Violence in Healthcare

Should Hospital Staff Brings Guns to Work with Them?

Posted on September 3, 2011 5:47 pm by Caroline Ramsey-Hamilton Comment

Should hospital staff bring guns to work with them?

At a time when many hospital security departments have unarmed security officers, and some departments don’t even allow the use of mace, changes in state laws allow hospital staff in some states to bring their guns to work with them.

This turn-around, where the nurses may have guns – and security officers do not, has created a big, contentious debate in the security community.

In a recent paper printed in the Journal of Healthcare Safety and Security, my co-author, Jim Sawyer and I discuss the different elements of this debate and whether this is a constitutional issue, or a real threat-risk issue.

Here’s an excerpt,

Violence is not a concept that people usually associate with hospitals. For years, hospitals have been seen as almost a sanctuary of care for the sick and wounded in our society. However, the perception of hospitals has been changing over the last fifteen years due to a variety of factors.

or you can read the entire article (below).

Critical Issues on Gun Violence in the Hospital Workplace

By James Sawyer and Caroline Ramsey-Hamilton

Background

Every reader knows that violence in hospitals is increasing at an increasing rate. The Joint Commission has issued Sentinel Alerts, the Journal of the American Medical Association, the bastion of the American healthcare system, published an article in October, 2010, written by two doctors about the murder-suicide at Johns Hopkins Hospital in September of 2010^1..

This article started as a guest blog from a security professional at a west coast children’s hospital. After the blog appeared, we received dozens of notes, letters and angry outbursts, as well as emails arguing for a more reasoned approach. This article will explore those issues, and includes quotes from the emails themselves.

Why Violence in Hospitals is Increasing

Doctors are no longer thought of as “Gods”. This means they are
are more easily blamed when a patient’s condition deteriorates.
Hospitals are now regarded as businesses. This perception has been
been aggravated by television in shows like a recent “60 Minutes”, as well as
by the effects of the recession on jobs and the loss of health insurance.
Lack of respect and resources (funding) for hospital security departments
   . Rather than being seen as a crucial protection for the hospital staff and
      patients, many security departments are chronically underfunded and used
      for a variety of non- security functions, such as making bank deposits for
      the hospital gift shop.

A Dirty Little Secret about Reporting
The U.S. Department of Labor tasks OSHA with workplace violence information, but there is not one sanction against it, it says right on the OSHA web site that this is solely left up to the employer. It makes it hard for hospitals to justify spending money on workplace violence prevention, if it is not a standard, and a major compliance issue (as it should be). And here is a dirty little secret for looking at the statistics, OSHA does not count domestic incidents (like homicides) that take place in hospitals as officially “workplace violence incidents”, instead they are counted in another system. Similarly, many hospitals don’t count staff to patient violence incidents, or patient to patient incidents. These practices create a false impression of the actual number of violent incidents, by reporting only a fraction of the actual events.

Gun Violence Represents a Significant Security Challenge

The prevention of gun violence in hospitals and the hospital as workplace may well be the most challenging issue for hospital security professionals in the foreseeable future. What are some of the reasons for this growing concern? There are many and they include:

1. The sheer numbers and easy availability of guns. There are over 270 million guns in circulation in theUnited Statesand the numbers continue to grow. After the 2008 election, gun ownership surged and in some areas of the country, guns sold at such a pace that retailers literally ran out of ammunition.

2. Approximately a 100 people a day die from gunfire in the United States and an individual is shot approximately every twenty-two seconds.

3. One in four Americans suffer from some form of mental illness, according to the Federal government.

4. The U.S. is living in an era of economic instability, following the 2008 recession and the erosion of the middle class. The Wall Street-triggered economic meltdown has propelled what was a slow steady decline into economic apocalypse for millions of Americans. This has resulted in an environment of record home foreclosures, record personal debt, record banktupcy, record unemployment and record numbers of homeless individuals.

5. The reluctance on the part of many hospitals to install magnetometers and limit entrances to hospitals so that the flow of guns into hospitals can be controlled.

The U.S. gun lobby has been very successful in pushing and supporting state legislation which permits guns in the workplace, and on college campuses.

