Violent crime in hospitals is up, according to a 2023 report by a nonprofit organization that works to improve U.S. health care by accrediting and evaluating facilities. Last year was the first in which a category that includes assault, rape, sexual assault and homicide was among the top five patient safety events reported by hospitals, according to the report.

Even though most states require hospitals to report these incidents, they don’t always do so, according to lawsuits and regulatory records reviewed by NBC News. And self-reported data significantly understates the number of sexual assaults in hospitals, experts say.