Washington Navy Yard Shooting

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

Posted on July 29, 2014 by Caroline Ramsey-Hamilton • 0 Comments

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

Why We Need to Switch to a Risk-Based Security Model – School Stabbing at Franklin Regional, Active Shooter Incidents at Fort Hood (twice), LAX, and The Washington Navy Yard.

Posted on April 15, 2014 by Caroline Ramsey-Hamilton • 0 Comments

When I turned on the news today, I was in the middle of writing an article on the 2^nd Shooting
at Ft. Hood from last week, and then saw that there had been a violent knife attack at a
Pennsylvania high school, with 20 casualties and at least eight injured critically, the next day,
there was a hate crime shooting at the Jewish community center in Overland Park, Kansas.

Once again, we see violence on a mass scale, the FBI has been brought in, and next will come
information on the victims. With two major events, in two weeks, what can we deduce about the
security in place at both Franklin Regional High School, Pennsylvania, and Fort Hood, Texas.

NEWS FLASH: THE CURRENT SECURITY MODEL IS NOT WORKING!

CURRENT SECURITY MODELS

Disaster preparedness is improving, Emergency Management is working, but security is
still not where it needs to be. It is a systemic problem based on the fact that security around
the U.S. is still locked in a REACTIVE mode, not a PROACTIVE mode.

The main reason for this reactive mode in security organizations, is because most security
officers come from a law enforcement background, with a model which is based on crimes
and arrests, and it is totally REACTIVE. A crime happens and police officers go into action
and arrest the perpetrator(s).

CRIME HAPPENS = PERP IS IDENTIFIED = PERP IS ARRESTED

Unfortunately, this reactive model does not work for preventing security incidents and mass violence
because it is INCIDENT DRIVEN, not Risk-Driven. It focuses on individuals, not on a more holistic,
generalized view of Threats, and it totally leaves Solutions (Controls) out of the equation.

After studying pages of after action reviews, post-incident analyses and media sources, the one
recommendation that makes sense is that organizations need to switch to a RISK-BASED,
PROACTIVE mode for security to work.

This was highlighted in a remark made by a Pentagon official, commenting on the 2^ndFort Hood
Shooting on April 2, and the fact that new DOD recommendations for security, had just been released.

“After the Navy Yard shooting in September 2013, another round of recommendations were made
to improve security at all DOD installations, however, a Pentagon official said that the new
recommendations had not yet been put into effect at Fort Hood. At Fort Hood, very little had
changed from 2009 regarding security procedures for soldiers at the entrance gates.”

The question for the Department of Defense is “how could this happen again at the same military
base? I took extra time to study the 89-page document called An Independent Review “Protecting
the Force”, one of 3 reports created after the initial Fort Hood Shooting, whene 13 were killed, and
43 injured.

If you look at the recommendations, they are very bureaucratic and procedural. They could have
been written by an efficiency expert, not by anyone with a background in security, and covered things
like policy changes, and having screening for clergy and psychologists, and improved mental health
programs. These are all important, but they do not provide a secure environment.

The LAX after action analysis’ Number One recommendation was to change
the security focus to a Risk-Based approach.

RISK-BASED SECURITY

The problem with a reactive approach is that you can’t screen and lock down everyone. At Fort
Hood, for example, there are 80,000 individuals living on the base, and probably hundreds of
visitors who go in and out every day. It’s impossible to assess the mental health, and the
‘intentions’ of all of them.

That’s why a Risk-Based Approach works – because it focuses on the potential threats and then evaluates the existing controls to see whether they offer the required amount of protection based on the likelihood of the threat occurring.

You stop violent events by controlling access and by controlling weapons. No matter how unpopular they are, you use metal detectors at certain points, you use security officers at key entrances, you control entrances and exits.

Once the event starts, you can improve security by having faster notification (panic alarms), ability
to block, or disable weapons and attackers, adequate transport, better emergency response, but to
avoid the violence, you need to have strong access control.

