Workplace Violence

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

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

RiskAlert Incident Report #473 – Hospital Admin Killed at Home

Posted on January 6, 2014 12:43 pm by Caroline Ramsey-Hamilton Comment

RiskAlert INCIDENT REPORT 473 – ACTIVE SHOOTER 12-27-2013

Oschner Hospital Administrator Shot to Death in his Home in Active Shooter Spree

Dateline: December 27, 2013 pm

A Louisiana man attacked his former in-laws, his current wife, and the Administrator of a hospital
where he’d worked, killing three and wounding three others before killing himself, authorities said.

The shooter, Ben Freeman, 38, was found late Thursday night in his car along a highway,
dead from a self-inflicted gunshot wound to the head.

The shootings happened at four locations in two parishes about 45 miles southwest of New Orleans
on Thursday. The first report came about 6:40 p.m., when Lafourche Parish Councilman Louis Phillip
Gouaux, who was shot in the throat, called 911 from his home in Lockport, Houma, La.

The suspect, Ben Freeman, 38, was the ex-husband of Gouaux’s daughter Jeanne, Lafourche Parish
Sheriff’s Office spokesman Brennan Matherne said in a news release.

Gouaux’s wife, Susan “Pixie” Gouaux, was dead when deputies arrived. Louis Phillip Gouaux and his
daughter, Andrea Gouaux, were injured and taken to Interim LSU Public Hospital in New Orleans.
Both were in critical but stable condition, Matherne said.

About 20 minutes later in Raceland, Ochsner St. Anne General Hospital Administrator Milton Bourgeois
was shot and killed at close range at his home. His wife, Ann Bourgeois, was shot in the leg, and taken
to the New Orleans hospital, where she was listed in stable condition. Raceland police said Bourgeois
was shot at close range and his wife was shot in the leg.

Freeman had been employed at three area hospitals over the last few years, including Oschner St. Anne Hospital, where Lafourche Parish Sheriff Craig Webre said he had been a registered nurse before he was fired in 2011. All three hospitals were put on lockdown for a while Thursday.

Freeman’s wife, Denise Taylor Freeman, was found dead in the couple’s home in Houma in Terrebonne Parish. Matherne said her cause of death was not immediately known.

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

Get Management’s Attention for Security – Shooter Kills the Hospital Administrator

Posted on January 6, 2014 12:14 pm by Caroline Ramsey-Hamilton Comment

Every Security Officer I’ve ever met has mentioned how difficult it can be to get funding for additional security! It is a never-ending mission, to get the budget for a security program that will truly protect an organization.

Hospitals are no exception. They have suffered their own financial problems and because security is not seen as a ‘clinical’ or ‘patient care’ issue, it is easy to take money from security and put it somewhere else.

But there’s one sure way to get management’s attention for Security — having a security incident. And if you don’t have one at your organization, high profile security incidents at other facilities will all grab management’s attention.

In my Risk-Pro Security Incident Report today, a shooter killed four, wounded three, and then killed himself. What was unusual about this incident was that the shooter went to the Hospital Administrator’s house and shot the administrator dead, and then shot his wife who was taken to an area hospital.

Most executives and administrators think about security as sort of an abstract concept, that doesn’t directly affect them. But it might, and by sending your management a copy of our Risk-Pro Incident Report, you’ll get their attention this time!

(Subscribe to the Risk-Pro Incident Report program by sending an email with the word SUBSCRIBE on it to info@riskandsecurityllc.com)

New Active Shooter App Announced on October 20, 2013

Posted on October 19, 2013 12:27 pm by Caroline Ramsey-Hamilton Comment

FOR IMMEDIATE RELEASE

New Active Shooter app released to reduce likelihood of an Active Shooter Incident.

Active Shooter incidents have increased both in the number of incidents, as well as the number of people killed and injured in the last five years. As an aspect of workplace violence, the active shooter has become is a serious recognized occupational hazard, ranking among the top four causes of death in workplaces during the past 15 years. More than 3,000 people died from workplace homicide between 2006 and 2010, according to the Bureau of Labor Statistics (BLS). Additional BLS data indicate that an average of more than 15,000 injuries were annually during this time.

The latest figures show that high-risk organizations like hospitals, schools, malls, universities, military installations and even hair salons have experienced an active shooter incident and are likely to have a dramatically increased risk for experiencing an active shooter incident in the future.

Risk & Security LLC has released a new web-based app, Active Shooter Risk-Pro©, which offers an easy to use risk assessment program that assesses your organizational risk of an active shooter incident, as well as recommending solutions to prevent an incident from occuring in the future.

In additional to using the Department of Homeland Security (DHS) Guidelines on Active Shooter Response, the OSHA standard 3148 (Guidelines for Preventing Workplace Violence for Health Care, the FBI and Secret Service Guidelines on Active Shooter Incidents, and the new OSHA Inspection Directive, Enforcement Procedures for Investigating or Inspecting Incidents of Workplace Violence, from September, 2011, are both included in the new, easy-to-use application.