It is a serious mistake for security professionals to deride, make light of, or dismiss this surge of pro-gun-at-work-and-school legislation. These laws are getting passed (see Texas, Indiana, and Tennessee), and the likely result is that we will see an ever greater numbers of guns at work, and if our work is in the hospital, then the guns will be coming to work here, too.

Guns aren’t just increasing in numbers, but they are getting more lethal and currently 30- shot clips and armor piercing bullets are readily available for the civilian population. Citizens can now buy weapons that rival what is found in military armories. These lethal weapons again present a sentinel challenge to security professionals.

Most security directors remember life when Space Invaders was the only video game around. Now children are exposed to violent images from a very early age. Children and teenagers sit entranced watching endless hours of violent programming where gun violence is choreographed in slow motion action scenes where the scripted hero’s miraculously avoid injury even while they are dispatching the prime time villains while showcasing their amazing gun prowess.

By the time they show up at your hospital, the average child over 18 years of age will have viewed over 45,000 murders and 200,000 acts of violence just on television! This grim tally does not account for the high octane bloodshed and slaughter that make up the majority of the most popular video games.

All of these factors suggest that the prevention of gun violence in our hospitals will become our premier challenge. Many hospitals are already hosting ‘active shooter’ seminars to teach hospital staff how to deal with “shooters in the workplace”. This subject promises to become a cottage industry for consultants and violence prevention professionals.

As hospital security professionals, there are some strong, prevention-based practices that we can implement and develop that drastically reduce the chances of gun violence in the workplace. Some of these best practices include:

1. Acknowledge the reality and the persuasiveness of the U.S. gun culture.

2. Develop a strong, multi-department workplace/domestic violence response team at your facility, and make sure that both Human Resources, and Security are part of this team.

3. Develop a written workplace violence plan that is reviewed annually.

4. Do an annual baseline workplace violence assessment that you can build on.

5. Have your workplace/domestic violence response team respond and meet within 4 hours of any reported incident. Have a response plan/action plan in place within 24 hours.

6. Encourage reporting of all workplace/domestic violence incidents to the police – without exception.

7. Run background checks of individuals of concern. Information is light and a background check may provide you with crucial information. Obtain orders of protection – anti-harassment orders against individuals of concern. Security should take the lead here.

8. Flag problem patients – problem families – have a “red alert” or a “red flag” program that alerts – tips off – advises both the care team and security that a potential problem exists. This is especially important if the patient/family member has a history of violence.

9. Build a workplace culture where verbal threats are reported. Have Security immediately investigate all verbal threats. Make sure that Human Resources is fully informed of any situation involving threats.

10. Post large, prominent“No-Weapons” signs at your facility – especially in parking lots, perimeter areas and all main entrances.

11. Officially prohibit staff from bringing firearms to work.

12. Offer annual violence prevention and threat awareness training to all staff.

13. Require workplace violence training – either on line or via classroom training for all new staff and annual retraining.

14. Have security involved and part of the planning for all “problem” terminations. Note – Advise Human Resources to never terminate a disgruntled staff without strong pre-planning.

15. Screen all hospital patients and visitors. Develop a major entrance screening program for your institution. Knowing who is inside your facility is a critical part of any good prevention program.

These pro-active solutions will support and enhance a hospital gun violence prevention program. Let me state again, it is critically important to have a hospital gun violence prevention program in place.

AND IN RESPONSE

Here are some of the comments that were received by other hospital security professionals around the country, after the original blog post.

“Please remove me from your mailing list immediately. Apparently the letter below blames the firearm and not the person holding it and putting 5-7 lbs of pressure on the trigger with their index finger. I find it difficult to separate the “Spirit of the Security Community and our commitment to safety and protection” from this attack on my Second Amendment rights.”