The Risk-Based approach makes use of annual risk assessments that are holistic in nature. They
are not done in stovepipes, they include the entire organizations, they include input from staff
members, visitors, students, vendors, soldiers, patients on how they see security from their point
of view, which is always dramatically different from management or administration.

A risk-based approach requires an organization to:

Define potential security risks.
Develop standardized risk assessment processes, for gathering and
analyzing information, and use of analytical technology
Risk-Based Security focuses on PREVENTION OF NEW INCIDENTS
whether they are active shooter, general violence, etc.
Enhances security’s ability to rapidly respond to changes in the threat environment.

MORE BANG FOR THE BUCK

According the LAX (LAWA) after action report, “Simply adding more security does not
necessarily provide better security. Determining priorities and where to achieve great
value for the dollars invested requires regular, systematic assessment of the likelihood
and consequences (risks) associated with a range of threat scenarios that morph and
change more quickly now than ever before.

Collaborative engagement in a security risk assessment process across the community builds
the buy-in needed to develop and sustain a holistic security program over time. Leaders must
be open to challenging established practices and demonstrate a willingness to change direction”.

Making the switch to a Risk-Based security program is the best recommendation for those who
want to protect their staff, students, patients, vendors, clients, soldiers, and visitors from a mass
casualty event, or for all the organizations who don’t want to have a terrible incident happen in
the first place!

Caroline Ramsey-Hamilton

President, Risk and Security LLC

Caroline@riskandsecurityllc.com

www.securityinfowatch.com/blogs

www.riskandsecurityllc.com

What Went Wrong at Fort Hood? Another Active Shooter?

Posted on April 8, 2014 by Caroline Ramsey-Hamilton • 0 Comments

RISK Alert Alert #530 – Fort Hood Active Shooter-April 2, 2014

Dateline: April 5, 2014

Shock and grief were the reactions when the news said, for a second time, a shooter
inside Ft. Hood near Killeen, Texas had killed 4 and injured 13 in another Active Shooting
Incident. Everyone remembered the first major shooting attack in November 2013, when
a major killed 13 and injured 43 because he did not want to be deployed to Afghanistan.

A total of 73 injured and/or killed in the two incidents!

How could this have happened? The Department of Defense had implemented many of
the recommendations of its internal, and independent review panels, and the changes had not
been enough to prevent another active Shooter incident.

The 34-year old shooter had apparently been denied a leave form, and asked to come
back the next day and he came back, with a .45-caliber Smith & Wesson semiautomatic
handgun, recently purchased at Guns Galore, and started shooting. He eventually turned
the gun on himself, after firing 35 rounds in two buildings over a 2 block area. He had a
history of mental issues, and had recently been transferred to Fort Hood.

What We Learned: The After Action Review “Protecting the Force” had detailed 89
recommendations, but by Sept. .2013, only 52 had been
implemented and none included an Active Shooter Risk Assessment.

A comprehensive Active Shooter Risk Assessment has to be the first recommendation
after any Active Shooter event. Recommendations from the previous shooting were concentrated
on new policies and procedures, mental health screening, education and training programs but
those controls did not directly influence PREVENTION of incidents.

A Review of the Most Important Active Shooter controls would have been more
likely to prevent a future shooter event, like:

Tightened Access Controls for Facilities
- Panic Alarms
- Tracking of Potential Troubled Individuals
- Metal Screening for Weapons
- Policy on Personal Weapons on Base
  
  After the Navy Yard shooting in September 2013, another round of recommendations
  were made to improve security at all DOD installations, however, a Pentagon official
  said on Thursday, April 4th, that the new recommendations had not yet been put into
  effect at Fort Hood. Unfortunately, at Fort Hood, very little had changed from 2009
  regarding security procedures for soldiers at the entrance gates.
  
  Stay Alert and make sure that any Security Incidents are reported IMMEDIATELY!

New Active Shooter App Announced on October 20, 2013

Posted on October 19, 2013 by Caroline Ramsey-Hamilton • 0 Comments

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 by Caroline Ramsey-Hamilton • 0 Comments

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 by Caroline Ramsey-Hamilton • 0 Comments

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.

Category Archives: Washington Navy Yard Shooting