Issue link: https://beckershealthcare.uberflip.com/i/759108
64 CMO / CARE DELIVERY How 3 Health System Executives Weighed Decisions About Armed Security By Tamara Rosin V iolence in hospitals is a growing public health concern. In recent years, attacks on patients and providers in the healthcare setting, particularly those perpetrated by patients and visitors, have impelled administrators to consider ways to enhance systemwide security models. ough still relatively rare, acts of violence are occurring in hospitals with increasing frequency. Healthcare institutions reported a 40 percent spike in violent crime between 2012 and 2014, with more than 10,000 incidents aimed at hospital staff, according to a survey from the Interna- tional Association for Healthcare Security and Safety. Individual acts of violence in hospitals made headlines numerous times this year. In January, Michael Davidson, MD, a cardiac surgeon at Brigham and Women's Hospital and assistant professor at Harvard Medical School in Boston, was shot and killed in the hospital by a deceased patient's son. e shooter then committed suicide in an exam room. In March, a 22-year-old patient nearly tore off a nurse's ear and attempted gouge out her eye at Pembroke (Mass.) Hospital. In early July, a 55-year-old male patient attacked Ruth Anne Mardock, MD, at Timberlawn Mental Health System in Dallas by tackling her and knocking her head into the ground. She lost consciousness and later died from her injuries. Later that month, a man entered a patient's room at Parrish Medical Center in Titusville, Fla., and opened fire, killing an 88-year-old patient and a 36-year-old hospital employee. Police deemed the shooting a random attack and charged 29-year-old David Owens with two counts of first-degree murder. According to his lawyer, Mr. Owens is severely mentally ill and incompetent to stand trial. e New York Times, in collaboration with WBEZ's is American Life, in February published a detailed report on the case of Alan Pean, a 26-year-old college student who was shot just millimeters from his heart by armed hos- pital security at St. Joseph Medical Center in Houston while he was having a manic bipolar episode. Nurses called hospital security — who were off-duty police — to his room when Mr. Pean refused to comply with their orders, and aer a confrontation ensued, the officers shot him. "I thought of the hospital as a beacon, a safe haven," Mr. Pean, who sur- vived the gunshot, told e New York Times. "I can't quite believe that I ended up shot." Aer CMS launched an emergency investigation of the event, the agency faulted St. Joseph for the shooting, concluding the hospital created "im- mediate jeopardy to the health and safety of its patients," and that "the facility had no clear guidance for the role, duties and responsibilities of the police officers they employ to provide security services," according to e New York Times. CMS demanded the hospital restrict its use of weapons or risk losing federal reimbursement. Tragic episodes of violence in hospitals have prompted many healthcare executives to rethink their security models, with some electing to arm security guards. Meanwhile, others warn the presence of guns in hospi- tals could increase the likelihood of violence, as in the case of Mr. Pean. ere is also concern that patients or visitors could obtain officers' guns from their holsters, particularly behavioral and mental health patients with conditions that manifest as aggressive behavior. Given the complexity of the violence and security, Becker's Hospital Review asked three health system executives to break down the deci- sion-making process behind their unique security models. Scripps Health CEO weighs pros and cons of introducing armed guards Concerns about excessive force used to restrain mental health patients are partially what has kept Chris Van Gorder, CEO of San Diego-based Scripps Health, from deploying armed security guards in Scripps facil- ities. A great proportion of people who visit hospitals, and emergency rooms in particular, have mental or behavioral health conditions. A va- riety of factors contribute to this, including underfunding of behavioral health and social programs in the community, the release of mentally disturbed prisoners with inadequate support and a large homeless popu- lation, according to Mr. Van Gorder. "If [the police] don't know what to do with [a mentally disturbed person] and they haven't committed a crime, they just drop them off in the ER," says Mr. Van Gorder. "We're seeing people with behavioral health issues boarded in our ERs because there is no other appropriate place for them. When we don't have enough mental health units, we have to put them in a regular medical bed." In addition to the fact that patients with mental and behavioral health issues would be better served in a psychiatric department than the ER, overcrowding in the ER with people who may be suffering mental health crises could increase the risk of aggressive behavior, leading to a confron- tation with security. In the event security is called on any patient, Mr. Van Gorder says, "We don't want a situation where security personnel are shooting or injuring pa- tients. If law enforcement shoots a citizen out on the street, that's different than a hospital security officer shooting a patient. And if you use a Taser in a hospital, you could be injuring someone with a heart condition. Same with using pepper spray on someone with a respiratory disorder." However, Mr. Van Gorder notes the health system leadership has an obli- gation to protect Scripps' staff, patients and visitors. "ere does seem to be an uptick in violence. I'm trying to find a balance between providing "While safety is important, we don't want to alarm the public or make them feel like they are in a restraining environment." — Mark Solazzo, executive vice president and COO of Northwell Health