— Hospital Security Director in the Northwest

“I believe we should focus our attention, and when I say attention I actually mean money, on mental health resources (or the lack there of) and domestic violence issues, which quite often lead to fatal shootings. Our emergency rooms have become a revolving door for patients with drug abuse, depression and other psychological issues and there appears to be very little our legislators and community/government leaders are doing about it. To me, that is the real injustice and crime related to the firearm issue!
— Hospital Security Director in the Midwest

“I would agree with the individual that I don’t believe there is a place in hospitals, government buildings and places of worship for guns; however if there had been guns on some of the college campuses, maybe there wouldn’t of been the blood baths they turned into.
– Security Analyst – Washington DC

“As for firearms being banned from the workplace, I agree. Policies and procedure should dictate along with a severe disciplinary, then handle accordingly. Just that simple.”
Let’s clean it up, let’s clean up America! Let’s lessen the need for firearms to be in the hands of thugs as well as those who just want to feel safe. The FIRST STEP would be to BAN and make it ILLEGAL for businesses to sell paraphernalia, pornographic anything, strip clubs, places that promote alcohol and drug use, etc.

Let’s Clean That Up! …something that is tangible and promotes drug and alcohol use as well as many other criminal actions just to run these types of businesses. Let’s make that illegal. Let’s get Americans involved in the real issues of illegal firearms and drugs coming into this Country. All law enforcement know that it takes big money to keep drugs coming into this Country. Disarming America. RIDICULOUS. Keeping firearms away from the workplace, understandable.

— Ex Army, Ex-Police, Hospital Security Officer

Conclusion
While the issue of “gun control” is both a “hot button” and simultaneously, a topic that is seemingly a forbidden or taboo matter for hospital security professionals. It should not be this way. Questioning the wisdom of allowing citizens to buy 30-round clips for semi-automatic handguns and keeping assault rifles at home is not a crazy liberal rant, it is a reasonable, non-political position.

Challenging the wisdom, if not the sanity, of the current flood of legislation that both allows and actually encourages guns in the workplace is neither “liberal” or “radical” – but pragmatic and grounded. Hospital security professionals are the vanguard for progressive crime prevention education and development in the United States. This is a mandate and responsibility that we all share. How we respond and learn to protect our staff, our hospitals and our patients from this senseless violence may prove to be our greatest and most important challenge.

www.riskwatch.com www.caroline-hamilton.com

Put your Hospital Security Department on a Low Fat Diet

Posted on August 11, 2011 12:55 pm by Caroline Ramsey-Hamilton Comment

Hospitals are reeling from potential losses in funding related to state budget cut-backs
and potential cuts in Medicare programs. Every area of the hospital budget are being scrutinized, looking for areas to cut and reduce costs.

Instead of waiting for a memo about cuts that affect YOUR department, be a
pro-active manager and right-size your security department and show management
the changes you want to make.

It is possible to have an efficient, accountable security department without having costs run out of control. It has to be based on real dollars, on real risks and it has to have the ability to show management WHY you need each element in your program.

The already-required risk assessment is the first start in this process. When regulators come in to a hospital, they want to see the risk assessment first, and then they look to see if you followed the remediation plan identified in the risk assessment, which means they want to see you made the right improvements, based on the plan.

By including program elements in the risk assessment, and mapping it back to your actual budget, you can easily say that the Return On Investment is for each part of your program.

Is $7000 Enough of a Fine for a Young Girl’s Murder?

Posted on August 3, 2011 8:48 pm by Caroline Ramsey-Hamilton Comment

OSHA workplace safety officials have fined the organization that runs a Revere group home, where a Peabody mental health worker was stabbed in January, for not having adequate safety measures in place despite high probability of an incident occurring.

The Revere mental health clinic where Peabody caseworker Stephanie Moulton was stabbed in January as fined $7000.00 by OSHA for not having adequate safeguards against violence in place for employees at the clinic. OSHA cited the facility for “a serious violation of [OSHA’s] ‘general duty clause’ for failing to provide a workplace free from recognized hazards likely to cause serious injury or death.”

Moulton, 24, died from her stab wound inflicted by a patient, 27-year-old Deshawn Chappell, after he fled the group home, taking her with him and then dumping her body behind a church in Lynn. Chappell, who had a history of violent behavior, attacked Moulton during a counseling session.

The fine is a piddling amount, but the damage done by the fine is much worse. Because the organization was directly fines by OSHA, that gives the victim’s family solid grounds for a lawsuit for negligence, and they can quote OSHA, that they “failed to provide a workplace free from recognized hazards likely to cause injury or death”.

