Hospital Suicide

A Hospital Employee at Kadlec Regional Medical Center came back to the hospital on his day off, threatening to kill other employees and himself. Other violent attacks on staff have also occurred recently including choking of a nurse in the ICU!

Posted on October 24, 2018 11:22 am by Caroline Ramsey-Hamilton Comment

RISKAlert Report Updated: October 23, 2018 Richland, Washington

A Hospital Employee at Kadlec Regional Medical Center came back to the hospital on his day off, threatening to kill other employees and himself. Other violent attacks n staff have also occurred recently including choking of a nurse in the ICU!

In a workplace violence incident on Oct. 18, 2018, Kadlec employee Matt Ganz, 51, walked into the
hospital where he worked, on his day off and began talking to fellow co-workers about how he wanted to die by suicide and how he would kill others as well, said Lt. Chris Lee.

Several people called 911 to report seeing a man with a gun at the 270-bed hospital. Richland police responded and were on the scene within a minute and a half. But Ganz was gone before Richland and Kennewick police along with deputies from the Benton County Sheriff’s Office finished searching the hospital.

Police continued to hunt for Ganz and officers finally found him about 40 minutes later on the 300 block of East Third Avenue drunk behind the wheel of his truck, police said. He was booked into
the Benton County jail for making threats, for interfering with a health care facility and for driving
under the influence (DUI).

Kadlec Regional has experienced other incidents including multiple staff members who were hurt by patients, and it highlights the problem of workplace violence in healthcare. In one incident, a patient in the ER hurt 3 nurses, a doctor, and a security officer. In another recent case, a patient in Intensive Care choked a nurse, as she was trying to change his IV.

The nurse in question posted these remarks on Facebook, “Let me tell you, having a strong individual’s hands around your neck, the inability to breathe, let alone call for help, to the point where you can’t see a thing and can only hear an emergency “staff assist” tone going off, is one of the absolutely gut-wrenching, most terrifying feelings anyone could ever imagine. It didn’t help that it was preceded with the words “I’m gonna kill you.” Ashley Schade described in a Facebook post about the event that has now gone viral.

Both of those patients were charged with assault.

LESSONS LEARNED:

1. Workplace Violence is still a major problem in healthcare, with most of the violent incidents
directed at nurses. More needs to be done.

2. Report every incident to management and increase staff to avoid having nurses work alone.

THANKS FOR READING THE RISKAlert Report©

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Western State Hospital (Tacoma, WA), Could Lose $65 Million in Federal Funds as CMS Finds Serious Risk for Exposed Fire System Devices that could be used by Patients to Commit Suicide by Hanging

Posted on May 30, 2018 10:50 pm by Caroline Ramsey-Hamilton Comment

RISKALERT #1040 – Report Updated: May 30, 2018

In a memo sent to top staff earlier in the week, “CMS identified a serious risk of harm to patients due to ligature risks
from the fire system in patient care areas of Building 21 ,” said the memo, which was obtained by public radio. Building 21 is where civil, or non-criminal, patients are treated on five different wards. Typically a ward has 30 patients. Western State Hospital is a Psychiatric Residential Treatment Center (PRTC) with over 800 beds.

A CMS finding of serious risk of harm is also known as an “immediate jeopardy.” The memo also said that if the issue is not resolved, funding could be lost in 23 days.

Since 2015, Western State Hospital has been under scrutiny for serious repeat violations that inspectors said put patients and staff at risk. The litany of troubles included violent assaults on patients and staff, the 2016 escape of two high-risk patients and scores of unauthorized patient “walkaways.”

The safety violations were discovered by a team of 22 federal surveyors who were re-inspecting the hospital last week as part of a turnaround plan that is approaching the two-year mark. The sprawling hospital, which serves civil and forensic patients, must meet standards on 26 federal “Conditions of Participation” in order to continue receiving federal funding.

A “root cause” report in 2016 identified ineffective management, staff reductions and turnover leading to patients who felt “neglected” and a “culture of helplessness” among staff. A review by the Department of Corrections also found numerous security gaps including 25,000 master keys unaccounted for.

LESSONS LEARNED

1. CMS requires all residential treatment facilities to maintain a safe physical environment, and any
identified risk situations should be addressed immediately to prevent loss of CMS reimbursement funds..

Management must take the lead even in facilities related issues, instead of leaving the improved
implementations up to lower level staff members.

THANKS FOR READING THE RISKAlert Report©For more information and a free subscription: write to: caroline@riskandsecurityllc.com

We provide the best Active Shooter Training, Workplace Violence Assessments, and & CMS Facility All-
Hazards Risk Assessments, Drills & Training Programs.

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Shooting at University of Cincinnati Medical Center Ends in Suicide

Posted on January 22, 2018 10:04 pm by Caroline Ramsey-Hamilton Comment

“I thought he was going to kill everyone”, said the witness taking her child to Cincinnati Children’s
Hospital and Medical Center, before a 20-year-old shot and killed himself after shooting a University of
Cinncinnati Health security guard inside the UC psychiatric emergency services facility.

The man the witness saw was Isaiah Currie, 20, who eventually shot himself after shooting a UC Health security
guard inside the psychiatric emergency services facility on Burnet Avenue.

“He was focused. It was, ‘I’m here to do what I need to do and that’s it,'” she said. “I see him do this and
then drop (the gun) down and then I see the concrete come up, where the bullet had hit the concrete.
I thought he was on his way into the facility and I thought, ‘Oh, my god, he is going to kill everybody.'”

At this point, the witness called 911 to report the suspect. Authorities didn’t know where or how Currie
obtained the two handguns he carried into the lobby Wednesday at UC Medical Center’s Emergency Psychiatric
Services. Cincinnati Police Eliot Isaac said at news conference Thursday that one of the guns had been
reported stolen in Kentucky.

