How 3 health system executives weighed decisions about armed security

Violence in hospitals is a growing public health concern. In recent years, attacks on patients and providers in the healthcare setting, particularly those perpetrated by patients and visitors, have impelled administrators to consider ways to enhance systemwide security models.

Though still relatively rare, acts of violence are occurring in hospitals with increasing frequency. Healthcare institutions reported a 40 percent spike in violent crime between 2012 and 2014, with more than 10,000 incidents aimed at hospital staff, according to a survey from the International Association for Healthcare Security and Safety.

Individual acts of violence in hospitals made headlines numerous times so far this year.

In January, Michael Davidson, MD, a cardiac surgeon at Brigham and Women's Hospital and assistant professor at HarvardMedicalSchool in Boston was shot and killed in the hospital by a deceased patient's son. The shooter then committed suicide in an exam room. In March, a 22-year-old patient nearly tore off a nurse's ear and attempted gouge out her eye at Pembroke (Mass.) Hospital.

In early July, a 55-year-old male patient attacked Ruth Anne Mardock, MD, at Timberlawn Mental Health System in Dallas, by tackling her and knocking her head into the ground. She lost consciousness and later died from her injuries. Later that month, a man entered a patient's room at Parrish Medical Center in Titusville, Fla., and opened fire, killing an 88-year-old patient and a 36-year-old hospital employee. Police deemed the shooting a random attack and charged 29-year-old David Owens with two counts of first-degree murder. According to his lawyer, Mr. Owens is severely mentally ill and incompetent to stand trial.

The New York Times, in collaboration with WBEZ's This American Life, in February published a detailed report on the case of Alan Pean, a 26-year-old college student who was shot just millimeters from his heart by armed hospital security at St. Joseph Medical Center in Houston while he was having a manic bipolar episode. Nurses called hospital security — who were off-duty police — to his room when Mr. Pean refused to comply with their orders, and after a confrontation ensued, the officers shot him.

"I thought of the hospital as a beacon, a safe haven," Mr. Pean, who survived the gunshot, told The New York Times. "I can't quite believe that I ended up shot."

After CMS launched an emergency investigation of the event, the agency faulted St. Joseph for the shooting, concluding the hospital created "immediate jeopardy to the health and safety of its patients," and that "the facility had no clear guidance for the role, duties and responsibilities of the police officers they employ to provide security services," according to The New York Times. CMS demanded the hospital restrict its use of weapons or risk losing federal reimbursement.

Tragic episodes of violence in hospitals have prompted many healthcare executives to rethink their security models, with some electing to arm security guards. Meanwhile, others warn that the presence of guns in hospitals could increase the likelihood of violence, as in the case of Mr. Pean. There is also concern that patients or visitors could obtain officers' guns from their holsters, particularly behavioral and mental health patients with conditions that manifest as aggressive behavior.

Given the complexity of the violence and security, Becker's Hospital Review asked three health system executives to break down the decision-making process behind their unique security models.

Scripps Health CEO weighs pros and cons of introducing armed guards
Concerns about excessive force used to restrain mental health patients are partially what has kept Chris Van Gorder, CEO of San Diego-based Scripps Health, from deploying armed security guards in Scripps facilities. A great proportion of people who visit hospitals, and emergency rooms in particular, have mental or behavioral health conditions. A variety of factors contribute to this, including underfunding of behavioral health and social programs in the community, the release of mentally disturbed prisoners with inadequate support and a large homeless population, according to Mr. Van Gorder.

"If [the police] don't know what to do with [a mentally disturbed person] and they haven't committed a crime, they just drop them off in the ER," says Mr. Van Gorder. "We're seeing people with behavioral health issues boarded in our ERs because there is no other appropriate place for them. When we don't have enough mental health units, we have to put them in a regular medical bed."

In addition to the fact that patients with mental and behavioral health issues would be better served in a psychiatric department than the ER, overcrowding in the ER with people who may be suffering mental health crises could increase the risk of aggressive behavior, leading to a confrontation with security.

In the event that security is called on any patient, Mr. Van Gorder says, "We don't want a situation where security personnel are shooting or injuring patients. If law enforcement shoots a citizen out on the street, that's different than a hospital security officer shooting a patient. And if you use a Taser in a hospital, you could be injuring someone with a heart condition. Same with using pepper spray on someone with a respiratory disorder."

However, Mr. Van Gorder notes that the health system leadership has an obligation to protect Scripps' staff, patients and visitors. "There does seem to be an uptick in violence. I'm trying to find a balance between providing security with the tools they need to maintain safety, but not go so far as to increase the risk for patients in the hospital."