It will be interesting to see if a lawsuit develops, and if the organization puts stricter controls in place to protect staff members.

OSHA and the Joint Commission have reported for several years that violence against healthcare workers has steadily increased, and the Joint Commission even issued a Sentinel Event about the increase in violence.

Risk Assessment: How about Giving Guns Back to Former Mental Patients

Posted on July 6, 2011 2:37 pm by Caroline Ramsey-Hamilton Comment

A recent New York Times article explained that a provision tucked in a bill to make it harder for people diagnosed with mental illness to possess firearms, actually restores the rights of mental health patients to get their firearms back. The legislation was passed after the massacre at Virginia Tech in 2007.

One of the main elements of risk assessment is a quantitative (meaning = real numbers) on what has happened in the past. Looking at 2 or 3 years of incident reports, for example, show how many times there has been an incident involving gun violence in a particular neighborhood, city or organization.

Another element is the history of a particular individual to see whether individuals with a diagnosed history of mental illness are MORE OR LESS likely to trigger (forgive the pun) – a violent incident.

If we run that scenario, we will find that individuals who previously had a violent incident with a firearm are MORE LIKELY than the standard population to have another incident.
And that especially holds true if other threat indicators are present, for example:

Termination from a Job
Romantic Difficulties
Foreclosure
Difficult Economy

There is a ‘risk multiplier’ effect that takes place that makes the risk higher. By combining different sets of threat categories with areas of weakness, we are create general predictions on the likelihood of repeated violent incidents.

Do the math – it doesn’t make sense for people with a history of mental illness to
get their guns back!

Tags:
crime
Physical Security
risk assessment
Workplace Violence

5 Tips to Prevent Workplace Violence

Posted on June 24, 2011 3:22 pm by Caroline Ramsey-Hamilton Comment

After studying the twenty-seven state guidelines and also new guidance from
OSHA on how to prevent workplace violence incidents,

Here are 5 tips of what areas to work on in your organization:

1. Redo Policies – Make sure you have a clear ‘no weapons’ policy and make
employees sign a pledge when they join the organization.

2. Dynamic Awareness Training   – Make sure that EVERY employee attends
     a training program about workplace violence issues, whether it’s 1 hour or
     4 hours annually. But boring computer training is not enough.

3. Do a Baseline Violence Assessment   – See where your organization
     rates compared to other companies and see how closely you match to
     new standards and guidelines on Workplace Violence issues.

4. Require Employees to Report Every Incident – Communicate to employees
that they are required to report EVERY incident, whether it is domestic
violence at work, Patient violence, or anything else. Be tough!

5. Use Incident Tracking – Work with both Security and HR to make sure
every incident is tracked for analysis, and all employees know where and how
to report incidents

The 5 Missing Elements of Most Workplace Violence Prevention Programs

Posted on June 10, 2011 4:38 pm by Caroline Ramsey-Hamilton Comment

The 5 Missing Elements of Most Workplace Violence Prevention Programs

After working with a variety of organizations on a baseline Workplace Violence assessment, there are several areas that seem to be common problems for most organizations. These elements are not expensive, and not timing-consuming, so they are natural candidates for improvement.

A baseline workplace violence assessment is a survey of employees in different roles, combined with a threat analysis and an analysis of existing controls and a historical incidents that can be reviewed and aggregated.

Here are the top 5 most common missing elements, with potential solutions.

1. Missing workplace violence awareness/training programs. Many organizations report that they have set these up, that they have sent out emails to all employees, but we consistently find that the employees didn’t read the emails, didn’t know the training was available, or that it wasn’t included in their initial company orientation.

2. Mis-categorization of workplace violence incidents. There is a mistaken (in my opinion) idea that domestic violence incidents that happen at work should not be categorized or reported as a Workplace Violence incident. This is a mistake, and leads to bad information about the true nature of the problem. If someone comes and shoots her significant other at work (IN THE WORKPLACE) – it is a workplace violence incident.

