Hospital Risk-Based Security

Healthcare’s failure to address link between mental illness and violence putting lives in jeopardy

Posted on July 29, 2014 9:50 am by Caroline Ramsey-Hamilton Comment

DATELINE: JULY 28, 2014

Richard Plotts, the man who allegedly murdered a 53-year old caseworker at a suburban Philadelphia hospital last week by shooting her in the face, was formally charged with murder on Saturday following surgery to remove bullets in his torso.

According to Delaware County District Attorney Jack Whelan, police in Upper Darby, Pa., where Plotts lived, were aware of at least three mental health commitments, including once after he cut his wrists and once when he threatened suicide — but said such stays can last just one to three days. Whelan also noted in his press conference that Plotts had also spent time in a mental health facility.

Every week brings a new story in the media about murder-suicides, patients killing healthcare workers, random shootings and assaults. We can read the new polls like the article on U.S. shootings in healthcare, as well as the recent healthcare crime study by the International Association of Healthcare Security and Safety (IAHSS) that routinely reports that violence in healthcare is soaring.

Not only in healthcare, but throughout the U.S., these random active shooter trends are increasing. To see how much of this violence is related to severe mental health problems, we only have to look as far as these high profile incidents:

June 14, 2012 – Buffalo, N.Y., trauma surgeon shooting
July 20, 2012 – Aurora, Colo., movie theater shooting
Sept. 16, 2013 – Washington Navy Yard shooting
Dec. 17, 2013 – Reno, Nev. urology clinic shooting
Jan. 22, 2014 – LAX active shooter incident
April 2, 2014 – Fort Hood (2nd) active shooter incident

None of these incidents were related to poor performance review, losing a job, and only one of these could be called “domestic violence,” but what they all have in common is that the perpetrators were all severely mentally ill.

Guns scare me. Guns kill people by accident and on purpose. I never let my children play with guns. However, as I analyze the elements of these shootings and dozens more, my bias is changing. I think it’s less about guns and more about mental illness.

Healthcare and hospitals would be the one industry where you would think that people would be concerned about the state of mental health of their patients and staff. Instead, it seems like mental health problems are walled off by society, treated ineffectively, and violent tendencies (which sometimes make their way onto patients’ Facebook pages) are largely ignored and unreported by the clinicians treating them.

So it’s left to the security and law enforcement community to deal with these individuals who are paranoid, depressed, angry, frustrated, disappointed, hurt, confused, and, ultimately, violent.

Now that mental health has been re-classified as another medical problem, the money is flowing to the treatment centers and it’s covered by Medicare. But progress doesn’t seem to be either easy or effective.

Dr. Graham C.L. Davey, Ph.D. writing in Psychology Today in January said: “Many of those health professionals (GPs and family physicians) at the first point of contact with people suffering mental health problems are poorly trained to identify psychological problems in their patients, and have little time available to devote to dealing with these types of problems. This increasingly makes medication prescription an attractive option for doctors whose time-per-patient is limited—an outcome which will have all the potential negative effects of medicalizing the problem into a “disease.”

And that’s exactly what we see, patients who don’t take their meds because of the negative side effects and so they become isolated and increasingly violent. The side effects are clearly pointed out in TV commercials, that you’ve probably watched.

For example, one medicine has side effects that include sexual side effects, convulsions, brain shrinkage, stroke, death, suicide, violent thoughts, psychosis and delusional thinking.

The increase in hospitals adding seclusion rooms, expanding the number of beds for psych patients, and the time spent by both law enforcement and security professionals in dealing with these troubled individuals, may account for one-quarter to one-third of an organization’s security budget.

Many of the security risk assessments we do are focused on handling mobile mental patients, including the baby boomers suffering from Alzheimer’s and dementia.

As violent incidents continue to increases in our society, our workplaces, and in our hospitals, we need to spend more time looking for, and demanding treatments that work and that are sustainable by the patients so they can lead happier lives and we can protect the rest of society, and our healthcare facilities, from their potentially violent behavior.

http://www.securityinfowatch.com/blog/11598089/healthcares-failure-to-address-link-between-mental-illness-and-violence-putting-lives-in-jeopardy

Author: Caroline Ramsey Hamilton

Since 1988, Caroline Ramsey-Hamilton has been a Thought Leader in All Aspects of Active Shooter and Security Risk Assessment in both Public and Private companies and organizations. Specializing in Hospital and Healthcare Security. Hamilton is Certified in Homeland Security (CHS-III), Anti-Terrorism (ATAB) and Security Risk Assessment. As President of Risk & Security (www.riskandsecurityllc.com) she works with many hospital clients, and develops affordable risk-based apps for improving security risk assessments, and publishes the RISKAlert security awareness program. She lives in south Florida with two beagles, a rescued kitty and (on weekends), 4-year old twins.

