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Common threats and how to deal with them
Assault, domestic violence, prisoner patients
Experts Hospital Peer Review spoke with say some of the most common criminal activity in hospitals involves assaults by patients on other patients or staff; patients in psychiatric units; patients on drugs; prisoner patients; acts prompted by domestic violence; patients on drugs; and gang members or VIP patients. All present unique challenges.
Assaults, sexual crimes
Don Charley, executive director, security and parking at UPMC Presbyterian Shadyside and Magee-Womens Hospital of UPMC, says, "I think assaults are probably one of the largest categories, both physical and, particularly, verbal assaults (patient visitor to health care worker) seem to be where we spend a lot of our time... The thing that I've noticed in my career is that there's factions of families that have never gotten along and they have a loved one in common. The hospital can bring all those factions together, and a lot of those old grievances play out in this setting, and that's certainly another area we deal with a lot."
Beatrice Yorker, JD, RN, MS, FAAN, dean of the college of health and human services at California State University Los Angeles, says, "When I saw [The Joint Commission's Sentinel Event Alert on violence in hospitals] I was very, very pleased to see that they recognize crimes by health care workers because I have expanded my topic when I give presentations, and I talk about the sort of slew of sexual assaults, particularly in pediatric hospitals or an area in where the patients are compromised developmentally delayed or comatose things like a nurse's aide taking photographs of a patient's genitals on their cell phone and then distributing it on the internet."
Another situation she sees, which she says is too often minimized, is "when patients sexually assault other patients, like in psychiatric hospitals." She recalls one case of a 13-year-old female patient placed in a co-ed inpatient psychiatric unit. Two 16-year-old males entered her room and sexually assaulted her. "The nurse punishes all three of them for sexually acting out, never reporting it as a sexual assault until a couple of days later when in therapy the girl is clearly traumatized," Yorker says. In another, similar case, the female patient was taken to the rape crisis center but the case was never reported as an incident.
Michael R. Parks, director of security at Mercy Medical Center in Baltimore, says the hospital "has a very robust workplace violence policy. Security works very closely with the human resource department to identify those employees who are victims of domestic violence or whether or not there's an employee act of violence, be it a relationship that's gone bad or just heatedness between one coworker and another. So we do everything we can to identify if there's a chance for those types of incidents to find themselves on our campus."
If there is a domestic abuse situation and the offender is not an employee, the security team asks the employee:
Security alerts other staff about the situation and tries to obtain a photograph of the offender, even though it's kept confidential. "We wouldn't want all the hospital employees to know that Mary Jane has a domestic issue. We do alert our staff and have these photographs posted in security locations so that in the event that we think that that person may come through, we can make a quick identification and call law enforcement."
To encourage staff to come forward with the issue, security includes discussions of domestic violence in the hospital's new employee orientation. It also has a domestic violence unit on campus, and the director presents to all new employees. "I give a similar presentation encouraging employees that if they're the victim of abuse or if they overhear an employee who's talking about an abuse and they believe that violence or abuse could find its way on our campus to call us," Parks says. Patients are also asked at registration whether they are victims of domestic abuse and whether they believe their abuser may come to the campus.
Domestic violence or paternity/financial issues can also present problems in mother/baby units, Parks says. Joe Bellino, CHPA, HEM, president of the International Association for Healthcare Security & Safety and system executive, security at Memorial Hermann in Houston, TX, suggests staff also look for instances of domestic abuse for instance, if a couple walks in and the wife is bloodied and bruised.
With more than 700 prisoner patients coming through its facilities each year, Mercy Medical has implemented a number of policies to address this population. Parks says the problem is one many hospitals have to consider. "Many, many hospitals across the country deal with the issue of prisoner patients, or forensic patients, because there have been a number of documented cases where a prisoner patient has escaped or attempted to escape from a hospital setting, taken an officer's weapon, and either killed the officer that was guarding them or shot someone during their escape," he says. "You really need to have a very strong prisoner-patient policy in place and communicate with the leadership of those various law enforcement agencies that bring prisoners to you and what your expectations [are]."
A security officer with a canine visits each prisoner patient admitted. Mercy's policy requires that all prisoner patients be accompanied by two officers throughout their stay. "We deliberately go to that patient care room and engage these folks in conversation and let that prisoner patient see that dog, and I think it just sends a very subtle message that if that prisoner patient is contemplating an escape attempt that maybe he may not want to do that. Because they never know where that dog is going to be. We find that very helpful," he says.
He says Mercy is the only hospital in Baltimore to require prisoners have two police escorts. "Mercy had an incident here a couple of years ago where we just said to all the agencies that bring prisoners here, 'Effective immediately, you must have two guards with every prisoner patient,' and we haven't deviated from that in the last several years."