Impostors targeting U.S. hospitals: Could terrorists come to your ED?
Impostors targeting U.S. hospitals: Could terrorists come to your ED?
Recent spate of events has law enforcement officials concerned
It began with the Joint Commission on Accreditation of Healthcare Organizations issuing formal warnings about people posing as surveyors to gain access to health care facilities. However, they may have been only a small piece of the problem. ED Management has learned of more than a dozen such incidents — several involving EDs — in which individuals claiming to be Joint Commission surveyors, physicians, or members of government agencies presented themselves at hospitals and began asking probing questions about areas such as staffing and bed capacity.
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ED managers should be suspicious — very suspicious Perhaps the most powerful weapon you have at your disposal when it comes to impostors seeking to "case" your ED is a suspicious mind, says Bill Rogers, MD, FACEP, vice chairman of the ED at Middletown (OH) Regional Hospital. Rogers also is a full-time police officer with the Blue Ash (OH) Police Department and a tactical team member and medical support officer with the Hamilton County (OH) SWAT. People who work in medicine are very trusting, Rogers says. "We believe that since we have white coats and a stethoscope, that will protect us from all harm," he says. "We are kind of hamstrung by our willingness to help and probably divulge things we have no right to do." Don’t be afraid to challenge visitors and ask them to verify that they are who they claim to be, Rogers advises. "Most of the time, legitimate people will not be deterred by questions," he says. "We [in law enforcement] don’t do covert operations without notifying [hospital] security, and we don’t enter without a search warrant or subpoena, which shows we have a legal reason to be there." You certainly can ask for a business card, he continues. "One thing you cannot do is ask to make a copy of credentials," Rogers warns. "For many federal agents, that’s a crime," he says. However, you should be able to verify the credentials of federal agents and accreditation surveyors, Rogers says. "They should have no problem showing their ID, letting security write down the information, and verify it." You also should be more cautious of people who come at night, he adds. Trust your instincts, Rogers adds. "In all the cases reported, there were clues in mannerisms of behavior. You have a sixth sense that tells you when something is not right." Impostors may be uneasy, for example, Rogers notes. It also helps to think like a terrorist, which is something law enforcement officials can help you do. "They are very good at thinking about what if’s,’ — and their services are free," he points out. Law enforcement officials, for example, could do a walk-through and, based on what they know about reasonable threats, tell you what you should do. Smaller field offices may not have individuals who can provide these services, but field offices in major cities definitely will, Rogers adds. |
Here is a sampling of some of those incidents:
- March 11, 2004, a man of Middle Eastern appearance entered the ED at Warren Hospital in Phillipsburg, NJ, and directed several atypical questions to the duty nurse relating to the hospital’s bed capacity, the means by which care was delivered, and how many patients the department had at certain times. When he noticed the department’s surveillance cameras, he left the premises.
- March 23, 2005, an e-mail was sent to Indiana health care security officials by Thomas Huser, a former safety officer at St. Vincent Hospital and Health Services in Indianapolis, that said men of Middle Eastern descent tried to gain access to EDs at three hospitals, which were not named.
- In October 2004, officials at two hospitals in the Phoenix metropolitan area reported suspicious activity, including photography, requests of building layout, inquiries regarding the location of the pharmacy, and computer fraud.
- Three men inquired as to the location of the pharmacy at St. Joseph’s Hospital in Phoenix. The men previously had visited hospitals in Texas and Indiana. All three hospitals are distribution points for the antidote medicines for biological attacks.
The following incidents involved impostors posing as Joint Commission surveyors:
- Feb. 26, 2005, at about 3 a.m., a Caucasian man and Caucasian woman posing as surveyors arrived at a Los Angeles hospital. The man is described as mid-30s, dark hair, approximately 6-feet tall, and dressed professionally. The woman, also in her mid-30s, has dark reddish hair. A security guard at the hospital believed he saw the two individuals wearing badges similar to those used by genuine surveyors. The impostors exited after they were stopped by hospital security.
- In the second incident, March 3, 2005, at 3 a.m., a man described as 35-40 years old, of South Asian descent, 6-feet tall, and with a short black beard and mustache, demanded to inspect a medical facility in Boston. The man left the premises after being questioned by hospital staff.
