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The most common response to an adverse security event in a healthcare setting is: "We never thought it would happen here." That is what the folks in Carthage, N.C. probably thought as they try to unravel the mystery of why a 45-year-old painter tore through a North Carolina nursing home on a terrifying rampage that left eight dead; a slaughter halted by a single shot fired by a decorated police officer responding alone to a 911 call. Other shootings in New York, Pennsylvania and Washington, all within a two week time frame, demonstrate the possible relationship between tough economic times and acts of violence. Recently a baby was abducted from a hospital in Santa Barbara, California. Even though the baby was recovered within three hours both the hospital and the parents of the child were traumatized. Most likely the mother/baby unit of this hospital thought their security program was sufficient and that it "would never happen here." On April 16th a Long Beach, California hospital pharmacy employee went on a shooting spree killing two before turning the weapon on himself ending his life.
As a security consultant and a court certified forensic security expert for approximately 600 litigations over the past 30 years, encompassing about 40 states, I have seen the aftermath of these acts. The hospital cases I have seen have included homicides of both patients and employees and have included sexual assaults, child molestations, elder abuse, infant abductions and assault and battery. I have also seen intentional tort cases such as sexual assault by employees against patients and use of excessive for by security personnel and by behavioral health workers.
The potential for security litigation is further enhanced by the general milieu of the healthcare setting itself. Generally speaking healthcare employees are altruistic and nurturing. As one would expect, clinical personnel are focused on patient care, but all too often at the exclusion of staying alert to security threats. The architecture of most hospitals affords virtually hundreds of points of ingress and egress. Most hospital administrators support this open architecture because they want to want to portray a welcoming sense openness to the community they serve. These factors and others make hospital security a challenging enterprise. Unfortunately, all too often, effective security programs do not emerge until there is a sentinel or near-sentinel event.
The challenge becomes, "How do we prevent patients, visitors and staff form being victimized by crime, while at the same time maintaining a perception of openness." The key is, to use a football analogy, "Establish a bend, but don’t break, defense." This means, it is a given that folks will enter our hospital that we would prefer would go elsewhere. Therefore the hospital must control where these folks go and what they can do.
How can a hospital ensure the safety of their patients and employees?
No security program, in any environment, can guarantee safety. Security programs are all about managing the probability of occurrence. Security programs must reasonably reduce the probability of criminal opportunism. Security is also a situational discipline. This means that security programs must fit the individuated needs of each hospital and no two security programs are, or should be, the same.
The only way to achieve these objectives is to conduct a complete security assessment of all hospital operations. The purpose of a security assessment is not to establish a ceiling for security remedies, but to rather establish the foundation on which to build upon for the foreseeable future. The only way to ensure an effective security and loss prevention program is to make sure that your security program is predicated on the unique set of identified needs of your hospital. This is the only means by which your security program can move from reactive to proactive. Typically hospital security assessments are and should be conducted by qualified healthcare security experts who also bring the perspective of objectivity to the task at hand.
On the solution side of the equation, without getting in to the plethora of potential security measures from guards to CCTV and everything in between, let us consider a few of the components that should be included in all hospital security programs. The single best and most cost-efficient security methodology is the full and enthusiastic participation of all employees in a comprehensive security awareness program. Anecdotally, we have found that the most frequent common denominator in most hospital security lawsuits is employee apathy and inattentiveness. By way of example, we have experienced cases where nurses have held the door open for a perpetrator who is walking out with a baby. We had a case involving the sexual assault of the female patient while hooked up to telemetry. In a case involving the homicide of a patient, 15 staffers, after-the-fact, reported seeing a "suspicious person" at various locations within the hospital, but none took action. All too frequently aberrant behavior is not recognized and dealt with in the incipient phase.
The same effort that goes into to promoting safety and infection control should be applied to security and loss prevention. Security needs to be sold as part of a positive value system. This effort must begin during effective new-employee orientation and must be reinforced on a continual basis thereafter. Hospitals cannot assume employees will "do the right thing," nor can they assume that employees that employees even know how to do the right thing.
It is reasonable to assume that sooner or later a qualified security professional will do a security assessment of your hospital. If it is not done sooner, it will surely be done in the wake of a major security breach. The problem with the later approach, that security assessment will be conducted by the plaintiff’s security expert.
William H. Nesbitt, CPP is a Board Certified Protection Professional certified in Security Management and the President of Security Management Services International, Inc. He has more than 35 years of diverse security management experience. That experience includes his participation in approximately 600 security driven lawsuits as a court certified security expert covering 40 states. Bill is a longstanding member of ASIS International, IAHSS, ASHRM, and ACHE. He is also a member of the ASHRM Patient Safety Interest Network. For questions call: 805-499-3800.
Submitted by:
William H. Nesbitt, CPP
President
Security Management Services International, Inc.
805-499-3800
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