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Violence in Hospitals

Former Nurse Commits Suicide in Hospital Bathroom at Valley View Hospital

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, housekeepingdidn’t want to bother securitywhen 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
 



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

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



How Risk-Based Security Can Reduce Violence in Healthcare

reprinted with permission from www.securityinfowatch.com

Using Risk-Based Security to Stem the Tide of Violence
in Hospitals and Healthcare


Created by:   Caroline Ramsey Hamilton

Date: May 22, 2014

Hospital and healthcare security is experiencing a major increase in violence,
instigated by patients, patient families and even healthcare staff.  Just last year,
there was an active shooter incident in Reno, Nev., in which two physicians were
shot, and in Houma, La., 
a hospital administrator was shot to death by a terminated
nurse. As recently as Easter Sunday in California, two nurses were stabbed at the
hospitals, where they worked.  One was stabbed in both the upper and lower torso
and is in critical condition. These two incidents add to the more than 100 
violent
incidents in 2013 and the first half of 2014.

Since 2010, violence in healthcare has skyrocketed. As a result, the Joint Commission has
issued a “Sentinel Event Alert” on the issue and contributed to numerous articles on shootings
in U.S. hospitals. The Department of Homeland Security and a consortium of state and local
hospitals recently released 
a standard for active shooters in healthcare. These all point to the
conclusion that the current law enforcement-based hospital security model is not working.

Changes in Healthcare
The changes in healthcare, including the increase in insured Medicaid patients and increased
traffic to emergency departments, highlights the fact that very well-intentioned people are
working with an outdated security model that hasn’t evolved to address a changing healthcare
environment. The change in billing and reimbursements for healthcare organizations, such as
tracking of readmission rates, has squeezed hospital profits causing reductions in funding in many
security departments at a time when violent events are steadily increasing.

A new risk-based model for hospital security is emerging that is less linear and more cyclical.
It uses technology to a greater extent, employs forecasting and statistical models to predict the
likelihood of future incidents, and is proactive instead of reactive, focusing money and energy on
preventing events instead of simply responding to them. This model also uses risk assessment
formulas to quickly assess the current security profile of a hospital, clinic, hospice, or behavioral
health facility, factoring in heightened threat-risk environment, not only for the facility in question,
but also adding in the wealth of healthcare data that’s now available.

Risk –Based Security Focuses on Continual Assessment
A major focus of this model is the continual assessment and evaluation of preventive security
controls, which are reviewed quarterly, semi-annually, or annually to discover gaps in controls,
and to fix gaps as soon as they are identified. This dovetails nicely into the assessment models
already required by the Joint Commission, OSHA and new CMS standards.

Looking at recent high-profile security events that took in place in hospitals shows that incidents
happen because of exploited gaps in the existing security of the healthcare facility. In the past,
security officers successfully worked hard to reduce response time so that often officers could
arrive in under two minutes, but it’s still too long.  In the Reno shooting, response time was under
two minutes, but that was long enough to kill two doctors.

Focusing on prevention makes sense for healthcare, much in the way the Joint Commission
focuses on patient safety, by continually assessing controls, reducing discovered gaps in controls,
and mitigating gaps by reassessing and tightening security, which creates a cycle of continual
improvement in the healthcare security environment.

Taking Advantage of Technology
The healthcare risk-based security model takes advantage of technology. Instead of waiting
for manual recording of security incidents every day, software programs allow hospital security
officers to enter data at the end of each shift, and that means security directors can map what’s
happening in the hospital or facility on a daily, weekly, monthly and yearly basis.  This can go a long
way to identifying trends early and help facilities make appropriate changes in controls so that
negative trends can be reversed 
quickly and both patient and staff security is increased.

In addition to automating incident collection and analysis, the healthcare security risk assessments
must be automated too.  Risk assessments are too time-consuming and labor intensive to be done
annually.   
By the time the risk assessment is over, the environment has changed again.  By
automating the risk assessments, including environment of care and hazard vulnerability,
it produces data that can be used instantly to analyze and recommend the most cost-effective
controls, and rank them by their return-on-investment (ROI).

The role of security in hospital and healthcare organizations is changing too. Security organizations
should no longer be isolated without intensive interaction with others in the organization, including
the human resources department, the facilities managers, safety managers, and the emergency
management staff.

New DHS Guidelines for Active Shooters in Healthcare
With DHS issuing new guidelines for active shooters in healthcare, hospital emergency managers
are now required to prepare for active shooter incidents, as well as storms, hurricanes, tornadoes,
power interruptions and other events related to natural or man-made disasters.  This creates a
natural partnership between the emergency management staff and the security program,
because the skills of both functions are needed to properly prepare an organization for any disaster.

Instead of existing in a vacuum, healthcare security directors and managers should cheer at
this development because it expands the importance of security inside the hospital or healthcare
facility, and underscores its value in protecting the organizational assets –  the physical facility,
patients, visitors and staff –  to proprietary information, including the HIPAA mandated PHI
(Protected Health Information), vehicles, security systems, high-value healthcare equipment
and the healthcare provider’s reputation.

Security budgets have always suffered because security costs are seen as operating
expenses, not an income source, but by tying the security expenses more closely to loss
prevention and protection of the organization, it creates a cost justification for hospital and
healthcare security.

Risk-Based Security Links to Hospital Compliance Standards
A risk-based security model also links security to myriad compliance standards that affect healthcare
and this also supports and justifies the costs related to security. For example, hospitals are required
to have a variety of security controls in place related to tagging of newborns, posting of no-weapons
signs, and environment of care issues. Any healthcare organization accepting funds from Medicare
or Medicaid must comply with the new mandate for annual security risk assessments. 