3. Staff feels subtle pressure from management not to report every incident.
In my research, management wants every incident reported, every time, but
staff members report that their own direct supervisors may discourage them by not taking time to discuss these pre-incidents, and also by chalking up comments as merely office gossip.

4. Not linking Human Resources with Security on the issue of Workplace Violence Prevention. This is a management issue, but organizations that create bridges between HR and security are way ahead because this is one issue where cooperation makes a big difference in results. HR can’t do a security assessment and security can’t write termination policies and set up employment screening. They are both absolutely necessary.

5. Not doing an Annual Workplace Violence Assessment. Since late 2008, when the economy suffered major job losses, the number of workplace violence assessments have increased dramatically, especially in the healthcare field. Annual assessments are best way to stay on top of the ‘potential’ for violence in your organization.

Check out one of our regularly scheduled webinars to learn more about this important issue.

REMEMBER – Workplace Violence is the one threat that is PREVENTABLE!

— Caroline Hamilton

Caroline.r.hamilton@gmail.com

chamilton@riskwatch.com

www.riskwatch.com

Workplace Violence Against Hospital Staff Discussed

Posted on May 19, 2011 2:14 am by Caroline Ramsey-Hamilton Comment

Just got back from a regional meeting of hospital security officers in Myrtle Beach. Aside from the T’storms every night – and the college kids shooting off bottle rockets, it was a great conference.

It reinforced my feeling that violence against hospital staff is one of the biggest challenges facing healthcare professionals. Vermont passed a law this week making violence against a healthcare worker a FELONY instead of just a misdemeanor. That’s progress, similar laws are being passed in other states, too. The governor of Vermont signed the bill on May 12, 2011. Congratulations to Vermont — they were first on this important issue.

Tags:
accountability
Hospital
IAHSS
Security
Workplace Violence

Arming the Office – What Happens When We Let Employees Bring Guns to Work

Posted on March 30, 2011 12:25 am by Caroline Ramsey-Hamilton Comment

One of my colleagues wrote to me so passionately about the terrible gun violence he witnesses every day, that I wanted to share it with all of you. You can call it a ‘Guest Blog’ from the Field — a Hospital Security Director in a Major U.S. City.

The gun lobby had several recent legal “wins” for the gun rights advocates in Texas, Indiana, and Tennessee. Apparently lawmakers and gun rights advocates find it a sane and reasonable policy to open up the workplace to armed employees.

It t is also clear that our lawmakers are not satisfied with our current national gun carnage. Currently, we shoot to death about a 100 people a day in the United States, including 25 children killed every three days. And this tally accounts for only those killed by guns.

This doesn’t include all those I see on a daily basis who are shot, crippled, maimed and ruined by the daily shooting gallery in the USA. In order to continue to make money and sell more guns, the gun rights advocates, and the legislators they have paid off, corrupted and stripped of reason, are intent on even greater carnage and human tragedy.

Every day I witness the extreme becoming mainstream, and even commonplace.
Guns are now finding their way into the workplace, brought into churches, brought into our colleges and universities. They are brought to hospitals, and shot off over highway bridges.

The logic is totally missing. We are already a nation awash in fear and loathing. We hate people we don’t know and don’t understand. The answer to this problem is NOT to arm EVEN MORE people and have guns readily available to everyone.

Obviously, the recent horrors of Arizona and the slaughter of innocent people in a Safeway parking lot, has already been forgotten by security professionals and criminologists. There is no condemnation or follow up about a terminally troubled young man and the ease in which he purchased a semi-automatic pistol and 30 shot clips.

There has been no rallying cry to address the ease in which tormented and troubled and dangerous individuals on the margins of our society can easily obtain weapons of human mass destruction. These realities are not relevant and cannot be discussed. And in today’s political climate to even MENTION this makes one a pariah, or a “liberal”, or a “communist”.

I have been in the Security and Prevention profession for over 35 years, so I can easily dismiss the attacks from gun rights advocates and zealots. And in fairness, I have found many gun rights people to be in fact reasoned and decent and willing to engage in reasoned discourse.

