Health Care Risk Management

Hospitals Struggle with Security Risks

Health care facilities must balance safety and security concerns when considering protection methods.
By: | March 18, 2016 • 5 min read

A growing number of health care facilities are foregoing armed security because of insurance carriers’ concerns.

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Instead, some facilities are equipping security personnel with intermediate-level weapons, such as handcuffs, TASERs, batons and pepper spray.

“The cost and availability of insurance is almost certainly a factor in the decision,” said Jeff Young, a spokesperson for the International Association of Hospital Security and Safety, and executive director, Lower Mainland Integrated Protection Services in British Columbia.

“Since pepper spray and Tasers are less lethal than firearms, they’re less risky from a liability standpoint … but they’re less effective against an assailant with a gun.” — Michael DuBose, senior vice president, workforce strategies practice, Marsh Risk Consulting

“If insurance coverage isn’t available, the corporation might not be willing to assume the risk on its own.”

Michael DuBose, senior vice president, workforce strategies practice,Marsh Risk Consulting

Michael DuBose, senior vice president, workforce strategies practice, Marsh Risk Consulting

Some carriers “take a negative stance on arming staff,” said Michael DuBose, a senior vice president with Marsh Risk Consulting’s workforce strategies practice, particularly internal security staff (as opposed to contracted security personnel, such as off-duty police).

In health care facilities, as in schools, “if you go ahead and arm your staff, you may find out your carrier will drop you or boost your premiums.”

“Since pepper spray and Tasers are less lethal than firearms, they’re less risky from a liability standpoint,” said DuBose.

But there’s a tradeoff. “They imply less liability and require less training, but they’re less effective against an assailant with a gun.”

Shootings at hospitals are, unfortunately, not rare.

In February, an injured man seeking aid fired a bullet into a door at the Reston Hospital Center in Northern Virginia and then fired another bullet once inside the hospital. Medical personnel eventually convinced him to lay down his gun.

In December, a Los Angeles police officer shot and killed a patient at the Harbor- UCLA Medical Center in Torrance, Calif. when he attacked officers and reached for an officer’s gun, according to reports. The patient, arrested earlier in the day, fought ferociously with police at the hospital. Officers tried using a Taser on the patient first to no avail.

That was also a case last summer in Houston, when police were unable to subdue a combative patient with a Taser, according to reports.

The patient, who struggles with mental illness, was shot in the chest by the police, working off-duty as hospital security; that shooting was not fatal.

Determining the Risk

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DuBose said many facilities want to equip personnel with some means of protection for themselves and the public.

“They conduct an annual security risk assessment that considers, among other things, the prevalence of gun crime and violence in the neighborhood and the facility’s own history of violence. Then they ask, ‘Is that the right stance for our facility?’ ”

“How many local police officers would feel comfortable pursuing someone into a central sterilization area where there are toxic or flammable gasses?” — Dr. Jeffrey Ho, Hennepin County Medical Center

For example, he said, “firearms may have a role in a Level 1 trauma center that treats victims of violence, mental health patients and inmates. But you have to question very closely the need to arm a small community hospital that doesn’t have that same degree of risk.”

Barry Kramer, senior vice president, Chivaroli & Associates, a health care insurance broker, said that armed security in health care settings is more of a risk management concern than a coverage issue.

“It would be highly unusual for our clients’ liability policies to exclude claims involving security guards, whether or not they’re armed with guns,” he said.

He said many health care risk managers are not equipped to manage exposures associated with licensing and certifying guards or registering the facility’s own firearms.

Dr. Jeffrey Ho, Hennepin County Medical Center

Dr. Jeffrey Ho, Hennepin County Medical Center

For facilities that lack the bandwidth to manage, train and track certifications for in-house security staff, Kramer said,third-party vendors, such as local law enforcement or private security companies, can be contracted, since they have firearms experience as well as liability insurance coverage.

Jeffrey Ho, an emergency room physician in a busy Level 1 trauma center at the Hennepin County Medical Center in Minneapolis and a sworn deputy sheriff in neighboring Meeker County, cautioned that armed personnel must be thoroughly trained to work in a health care setting.

“How many local police officers would feel comfortable pursuing someone into a central sterilization area where there are toxic or flammable gasses?” he asked.

“How many would feel comfortable discharging a firearm or Taser, which generates an electric spark? Any weapon can be dangerous in those environments.”

Train for the Worst

“Prevention,” said Young, “is the first line of defense in potentially violent situations. You have only seconds or at most minutes to de-escalate a situation before it can go very wrong.”

Failure to recognize a potentially violent situation and take precautionary steps can lead to tension between security and clinicians.

Training – not just in lockdowns and active shooter drills but in de-escalation techniques and identifying potentially dangerous situations – is essential to preserving safety, said Ho.

Failure to recognize a potentially violent situation and take precautionary steps can lead to tension between security and clinicians, said Ho.

When his facility first undertook a comprehensive violence prevention program nine years ago that included debriefings after forceful intervention, “clinical staff pointed the finger at security and said, ‘How dare you put that patient on the floor, handcuff him, spray him with pepper spray?’ And security would say, ‘The situation was out of hand before we got there. What did you want us to do?’”

Looking back, he said, most situations never should have escalated to violence.

Eventually the entire staff – clinicians, therapists, food service and administrators – were trained to recognize stresses and talk down problems from flash points, which worked well in many but not all situations.

“Maybe the patient was hungry or thirsty or needed a blanket. Failure to recognize a simple problem often led to acting out.”

Greater force may be called for with intoxicated people, he said.

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Although security seldom if ever initiates violence but rather responds to aggression, patients may perceive the situation otherwise and pursue litigation, Young said.

“Especially in a psych setting, patients may turn it around,” said Jane Lipscomb, professor at the University of Maryland Schools of Nursing and Medicine, and author of “Workplace Violence in Health Care: Recognized but not Regulated.”

“They can say, ‘I was defending myself because the staff member was being abusive,’ and the staff member is put on administrative leave.”

The most effective environments value staff safety, she said, and see that it’s inextricably linked to patient safety and quality of care.

Susannah Levine writes about health care, education and technology. She can be reached at [email protected]

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