The program has been tested on some of the largest organizations in the US, and runs on a laptop, PC or tablet, and even on a smartphone!. Active Shooter Risk-Pro© is built to be affordable and simple to use.

The web 2.0 program, includes newly compiled, updated threat databases, new active shooter incident analysis metrics, and automated web-surveys based on the DHS Guidelines..

The new program gives human services and security professionals a quick and easy way to conduct a active shooter, or general workplace violence that will recommend that will pass an audit!

The Risk-Pro© model has been used for easy software applications by the Department of Defense and over hundreds of organizations, hospitals, and local, state and federal government agencies.

About Risk & Security LLC

Risk & Security LLC is a security risk assessment and risk analysis company with over 30 years of combined expertise in security risk assessment. It develops specialized programs and applications which are easy to use, affordable and which help organizations assess their risk, the likelihood of becoing a target, and which recommend cost-effective solutions.

Risk & Security offers full service consulting on critical risk assessments including HIPAA Risk Analysis, Facilities Security Assessments, Hospital Security Assessments, Workplace Violence, Active Shooter Incident Assessment, Environment of Care and more. Risk & Security partners with security companies around the world to provide state-of-the-art security expertise to analyze risk and recommend cost-effective security controls justified by return on investment metrics.

The team of risk and security experts is led Caroline Ramsey-Hamilton, who has created more than 40 software programs, and conducted more than 200 specialized security risk assessments in a variety of environments, including companies in the United States and around the world, including in Abu Dhabi, Hong Kong, Japan, South Africa and Qatar.

Contact Information:

Caroline Ramsey-Hamilton, CHS III

Email: caroline@riskandsecurityllc.com

Phone: 301-346-9055

Twitter: www.twitter.com/riskalert

DOD-OIG Report on Security Weaknesses at the Navy Yard

Posted on October 18, 2013 10:11 am by Caroline Ramsey-Hamilton Comment

The recently released 56-page report by the Department of Defense, Office of the Inspector General found that the Navy Access Control System did not adequately control the risks to the Washington DC Navy Yard and other sites under their control.

NCACS did not effectively mitigate access control risks associated with contractor installation access. This occurred because Commander,
Navy Installations Command (CNJC) officials attempted to reduce access control costs.

As a result, 52 convicted felons received routine, unauthorized installation access, placing military personnel, dependents, civilians, and
installations at an increased security risk.

Additionally, the CNIC N3 Antiterrorism office (N3AT) misrepresented NCACS costs. This occurred because CNIC N3AT did not perform
a comprehensive business case analysis and issued policy that prevented transparent cost accounting of NCACS. As a result, the Navy
cannot account for actual NCACS costs, and DoD Components located on Navy installations may be inadvertently absorbing NCACS costs
.
Furthermore, CNIC N3AT officials and the Naval District Washington Chief Information Officer circumvented competitive contracting
requirements to implement NCACS. This occurred because CNIC N3AT did not have contracting authority. As a result, CNIC N3AT
spent over $1.1 million in disallowable costs and lacked oversight of, and diminished legal recourse against, the NCACS service provider.

You can read the entire report at: http://www.dodig.mil/pubs/documents/DODIG-2013-134.pdf

Courtesy Caroline Ramsey-Hamilton at Risk and Security LLC

caroline@riskandsecurityllc.com

What’s Your Active Shooter Risk? How to Assess the Threat!

Posted on October 15, 2013 4:54 pm by Caroline Ramsey-Hamilton Comment

Just the idea of an Active Shooter in your organization, whether you’re a military base, like Fort Hood, and the Washington Navy Yard, or a school like Sandy Hook, a beauty shop, a cracker factory in Philadelphia, a retail mall, a movie theatre, a grocery store parking lot, or a hundred other places, is a terrifying thought.

I lived about 3 miles from one of the shooting sites, a gas station, used by the Beltway Snipers back in October, 2002. They killed ten people, totally at random, and critically injured three others. Both of the snipers were sentenced, and John Muhammad was killed by lethal injection in 2009.

If you lived in the DC area, do you remember how scary it was just to pump gas into your car, people were huddled against the side of their cars in the gas stations, and hidden by their shopping carts at the local Home Depots.

The fear of the Active Shooter comes from the seeming randomness of the action, which means there’s no way to prevent it, unless you give up, stay home, and hide under the bed all day.

But there are things you can do. Instead of thinking of an Active Shooter incident as a totally unique situation, it’s really a form a Workplace Violence, Gas Station Violence, Parking Lot Violence and other related forms of random violence. In fact, the Department of Homeland Security has identified quite a few steps you can take to keep yourself safer if you are in the vicinity of an active shooter (http://www.dhs.gov/active-shooter-preparedness).

Most of the shooters are mentally ill. Normal individuals do not enjoy planning and killing strangers, and it is usually a last ditch effort, with the suicide of the shooter as the grand finale. Their actions can sometimes be identified early, and the police can be alerted, or the Human Resources group at work, or even the local Sheriff can intervene before it gets to the actual shooting.