What troubles me, and why I wanted to write directly to YOU, is that the vast majority of professionals in the Security profession totally bypass, ignore and in fact, minimize the reality and tragedy that is our national gun slaughter. As a profession, we have done nothing to challenge these trends, or address them, or at the very least, debate the current flood of laws designed to turn American work places into armed camps.

And this in my view is nothing less than a tragedy.

Tags:
Gun Violence

Is Hospital Management Listening to Security Directors?

Posted on February 9, 2011 3:58 am by Caroline Ramsey-Hamilton Comment

Just finished a webinar yesterday to over 60 hospital security directors and managers and they later wrote in to say that their management listened politely to their suggestions, their budget needs, their warnings about the new violence levels — and then they said, “Thank you very much”, and went back to their paperwork.

We all know how tough it is to run a hospital, but when will the administration realize that violence in hospitals, whether it’s a distraught son, shooting his mother’s doctor in Baltimore, or a grief-stricken Chinese man running through a Shanghai hospital killing innocent bystanders with a knife — that we have a BIG PROBLEM with the increasing violence in hospitals.

The nurses know about the violence. In a recent survey of 1000 nurses who worked in emergency departments, nurses reported that 97% experienced verbal abuse, 94% had physical threats, and 66% HAD BEEN ASSAULTED. The saddest part of this was that 25% of the nurses said they expected abuse and violent attacks.

We need to devote some resources to this problem and not wait until 100% of nurses report assaults. It starts with awareness that there is a problem. Tomorrow we’ll discuss the next steps.

Maine Hospital Fined by OSHA for Not Providing a Safe Workplace

Posted on January 31, 2011 3:54 am by Caroline Ramsey-Hamilton Comment

The Acadia Hospital in Bangor, Maine was fined $11,700 by OSHA (Federal Occupational Safety and Health Administration) on January 26^th, 2011 for failing to provide a safe working environment for employees and improperly documenting workplace injuries.

They were referring to the fact that staff at the hospital had been subject to 115 attacks by patients between 2008 and 2010. The report went on to say, “”The serious citation points to the clear and pressing need for the hospital to develop a comprehensive, continuous and effective program that will proactively evaluate, identify and prevent conditions that place workers in harm’s way,” said Marthe Kent, OSHA’s New England regional administrator.

OSHA’s report on The Acadia Hospital was at least partially the result of hospital officials making a policy decision to not use restraints on violent patients. In fact, Acadia Hospital’s CEO, David Proffitt, Ph.D., was very proud of this policy, saying in a published article in 2010, “I want to share something I think is very exciting. The last mechanical restraint recorded at The Acadia Hospital was on June 21^st, 2009. This is a big deal. We set a goal to end mechanical restraints and you have done so. It reflects a commitment to be the best at what we do. And it gets better…… Our adult rate of restraint has been well below the national mean since May of 2009. . That means we are now in the top 3% of best performing hospitals! I hope that fact inspires great pride in your self, your co-workers, and this hospital. I know it does me!”.

Obviously, the no restraints policy wasn’t so great for the nursing staff!

Additionally, the OSHA report ordered the hospital to implement procedures to better protect staff, including screening patients for violent tendencies and offering more staff training on how to use physical restraints, though it did not specifically order the hospital to use them.

In the last eighteen months, OSHA has fined only a handful of hospitals for workplace violence-related incident, including Danbury Hospital, which had a homicide, and Oregon State Hospital in Oregon, which was fined in November 2010 for failing to give staff members self-defense training for dealing with violent patients.

According to The Statesman Journal, OSHA fined the hospital $3,750 for violating three major safety violations:

Failing to provide timely training for staffers to use shields as “a tool to protect employees from projectiles, riots, and to approach patients in order to secure them.”
Not reporting to OSHA that a worker was hospitalized in late January after being assaulted by a patient.
Lack of written verification showing that a “hazard assessment” had been performed to ensure employees were provided with adequate personal protective equipment.

Looks like OSHA is gearing up to take workplace violence incidents more seriously in the future. One of the backstories is that hospital employees talk to their unions, and the union leadership contacts OSHA on behalf of the employees.

The increasing problem with workplace violence in hospitals makes it absolutely imperative to start with a comprehensive program to combat and prevent workplace violence.