Currie, 20, who had a history of mental illness, shot the security officer twice in the torso, before turning the gun on himself. The officer was reported to be seriously injured.

LESSONS LEARNED:

1. Even when the witness saw the shooter advancing on the hospital, and called 911 – IT WAS ALREADY TOO LATE! Police could not get there in time to prevent the shooting. For an Emergency Psychiatric
facility, use of metal detectors is a MUST HAVE.

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Doctor Shot and Killed in Grudge Shooting Over “Mom”

Posted on January 25, 2015 9:53 am by Caroline Ramsey-Hamilton Comment

RISKAlert- Active Shooter No. 625, January 21, 2015, Boston, Mass.

Middle-Aged Shooter kills Cardiologist at Brigham and Women’s Hospital, and then Kills
Himself, in an apparent Grudge Shooting Because the Doctor had Operated on his Mother.

On Tuesday morning on Jan. 21, at 11 am, Stephen Pasceri, 55, walked into the Shapiro Center
at Brigham and Women’s Hospital, and asked to see cardiologist, Dr. Michael J. Davidson. When
he saw Dr. Davidson, outside of an exam, he shot him twice, critically injuring him.

Dr. Davidson later died from his injuries. Pasceri then went to the 2^nd floor and killed himself with a gunshot
to the head. Later, it was discovered that Dr. Davidson had operated on Pasceri’s mother, Marguerite, and
she had died on November 15, 2014. Pasceri’s sister was quoted as saying, “He loved his mom, and he
loved her very much. He appeared to be handling her death well,” the sister said of her brother.

“Everything seemed to be going really well. I have no idea why he snapped like this.
He was a great guy. He took care of his family, he had a beautiful house and he has four
beautiful children. He was an upstanding citizen.”

The hospital locked down and rushed Dr. Davidson into surgery, but he died during the night from his injuries.
Brigham and Women’s Hospital’s COO said the hospital was one of the first to institute an active shooter
training program. The hospital does not use metal detectors.

Lessons Learned : “A is for Access Control”

1. Metal Detectors can be are a reliable tool to Prevent In-Hospital Shootings.

2. Active Shooter Drills are NOT ENOUGH as these incidents unfold in just a few minutes.

3. Installing ‘NO WEAPONS’ Signage at Entrances can be a deterrent to these first time shooters.

Despite having a good job, family, and a beautiful home, when confronted with a mid-life crisis, his mother’s
death, another middle-aged shooter goes to a hospital and shoots the doctor, in a scenario that resembles
the Johns Hopkins shooting in 2010. To protect staff and patients, hospitals will have to increase their
security protective measures, including use of metal detectors, no weapons signage and
situational awareness of the staff.

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Former Nurse Commits Suicide in Hospital Bathroom at Valley View Hospital

Posted on August 7, 2014 12:45 pm by Caroline Ramsey-Hamilton Comment

RISKALERT INCIDENT REPORT # 574 – Suicide in the Hospital Bathroom

August 6, 2014

Former Nurse Commits Suicide, Fires A Single Shot to the Head, Locked in a Public Restroom at Valley View Hospital, Glenwood Springs, Colorado.

A hospital staff member reported Eric Knurr dead in a bathroom stall a round 11:30 a.m. Monday, morning, August 4, after maintenance had to be called to unlock the door to the men’s restroom off the emergency department. The former male nurse had been formally admonished by state regulators for brushing a patient’s teeth until they bled, and also slapping the patient, who was in restraints at the time of the incident in 2005. He had applied for a job at Valley View Hospital in 2012, but was not hired. In similar incidents:

In January, 2014, a man locked himself in the hospital bathroom at Cherokee Medical Center in Iowa, and committed suicide.
In August, 2013, 62-year-old man committed suicide in a public bathroom at the Veterans Affairs hospital campus at Fort Harrison, Montana, after locking the bathroom door and killing himself with a single shot.
In August, 2012, a similar incident happened at an Oklahoma hospital when a Oklahoma State University employee committed suicide in a public restroom off the emergency room.

LESSONS LEARNED

(1.) Hospital staff should IMMEDIATELY report any locked bathroom door in a public restroom. In several of the incidents, housekeeping “didn’t want to bother security” when they found the bathroom door locked, so they waited another two hours before reporting the problem, and by then it was too late.

(2.) Not having any form of metal detection allows people to bring guns into hospitals, lock themselves in bathroom, and commit suicide. Metal detectors or wand detectors can prevent a tragedy.

CHECK OUT: In December, 2010, The Joint Commission Issued a Sentinel Event Alert on Suicide Risk Outside Psych Units in Hospitals, including medical units, surgical units, and emergency departments. (http://www.jointcommission.org/assets/1/18/SEA_46.pdf).

“It is noteworthy that many patients who kill themselves in general hospital inpatient units do not have a psychiatric history or a history of suicide attempt – they are “unknown at risk” for suicide. Compared to the psychiatric hospital and unit, the general hospital setting also presents more access to items that can be used to attempt suicide – items that are either already in or may be brought into the facility – and more opportunities for the patient to be alone to attempt or re-attempt suicide.

“This Alert presents strategies that can be used and suggested actions that can be taken by general hospitals to help better prepare their staffs and their facilities for suicidal patients and to care for both their physical and mental needs. Suicide has ranked in the top five most frequently reported events to The Joint Commission since 1995. The Sentinel Event Database includes 827 reports of inpatient suicides. Of these events, 14.25 percent occurred in the non-behavioral health units of general hospitals (e.g., medical or surgical units, ICU, oncology, telemetry), 8.02 percent occurred in the emergency department of general hospitals and 2.45 percent occurred in other non-psychiatric settings.”

Stay Alert and Encourage Hospital Employee Awareness!

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