5 ways hospitals can mitigate risk of prisoner escapes

Hospitals contain many security features designed to keep unwanted threats out — think locked entrances, metal detectors, etc. — but they're less equipped to keep certain people in, says Tony Pope, vice president of the International Association for Healthcare Security and Safety.

Nationwide, authorities have reported at least five incidents of people in custody escaping from hospitals in the past two months. In one instance, a man tied together towels to rappel down the side of New York City-based Mount Sinai Beth Israel Hospital. In another, security footage captured a man calmly walking out of St. Louis-based Mercy Hospital South at 4 a.m. 

"While it is certainly not what we want to see and it is rare, prisoner escapes in general do not surprise me," Tony Pope, vice president of the International Association for Healthcare Security and Safety, told Becker's.

That's because unlike prisons or jails, hospitals aren't designed to be secure facilities. The ability to easily exit hospitals is required for fire and other safety reasons, said Mr. Pope, who also serves as chief of police at Columbus (Ind.) Regional Hospital. 

"However, the recent escapes of serious violent felons that have made the news are rare and tend to be more surprising," he added.

There is no single, national effort to track data on prisoner escapes from hospitals, so trends surrounding the prevalence of these incidents are unclear. The U.S. Department of Justice does track data on prisoner escapes overall, which shows a significant drop over the last two decades. Nationwide, 2,231 people escaped from state and federal prisons in 2019, down from 5,168 in 2000, federal data shows.

Prisoners with intentions to escape will look for opportunities any time they leave a secure area, including when they are taken to the hospital for treatment, Mr. Pope said.

While the custodial officers escorting prisoners are primarily responsible for ensuring they remain safe and in custody, hospital police and security officers also have a vested interest to protect the security and safety of everyone within the healthcare facility.  

"Anytime a prisoner or someone in custody enters into our facility, they should be seen as a high-risk patient," Mr. Pope said. "That should trigger a response from the healthcare facility police and security to assist that custodial officer to have an elevated level of awareness. They should be working with them to help maintain a safe and civil environment in that area."

Below are five best practices for hospitals to improve collaboration with law enforcement officials and reduce the likelihood of prisoner escapes.

1. Foster collaborative relationships and strong communication with law enforcement. Mr. Pope said it's crucial for hospitals to develop a good collaborative working relationship with law enforcement agencies. He recommended facilities also develop a preplanned process for law enforcement to follow when bringing a prisoner to the facility, whether he or she is being treated as an inpatient or in the emergency department. 

Ambulance bays are often an ideal place to have prisoners enter the facility, as it's a secure area and allows the prisoner to quickly be brought into the hospital's interior hallways, reducing the chances for them to escape. If preplanned, hospital security can also be at the entry point to aid in security support. 

"When you have a structured plan in place, I think the prisoner senses that as well," Mr. Pope said. "If they're predisposed to try to escape, and they realize that there's a plan in place, people are communicating and everyone is on the same page, it reduces the chances that they're going to try."

2. Standardize internal hospital processes. Hospitals should create a prisoner patient policy that security and clinical staff are educated on. Hospital security and police should also work to hardwire processes into their daily operations that keep them up to date on all high-risk patients in their facilities, especially those in law enforcement custody. This information allows hospital police to plan for frequent security rounding or increase security presence in appropriate areas, Mr. Pope said. 

The International Association for Healthcare Security and Safety also has a rich library of educational resources and guidelines on prisoner patient security that hospitals can reference, according to Mr. Pope. 

"If your security director or hospital police chief is not involved in IAHSS, he or she is missing out," he said. 

3. Create a law enforcement or forensic patient orientation packet. Once security protocols are established, hospitals should create an orientation packet that outlines everything law enforcement officers should know when bringing prisoners to the facility for treatment. Packets should include information on:

  • Procedures for responding to unusual clinical events and incidents.
  • Standard precautions (universal body substance precautions).
  • The distinctions between administrative and clinical seclusion and restraint.
  • The hospital's channels of clinical, security and administrative communications.
  • Important policies that apply to all persons who are on hospital property.
  • Patient's rights and confidentiality.
  • How to interact with patients, employees, and customers of the hospital.
  • Emergency and evacuation procedures.
  • Confidentiality expectations.

"This allows the custodial officer to understand what's going on around them, what's expected of them, and also how to get a hold of your security department if they need support," Mr. Pope said.

4. Designate areas for high-risk patients. Hospitals should also consider designating certain rooms to accommodate prisoners and other high-risk patients, especially in the ED. Leaders must ensure these rooms do not contain medical equipment or other items that could become weapons and do not have areas where a patient could hurt themselves, Mr. Pope said.

5. Don't assume escapes won't happen at your hospital. Mr. Pope stressed the importance of hospitals proactively investing time and energy to mitigate any vulnerabilities that might lead to prisoner escapes. 

"The outcome of such an incident can range from the prisoner simply escaping with nobody hurt all the way to the unthinkable loss of life," he said. "You just can’t afford to have a mindset that this only happens somewhere else."

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