The decision to introduce armed security personnel in hospitals isn't one-size-fits-all — each system can scale up or down their security system as leaders see the need. At Scripps, Mr. Van Gorder is considering the concept of a rapid response team to respond to violent emergency situations.

"While we wouldn't generally arm security, I've been thinking about having a small, highly trained response team of ex-law enforcement or former military police, put them through all the necessary screening and training, and have them on call to respond to a threat anywhere in our health system," he says. "Introducing guns to a hospital increases risk for gun violence, but a small rapid response team doesn't carry the same risks as if you armed all security officers."

Northwell Health aims to strike a balance
The security model in place at New Hyde Park, N.Y.-based Northwell Health is similar to Mr. Van Gorder's rapid response team idea.

Northwell Health has about 525 licensed security guards across the system, according to Mark Solazzo, executive vice president and COO. Of those, just 20 officers — each at the director level — are armed.

"You would never know we have an armed force," says Mr. Solazzo. "It's a very small proportion. During our deliberation on the matter, we knew we didn't want to appear as an armed force to patients while still being able to ensure a safe environment."

The armed officers, who are all former members of law enforcement, do not stand on the frontlines in Northwell Health facilities. They are intended to be deployed during particularly dangerous situations, such as the event of an active shooter. Otherwise, the health system predominantly relies on non-armed force to maintain security.

However, Mr. Solazzo notes that each of Northwell Health's 21 hospitals require varying degrees of security measures.

"Each hospital is extremely different and their risk profile is different," he explains. "We take that into account as to how we approach visitor access and the number and visibility of security force."

Whether armed or not, all 525 of Northwell Health's security personnel are licensed security officers of New York State. They are also trained on how to control and de-escalate situations involving patients experiencing a mental health crisis, and how to safely restrain them.

"We are trying to maintain a balance of a healing and caring environment with comfort and safety," says Mr. Solazzo. "While safety is important, we don't want to alarm the public or make them feel like they are in a restraining environment."

Health First's summer decision to enhance hospital security
Rockledge, Fla.-based Health First recently introduced armed security officers to its facilities. As of July 21, certain authorized security personnel at Health First, a 900-bed health system comprised of a tertiary hospital and three community hospitals, began carrying a firearm and baton. Stuart Mitchell, Health First COO, said the idea of arming hospital security had been under consideration for a long time, but the July shooting at ParrishMedicalCenter drove the final decision.

"Because of the tragic events at Parrish, we egged it on. But we were probably close to doing this regardless," says Mr. Mitchell. "We have to understand we're living in a world that's changing. We must face the reality that there are people out there who want to do harm."

The decision to introduce armed security guards adds to Health First's existing security model, which includes a visitor badging system that conducts immediate background checks, enhanced security staffing and processes and upgraded systems to help staff monitor and manage crises, according to a news release from the hospital.  

Not all security personnel at Health First qualify to hold a firearm. Additionally, armed guards, who are contracted through security vendor G4S, have completed all Florida Department of Licensing Firearms Training required for armed private security officers. This annual certification authorizes the selected officers to carry Tasers. The guards stationed at Health First facilities — primarily in the ER and main entrances — must also pass the same testing that all Florida law enforcement officers are required to complete, and maintain their certifications and licenses. In addition to rigorous training, the armed guards at Health First facilities wear holsters designed to guard against someone obtaining their gun.

Mr. Mitchell acknowledges concerns about introducing guns in hospitals. But he says that since G4S — not the health system — is responsible for organizing the guards' firearm training and certification, hospital staff, patients and visitors can be confident the armed guards are trained by leading security experts and have passed psychological assessments deeming them fit to serve in a hospital setting.

"If you think we'd give guns to just anyone, I'd be nervous too," says Mr. Mitchell. "We found a vendor that is a security expert to help us do this. We're not just arming regular people."

Overall, Mr. Mitchell says the health system staff and the community have supported Health First's decision to bring on armed security officers.

"It's unfortunate that we must take these actions, but through careful and thorough review and implementation, these steps will provide us a greater opportunity to avoid a tragic event within our organization," says Mr. Mitchell.

Ultimately, hospitals and health systems must determine the best strategy to preserve a safe healthcare environment. While it's unfortunate that violence is becoming more prevalent in centers dedicated to healing and restoring life, healthcare leaders must be vigilant in their mission to protect their patients, staff and visitors.

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