Shootings, other violence on the rise and pose major liability risks

Executive Summary

Shootings and other violence in healthcare facilities are increasing, which is prompting administrators to take another look at their security. Experts caution that priorities sometimes are misplaced and that failing to protect employees can lead to significant liability.

• A violent incident at a Virginia hospital proved the value of extensive preparations for such an emergency.
• The number of shootings at hospitals has increased significantly.

Escaped murderer David Sweat recently was shot and captured after a three-week manhunt in New York. He was taken to Alice Hyde Medical Center in Malone, NY, according to CNN.¹ He later was moved to Albany Medical Center, where vascular surgery specialists and others were involved in his care, CNN said.

The typical patient in outpatient surgery programs doesn’t usually pose a security risk to staff or other patients, but when a criminal is being treated in the facility, special precautions are essential. Consider this other recent healthcare example: At Inova Fairfax Hospital in Falls Church, VA, a convicted bank robber was being treated and stole a guard’s gun. A shot was fired, and he held the guard hostage before fleeing. The prisoner is thought to have carjacked two vehicles after leaving the hospital, and he was captured in a Washington, DC, neighborhood after a nine-hour manhunt involving hundreds of officers.

The incident prompted a five-hour lockdown of the facility. The facility’s preparations for such an event helped minimize the impact, says Greg Brison, the hospital’s director of emergency management and security.

A key part of that preparation was the workplace violence training required for employees at least once annually. That training includes information specific to responding to shots fired in the healthcare system. Inova Fairfax also works closely with local law enforcement and other emergency responders. In fact, it allowed them to use a new patient care center for training before the hospital moved in any patients, and they used a scenario very similar to what later happened.

The hospital had conducted full-scale drills as well as tabletop exercises to test its planning for an active shooter, including a meeting held just the day before the shot was fired. The Inova Fairfax incident illustrates how quickly a violent incident can put thousands of people in jeopardy and disrupt a healthcare facility, Brison notes. No one was injured at the hospital during the incident, and patient care resumed as smoothly as could be expected after a long lockdown. (For more on the lessons highlighted by the Inova Fairfax prisoner escape, see the story in this issue.)

“There’s no question that our planning and the extensive training for our employees made a difference in the outcome,” Brison says. “This is the kind of thing you hope never happens, but if it does, you want your people to know what to do and how to stay safe.”

Increasing violence

Healthcare workers are increasingly at risk from violence at work, and their employers face the prospect of huge payouts if they are found negligent for failing to protect employees and patients. Violence in healthcare is not what it used to be, the experts say, and the typical precautions might no longer be enough.

Some level of violence has always been an unfortunate but, seemingly, unavoidable part of providing healthcare services. (See these stories from the April 2014 issue of Same-Day Surgery: “2 incidents raise concerns: How do you protect staff and patients from violence?” “The unlucky 13: Early warning signs of potential violence at work,” and “Informed consent can play part in violence.”) However, the type of violence facing healthcare organizations is changing, as evidenced by a recent report in The Journal of the American Medical Association (JAMA). The JAMA article indicates that healthcare shootings are becoming increasingly prevalent, with “active shooter incidents” increasing from nine per year from 2000 to 2005, to an average of 16.7 per year from 2006 to 2011. (A portion of the article is available online at http://tinyurl.com/q8xopy2.)

When surgeon Michael J. Davidson, MD, was fatally shot on the premises of the Brigham and Women’s Hospital in Boston on Jan. 20, 2015, there had been 14 active shooter incidents in U.S. hospitals in the previous year. Fifteen people died in those incidents. “This reality and its potential amplification by copycats has reignited the debate over the adequacy of current and future hospital security arrangements,” the JAMA report says.

Bureau of Labor Statistics data show that healthcare workers are at higher risk of workplace violence than other U.S. workers. The rate of nonfatal occupational injuries and illnesses involving days away from work for healthcare/social assistance workers was 15.1 per 10,000 full-time workers in 2012, compared to 4.0 for private industry overall.

Keep prisoners restrained

The increase in shooting incidents is prompting more healthcare facilities to conduct active shooter drills, says Ben Scaglione, director of security in healthcare for G4S Secure Solutions, a security company based in Jupiter, FL.

Healthcare facilities should reassess how they handle inmate prisoners, he says. Handcuffs and other restraints can be a thorny issue, with clinicians sometimes insisting that a patient be released at least temporarily during treatment.

“It’s a lack of understanding. Clinical staff want the best for their patient, but the bottom line is they are prisoners and they need to be shackled,” Scaglione says. “Clinical staff need to understand that a shackled prisoner needs to stay that way. I saw a case years ago where a prisoner should have been shackled and wasn’t, and he was able to leave his room and sexually assault a female patient down the hall.”

In addition to potential civil liability, managers should remember the risk from running afoul of expectations from the Occupational Safety and Health Administration regarding workplace violence, says John Ivins, JD, a partner and leader of the Health Care Practice at Hirschler Fleischer in Richmond, VA. In 2011, OSHA issued Enforcement Procedures for Investigating or Inspecting Workplace Violence Incidents, document number CPL 02-01-052, to guide inspectors. Ivins suggests that managers should study the document to assess compliance with OSHA’s requirements. (See Resource below for information on updated guidelines.) Failure to protect employees from workplace violence can result in a general duty clause citation from OSHA, which Ivins calls “serious, significant, and costly.”

Reference

1. Feyerick D, Field A, Ford D, CNN. David Sweat shot and captured alive after New York manhunt. June 28, 2015. Accessed at http://cnn.it/1RG7sbs.

Resource

The Occupational Safety and Health Administration has updated Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers. Web: http://tinyurl.com/ohwgnoe.