Reprinted with permission from www.SecurityInfoWatch.com

Psychiatrist Shoots Mental Patient who Killed His Caseworker at Mercy Fitzgerald Hospital

Posted on July 25, 2014 7:07 pm by Caroline Ramsey-Hamilton Comment

Psychiatrist Draws Gun in Mercy Fitzgerald Hospital and Shoots the Mental Health Patient who Killed his Caseworker by Shooting Her in the Face. Witnesses near the scene reported hearing screaming and gunfire, as suspect and mental health patient Richard Plotts confronted his caseworker, Theresa Hunt, and then drew his gun, and killed her. Another bullet grazed a doctor, adjacent to the scene, but the doctor had a gun of his own, and he shot Plotts 3 times in the torso.

The doctor, identified as Lee Silverman, was treated was treated for a head wound and released after being taken to the Hospital of the University of Pennsylvania. The shooter, Richard Plotts, of Upper Darby, Pennsylvania, who had a long criminal record, was undergoing surgery Thursday night at the Hospital of the University of Pennsylvania. If he survives, he will be charged Friday with murder, said Delaware County District Attorney Jack Whelan.

There is a Lesson Here — KEEP POTENTIAL SHOOTERS WITH WEAPONS OUT OF HOSPITALS.

A is for Access Control! Once a potential shooter brings a weapon into a hospital, everything is much more difficult to control. Keep them out.

Weapons should be checked at the hospital entry points and no-weapons signage should clearly indicate that weapons are not allowed, and that should be followed up with either stand-alone, or wand metal detectors which give staff members a initial level of protection.

usa-shooting-pennsylvania

Bernice Ho, a spokeswoman for Mercy Fitzgerald Hospital, said Thursday it was against hospital policy for anyone other than security guards to carry weapons, so there are questions about why this doctor disregarded the policy, although Donald Molineux, chief of the Yeadon Police Department, said “If Silverman returned fire and wounded Plotts, he without a doubt saved lives.”

District Attorney Whelan described how the meeting among Plotts, Silverman, and Hunt abruptly took a violent turn. Plotts and Hunt went to Silverman’s third-floor office shortly before 2:30 p.m., Whelan said. Plotts was apparently armed, and people near the room soon heard shouting.

Concerned, a hospital employee “actually opened the door, saw him pointing a gun at the doctor,” Whelan said. The worker shut the door quietly and immediately called 911. Plotts then opened fire. According to Whelan, he shot Hunt two times in the face. The psychiatrist then ducked under his desk, retrieved his gun, and came up shooting, striking Plotts three times.

Keep Weapons Out of the Hospital to Dramatically Reduce Violent Incidents!

How Risk-Based Security Can Reduce Violence in Healthcare

Posted on May 23, 2014 9:54 am by Caroline Ramsey-Hamilton Comment

reprinted with permission from www.securityinfowatch.com

Using Risk-Based Security to Stem the Tide of Violence
in Hospitals and Healthcare

Created by: Caroline Ramsey Hamilton

Date: May 22, 2014

Hospital and healthcare security is experiencing a major increase in violence,
instigated by patients, patient families and even healthcare staff. Just last year,
there was an active shooter incident in Reno, Nev., in which two physicians were
shot, and in Houma, La., a hospital administrator was shot to death by a terminated
nurse. As recently as Easter Sunday in California, two nurses were stabbed at the
hospitals, where they worked. One was stabbed in both the upper and lower torso
and is in critical condition. These two incidents add to the more than 100 violent
incidents in 2013 and the first half of 2014.

Since 2010, violence in healthcare has skyrocketed. As a result, the Joint Commission has
issued a “Sentinel Event Alert” on the issue and contributed to numerous articles on shootings
in U.S. hospitals. The Department of Homeland Security and a consortium of state and local
hospitals recently released a standard for active shooters in healthcare. These all point to the
conclusion that the current law enforcement-based hospital security model is not working.