- In the third incident, in the morning of March 10, 2005, a Caucasian woman described as mid-40s, 5-feet 7-inches tall, 160 pounds, with blonde hair, entered a Detroit hospital through the maternity ward and began wandering around the facility. When hospital staff questioned her, she stated that she was a Joint Commission surveyor. After further questioning, she fled the premises.
What is behind the recent activity? Are terrorists starting to "case" hospitals and EDs for potential attacks, or is it something less sinister afoot? Health care industry and law enforcement experts aren’t taking any chances.
"One thing that has always surprised me is that we had not had a stealth probe or two in hospitals by individuals looking to gain intelligence into America’s health care infrastructure, with an idea for sabotaging it," notes Bill Rogers, MD, FACEP, vice chairman of the ED at Middletown (OH) Regional Hospital. Rogers also is a full-time police officer with the Blue Ash (OH) Police Department and a tactical team member and medical support officer with the Hamilton County (OH) SWAT.
"Pieces of information they would be looking for might be bed capacity, transfer arrangements, the national disaster medical system — a lot of which is actually public record," he says. "But an actual visit gives you specific intelligence as to what the facility’s entries are like at different times of the night, what barriers you might have, if you can you gain access by the backdoor, and so on."
Such individuals also can gain a lot of information simply by driving around a facility — much like a bank robber would do before a planned heist. In fact, notes Joe Cappiello, the Joint Commission’s vice president for accreditation/field operations, this already may be occurring. "Among the reports of suspicious activity we’ve received was that of a pickup truck outside a Northern Virginia hospital’s ED, taking photographs of the facility," he shares.
Cappiello says the recent reports indicate something out of the ordinary may be afoot. "I probably get two or three calls a year from hospitals saying they have someone who claims to be from the Joint Commission," he adds.
Mostly, what they are trying to do is gain some service advantage — be seen in the ED faster or get a better room, Cappiello notes. However, those events almost always take place during the day, he says. "What was unusual about two of these recent events was that they occurred at 3 o’clock in the morning," Cappiello says.
Hospitals and EDs always have been targets for criminal activity, he continues, but these impostors were not asking where the drugs were stored or how they could get to the pharmacy. "They were asking things about structure, how many staff the hospital had on the second shift, what the capacity of the ICU was," Cappiello says. "Those aren’t questions criminals ask."
Double-check your plans
In light of these recent events, now would be a good time to double-check your all-hazards plan, Rogers advises. "This is absolutely essential," he says. "[Do you] know where your ventilator shafts are? How is your facility lighted and guarded? What type of security officers do you have, and what are they equipped with? What is your badge and access policy?
Rogers recommends that you — or even better, a friend or family member who wouldn’t be recognized by hospital staff — go into your department at 3 a.m. "Can they get in without being seen or without being deterred? If they are ungreeted and unnoticed, you have a huge problem," he warns.
Every medical facility needs to rethink its security plan, Cappiello says. "It’s a good time to go back and reflect on the reality of how freely accessible you really need to be."
There may be some key access points where a credential or badge should be required — or some sort of challenge, he says.
"Naturally, you don’t want to challenge folks in obvious pain and trauma, but what about all the other folks who come in and wander about?" Cappiello asks. "Who is making sure they have business at the facility? That they are being monitored? That they can’t get from one part of the medical center to another without some check?" (For more on how to protect your facility against impostors, see box, above.)
Sources
For more information on impostors in the ED, contact:
- Joe Cappiello, Vice President, Accreditation/Field Operations, Joint Commission on Accreditation of Healthcare Organizations, One Renaissance Blvd., Oakbrook Terrace, IL 60181. Phone: (630) 792-5757.
- Bill Rogers, MD, FACEP, Vice Chairman, ED, Middletown Regional Hospital, 105 McKnight Drive, Middletown, OH 45044-4898. Phone: (513) 200-1275. E-mail: [email protected]. (Please note: After pressing "send," hit "enter;" otherwise, your e-mail will be considered spam.)
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