last year detailing the issue and preventive measures being taken.

The report highlighted “how every 38 minutes in a Massachusetts healthcare facility there is a case of physical assault, verbal abuse, or threats made against someone — most often a clinician or staff member.”

“The pandemic has exacerbated the situation, as has the worsening behavioral health boarding crisis, longer wait times, and required limits on visitations,” the report states. “Some of the uptick in incidents can also be explained by the increase in overall reporting among employees as their organizations work to instill a ‘culture of reporting.’”

At the State House, leaders and advocates are pressing legislators to approve ‘An Act Requiring Health Care Facilities to Develop & Implement Programs to Prevent Workplace Violence.’

Hospitals would be required to develop a workplace violence prevention plan and submit it annually to the state Department of Public Health. The bill would also make aggravated assault against healthcare workers a felony and criminal charges would be reserved for patients and visitors “who intentionally impede the ability of workers to safely deliver care services.”

“There is no bigger priority than the protection of the professionals who have committed their lives to helping others,” said Patricia Noga, the MHA’s vice president of clinical affairs. “Hospitals are regularly updating their policies and protocols, sharing best practices, and encouraging a culture of reporting within their facilities. But they also need help from community members.”

Buxton, who said she’s been “hit and pinched and sworn at,” believes it will take some time for the code to fully resonate with all patients and visitors. But in the short time it’s been in place, she said she’s seen a colleague help deescalate a patient who had been swearing and upsetting other patients.

“Nurses and other healthcare workers have been on the receiving end of physical and verbal abuse for years,” Buxton said. “It was always kind of swept under the rug, like an expected part of the job. There was always the expectation that we should do our best but those interacting with us, there was no expectation on them to treat us with courtesy. I really appreciate this code of conduct because the hospital is taking a public position that that behavior is not acceptable.”