Changes in Healthcare
The changes in healthcare, including the increase in insured Medicaid patients and increased
traffic to emergency departments, highlights the fact that very well-intentioned people are
working with an outdated security model that hasn’t evolved to address a changing healthcare
environment. The change in billing and reimbursements for healthcare organizations, such as
tracking of readmission rates, has squeezed hospital profits causing reductions in funding in many
security departments at a time when violent events are steadily increasing.

A new risk-based model for hospital security is emerging that is less linear and more cyclical.
It uses technology to a greater extent, employs forecasting and statistical models to predict the
likelihood of future incidents, and is proactive instead of reactive, focusing money and energy on
preventing events instead of simply responding to them. This model also uses risk assessment
formulas to quickly assess the current security profile of a hospital, clinic, hospice, or behavioral
health facility, factoring in heightened threat-risk environment, not only for the facility in question,
but also adding in the wealth of healthcare data that’s now available.

Risk –Based Security Focuses on Continual Assessment
A major focus of this model is the continual assessment and evaluation of preventive security
controls, which are reviewed quarterly, semi-annually, or annually to discover gaps in controls,
and to fix gaps as soon as they are identified. This dovetails nicely into the assessment models
already required by the Joint Commission, OSHA and new CMS standards.

Looking at recent high-profile security events that took in place in hospitals shows that incidents
happen because of exploited gaps in the existing security of the healthcare facility. In the past,
security officers successfully worked hard to reduce response time so that often officers could
arrive in under two minutes, but it’s still too long. In the Reno shooting, response time was under
two minutes, but that was long enough to kill two doctors.

Focusing on prevention makes sense for healthcare, much in the way the Joint Commission
focuses on patient safety, by continually assessing controls, reducing discovered gaps in controls,
and mitigating gaps by reassessing and tightening security, which creates a cycle of continual
improvement in the healthcare security environment.

Taking Advantage of Technology
The healthcare risk-based security model takes advantage of technology. Instead of waiting
for manual recording of security incidents every day, software programs allow hospital security
officers to enter data at the end of each shift, and that means security directors can map what’s
happening in the hospital or facility on a daily, weekly, monthly and yearly basis. This can go a long
way to identifying trends early and help facilities make appropriate changes in controls so that
negative trends can be reversed quickly and both patient and staff security is increased.

In addition to automating incident collection and analysis, the healthcare security risk assessments
must be automated too. Risk assessments are too time-consuming and labor intensive to be done
annually. By the time the risk assessment is over, the environment has changed again. By
automating the risk assessments, including environment of care and hazard vulnerability,
it produces data that can be used instantly to analyze and recommend the most cost-effective
controls, and rank them by their return-on-investment (ROI).

The role of security in hospital and healthcare organizations is changing too. Security organizations
should no longer be isolated without intensive interaction with others in the organization, including
the human resources department, the facilities managers, safety managers, and the emergency
management staff.

New DHS Guidelines for Active Shooters in Healthcare
With DHS issuing new guidelines for active shooters in healthcare, hospital emergency managers
are now required to prepare for active shooter incidents, as well as storms, hurricanes, tornadoes,
power interruptions and other events related to natural or man-made disasters. This creates a
natural partnership between the emergency management staff and the security program,
because the skills of both functions are needed to properly prepare an organization for any disaster.

Instead of existing in a vacuum, healthcare security directors and managers should cheer at
this development because it expands the importance of security inside the hospital or healthcare
facility, and underscores its value in protecting the organizational assets – the physical facility,
patients, visitors and staff – to proprietary information, including the HIPAA mandated PHI
(Protected Health Information), vehicles, security systems, high-value healthcare equipment
and the healthcare provider’s reputation.

Security budgets have always suffered because security costs are seen as operating
expenses, not an income source, but by tying the security expenses more closely to loss
prevention and protection of the organization, it creates a cost justification for hospital and
healthcare security.

Risk-Based Security Links to Hospital Compliance Standards
A risk-based security model also links security to myriad compliance standards that affect healthcare
and this also supports and justifies the costs related to security. For example, hospitals are required
to have a variety of security controls in place related to tagging of newborns, posting of no-weapons
signs, and environment of care issues. Any healthcare organization accepting funds from Medicare
or Medicaid must comply with the new mandate for annual security risk assessments.