OSHA 3148 also requires hospitals and healthcare organizations to do annual workplace violence
assessments, and more than 33 states also require enhanced protection of hospital and healthcare staff.

As security incidents continue to increase and violence in healthcare escalates, making the
switch to a risk-based security program will provide better protection for hospitals and healthcare
organizations, making more effective use of existing security personnel, as well as justifying and
expanding healthcare security budgets.

 

For more information:  contactCaroline Ramsey-Hamilton at caroline@riskandsecurityllc.com

 



Two Nurses Stabbed on Easter Sunday in Different SoCal Hospitals

Dateline:  April 21, 2014

Stabbing at Olive View – UCLA Medical Center

In the early morning hours of Easter Sunday morning, 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

 



Joint Commission Reports on Shootings in Hospitals

Some of the most horrific shootings we see occur in hospitals.  Because most people still think of hospitals as “places of refuge”,  it is always a big shock when some kind of violence or shooting occurs in a hospital, especially gun violence.

With so many active shooter incidents in the US in recent months, the Joint Commission recently released information about the number of shootings in hospitals, and found that,

They analyzed a total of 154 hospitals shootings, which took place between 2000 and 2011.  They found that 59% of the incidents took place inside the hospitals, and 41% took place outside on the hospital grounds.

Of the 59% of incident that happened INSIDE the hospital, not surprisingly, about 30% took place in the Emergency Department, and 19% in the patient rooms.   We all remember the John Hopkins incident that occurred in a room where the shooter shot his mother’s doctor, and then locked the door and killed his mother and then committed suicide.

Of the 41% of incidents that took place outside, but on the hospital’s ground, 23% took place in the parking lot, which underscores how important it is to have a designated manager for the parking facilities.  We have seen stories about a man in Tennessee who had a meth lab IN HIS CAR in the hospital parking garage, and the poor baby tossed off the roof of a parking garage.

The 154 hospital shootings resulted in a total of 235  people who were Injured or who died in the incident.   The most common
victim was the perpetrator (shooter) and that accounted for 45% of the people injured or killed. 

Another 20% of the victims were the hospital employees, including physicians (3%) and nurses (5%).

hospitalhallway2-tiny
Another interesting highlight of the report, was that 50% of the shootings that took place in the
emergency departments were the result of the shooter taking the security officer’s gun!
The dramatic increase in Active Shooter incidents, including the Washington Navy Yard Shooting, the LAX
shooting and the Sparks middle school shooting all illustrate that the trend is moving toward more incidents per year, and more people dead or injured in each incident.
For example, from 2000 to 2004, there was, on average, only 3.8 active shooter incidents per year.  Then,
from 2005 – 2010, the average number of incidents per year increased to 11 incidents a year, and from
2011 to 2013, it jumped again to an average of 17 incidents per year, which is over a 300% increase from 2000.The statistics clearly show the trend of increasing gun violence in our society, and until society can find a way to reverse
the trend, hospitals will be looking at the possibilities to stop the violence at the door to their emergency department.

 

Source for hospital shooting data:   Hospital-Based Shootings in the United States: 2000 to 2011 by Gabor D. Kelen, MD, Christina L. Catlett, MD, Joshua G. Kubit, MD, Yu-Hsiang Hsieh, PhD

 



Why Violence in Hospitals is Increasing

Why Violence in Hospitals is Increasing

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. 

  1. Doctors are no longer thought of as “Gods”.  This means they are
          are more easily blamed when a patient’s condition deteriorates.
     
  2. 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.
  3. 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. 
  4. ASIS Security Association issued it’s industry guidelines for Workplace
         Violence 
    Prevention in September 2011, in conjunction with the SHRM – the
         Society for Human Resources Management to address this issue.

    The federal government   issued a guidance document for dealing with violence issues in healthcare,   OSHA 3148.01R, 2004, Guidelines for Preventing Workplace Violence for Health Care & Social Service Workers.

To Learn more:  join my webinar on Thursday, January 12th at 12 noon Eastern time by
       Clicking on this link:  https://www2.gotomeeting.com/register/835835290.



OSHA Starts New Enforcement Initiative for Workplace Violence Issues

On September 8, OSHA issued a new directive about enforcement activity on workplace violence issues.  This directive (CPL 02-01-052) takes effective on Sept. 8, 2011 and is called Enforcement Procedures for Investigating or Inspecting Workplace Violence Incidents.  It details new procedures for the OSHA inspectors, but it is also a valuable document to show employers what they can expect.

The directive follows the shocking news that in 2010, 18% of workplace fatalities were caused by assaults and violent acts, while only 14% were caused by falls, according to the Bureau of Labor Statistics.

Workplace violence incidents are even higher in the hospital and healthcare industries.

The new inspection directive shows how OSHA inspectors are going to look at employers to see whether they have performed a workplace violence analysis.  These assessments follow the security risk assessment model and should take into account the threat level at the organization, the history of incidents and examination of trends, and whether ‘accepted’ controls have been implemented at the place of employment.

Some of the ‘accepted controls’ they will be examining include:

  • Having a recent workplace violence analysis
  • Having a formal workplace violence training program in place
  • Showing the employer had incident reports to identity possible threat levels
  • Methods the employer used to inform employees of the risk of workplace violence
  • Evidence the employer has a workplace violence prevention plan in place
  • Evidence the employer has a current security plan
  • There are also a set of recommended physical controls that include proper lighting, cameras, curved mirrors, etc.

For more information, or a copy of the document, email info@riskwatch.com.




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