Signs that someone is having trouble negotiating their life, especially if that someone is a gun fanatic, with their living room full of AK-47 assault weapons and hollow point bullets, is not hard to spot, because these individuals often leave lots of warning signs, like:

Irrational Posts on Facebook or inappropriate tweets.
Threats made against friends and family.
A dropoff in personal hygiene, as the person gets more obsessed.
Problems negotiating their personal life.
Demonstrating signs of isolation and groundless paranoia

Organizations can protect themselves from an potential active shooter through a combination of specific controls that include elements like access control, continuous monitoring of cameras, employee awareness and training programs, clear cut evaluation routes, regular active shooter drills, and hardening of facilities, to name a few.

One of the best preventive measures is to conduct an Active Shooter Risk Assessment, which is similar to other security analyses, except that it is focused on a particular set of threats related to an Active Shooter Incident. As part of my annual Threat Trend Reports, I’ll be releasing a new set of threat data about the Active Shooter, to help organizations calculate their risk of
having such an incident. For example, did you know that the number of active shooter incidents has jumped from 1 in 2002
to 21 incidents in 2010?

Locations have changed, too, and we found that

About 25% of active shooter incidents occur in schools,
About 25% in retail locations, and
About 37% in workplaces.

In future blogs, we’ll be looking at each element of the active shooter incident, and providing more information to keep
your organization safe.

Capitol Hill Security Incident Scares Congress- Could it Happen To You?

Posted on October 4, 2013 2:05 pm by Caroline Ramsey-Hamilton Comment

The Capitol Hill Security Chase and Shooting yesterday gave a bad scare to everyone – including Senators, Congresspeople, tourists, furloughed federal employees and staff who still have their jobs.

The atmosphere on Capitol Hill was already so toxic that almost everyone jumped to the (incorrect) conclusion that it was
a disgruntled voter, and so there was shock when:

1. It was a young WOMAN
2. There was a 1 year old child in the back seat
3. The driver of the car was not armed and mentally ill, (probably schizophrenic).

Where are you going today on a beautiful Fall Friday? Almost anywhere you’re planning to go has had a
major security incident in the past three years…. whether it is:

A school
A movie theatre
A mall
A hospital
The office
A public building
A hair salon

And if a security incident did happen where you were, are you confident you’d know what to do?

That brief incident at the Capitol showed how in literally one minute, the situation goes from what
passes for normal at the Capitol, to total chaos, fear and terror. The situation was handled correctly.

The communications systems were in place to send out a quick “Shelter In Place” order, and to keep
people updated. The poor tourists and staff who were walking in the area were laying on the ground,
hiding behind trees, and had no idea what was going on – so they probably experienced the greatest fear.

The Capitol Hill police, the first responders, were probably not expecting to have the driver be a woman
with no political agenda, if you see a car trying to rush a barracide, the logical assumption is that they
have an explosive device and are trying to get closer to the target, but that was no true in this case.

So before you venture out for the weekend, keep these tips in mind, write them down and keep them in your purse or wallet.

1. Be Situationally Aware – note where you at all times, how close a door is, or an alternate route for
your car when you’re in traffic.

2. Spend 30 minutes deciding how you would react in an emergency shooter situation, and make a plan,
like deciding to use your car keys as a weapon, or keeping pepper spray in your purse.

3. Remember to turn the sound off on your cell phone, if you’re caught in a developing security incident.

4. If police are on the scene, follow their directions quickly and exactly.

5. Have a local emergency number pre-set in your phone so you can call for help.

As they find out more about the Capitol Hill incident, this will probably be catalogued as an isolated incident,
which took place at a very inappropriate time, and a very inappropriate place, but it’s another wake up
for everyone.

Everything can change in a New York minute — be ready, just in case it changes for you!

Has it Been Only Two Weeks since the Navy Yard Shootings?

Posted on October 2, 2013 4:07 pm by Caroline Ramsey-Hamilton Comment

When i wrote my blog about the Shootings at the Washington Navy Yard on September 16th, I got some nasty notes about “Why did you have to write about this so soon after it happened?”

Well – I guess the fact that after about 15 days, no one can even remember the incident (8 people shot to death); the name of the shooter (Aaron Alexis), or much of the details. It seems that people have decided that it was a mentally distributed person, so couldn’t have been prevented. This is completely wrong.

One of the issues that security directors have is how to make their organization aware of the active shooter threat without terrifying them. How do you get a large group of people out of the “It can’t happen here” mindset? One of the main ways to bring an issue back home is by using the incident as a security awareness notice.

Write a “Lessons Learned” email and send it to everyone in the organization. Follow it up with a purse and wallet card with reminders on what to do when faced with an Active Shooter situation.

Keep everyone informed on what happens after the incident – how the injured are doing, and more importantly, what changes the organization has made to ensure that it won’t happen again.

Try doing a simple threat-risk assessment to illustrate to management what the chances of having an active shooter incident actually are, based on the industry, the region, and the number of problems/complaints that employees have expressed in the past.

Don’t let anyone forget that this can happen to any organization, no matter how well funded, or how secure they think they are. Remember, if it could happen in a DOD military facility – it could happen to YOU!