OSHA 3148 also requires hospitals and healthcare organizations to do annual workplace violence
assessments, and more than 33 states also require enhanced protection of hospital and healthcare staff.

As security incidents continue to increase and violence in healthcare escalates, making the
switch to a risk-based security program will provide better protection for hospitals and healthcare
organizations, making more effective use of existing security personnel, as well as justifying and
expanding healthcare security budgets.

For more information: contact: Caroline Ramsey-Hamilton at caroline@riskandsecurityllc.com

RISKAlert – May 2014 Shooting at VA Medical Center, Dayton, Ohio

Posted on May 15, 2014 11:01 am by Caroline Ramsey-Hamilton Comment

RiskAlert INCIDENT REPORT 552 – HOSPITAL SHOOTER

Terminated Employee Shoots Staff Member during Card Game
at Veterans Affairs Medical Center in Dayton, Ohio

Allowing terminated employees to have access to a hospital or facility where they
worked before is a questionable decision, because not only anger at the organization,
but also anger at individuals and former co-workers may turn into an incident as this report
explains.

In early May, a terminated housekeeper at the Veterans Affairs Medical Center in Dayton, Ohio came back to the hospital to play cards in a hospital break room with a group of current VA staff. The perpetrator, Neil Moore, had also brought a handgun to the hospital. Neil was upset because he thought another VA staff member was having a relationship with his wife, so he pulled out the gun, and as a result, one person was shot in the ankle.

It was not a typical active shooter scenario, but it does point out
the access control problem in hospitals, and also questions the
ability for anyone to walk into a hospital with a loaded gun.

LESSONS LEARNED:

1. Access to former employees should be prohibited or at
least limited on a case by case basis.

2. Visitors should not be allowed to bring guns into a hospital.
Metal detectors should be used to screen for weapons.

Moore, a former employee at the Veterans Affairs hospital, told police that he was going to a regular card game with
his former co-workers. He said he went to the hospital Monday intending to brandish the handgun to intimidate two former co-workers he believed were involved in relationships with his wife and daughter, both of whom reportedly work at the hospital. Moore planned to “hold the ex-co-workers at gunpoint while he punched them with his right hand,” according to court documents.

The hospital complex has beds for about 450 people and provides veterans with medical, mental health and nursing home care. It doesn’t have metal detectors at its entrances, but it does have its own security force.

VA spokesman Ted Froats said the force conducts active shooter training four times a year and showed outstanding response Monday. He said in a statement Tuesday that the hospital will consider additional steps to ensure safety, while making sure that any new measures won’t impede the hospital from providing care to veterans as quickly as possible.

RISKAlert® is a publication of Risk & Security LLC at www.riskandsecurity.com

Two Nurses Stabbed on Easter Sunday in Different SoCal Hospitals

Posted on April 21, 2014 7:17 pm by Caroline Ramsey-Hamilton Comment

Dateline: April 21, 2014

Stabbing at Olive View – UCLA Medical Center

In the early morning hours of Easter Sunday morning, a nurse at Olive View-UCLA
Medical Center in Sylmar, California was critically hurt after being stabbed
multiple times.

Prior to the stabbing, deputies said the suspect had entered the hospital and
allegedly bypassed the weapons screening area. As the deputies searched
for the perpetrator, they heard a woman scream, and located the nurse, who was stabbed in both the upper
and lower torso. The nurse was transported for medical treatment in critical condition.

Torrance Hospital – Later at 9:20 am on Easter Sunday, Thomas Fredette walked
into Torrance Hospital, in the south Bay, and grabbed a nurse from behind and
stabbed her in the ear with a sharp object, according to Los Angeles County
Sheriff’s officials. Fredette faces charges of assault with a deadly weapon,
sheriff’s officials said. He is being held on $130,000 bail.

What We Learned:

Strong Access Controls at Hospital Entrances and Exits are the first line of
defense against injuries to hospital staff. Both events were random and
apparently unprovoked.

Nursing staff in particular, should receive adequate training in situational
awareness, which may be in conflict with their total focus on caring
for patients.

Double Check these critical Potential Controls:
Stronger Access Controls
Panic & Duress Alarms at Entry Points and on Nurses working late shifts
Better Weapons Screening

Risk and Security LLC

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