Iowa hospital shooting a reminder of dangers posed by forensic patients

Experts discuss best practices for healthcare facilities in preparing for inmate escape attempts


Last week, a jail inmate being treated at Palmer Lutheran Health Center in West Union, Iowa, shot and wounded a sheriff’s deputy before turning the gun on himself in a failed escape attempt. No other hospital staff members or patients were injured as a result of the struggle. This is just one of the numerous incidents that take place in hospitals across the nation each year involving forensic patients. According to study conducted in 2011 by the International Healthcare Security and Safety Foundation, there were a total of 99 documented cases of hospital escapes by prisoners between April 1, 2010 and April 30, 2011.    

Thomas Smith, the former director of hospital police and transportation for UNC Health Care in Chapel Hill, N.C. and co-author of the aforementioned report, says two of the biggest precursors to an escape or attempted escape by an inmate in a hospital are the removal of restraints and when they allowed to use the bathroom unmonitored. In fact, of the incidents examined in the IHSS study, more than 68 percent of the escape attempts occurred when restraints had been removed.

The incident that happened this past weekend in Iowa is a prime example of the dangers in removing an inmate’s restraints. According to a statement released by the Iowa Department of Public Safety’s Division of Criminal Investigation, the inmate, identified at 32-year-old Steven Harreld, was in the process of being discharged from the hospital when the deputy released him from his handcuffs to allow him to change into his jail clothes. Authorities say Harreld attacked the deputy when he went to release his leg restraints and was eventually able to wrestle his firearm away from him.

Smith says that restraints should only be removed in cases where it is clinically necessary.

“Some hospitals require two restraints to be on at all times. If the inmate is in bed, then an arm and a leg needs to be restrained on opposite sides,” says Smith, who currently serves as president of Healthcare Security Consultants, Inc. “I’m familiar with one case where the inmate only had one restraint on and he was able to pull the bed over,  corner the corrections officer and disarm him. Several shots were fired in his attempt to escape and, ultimately, the inmate attempted to commit suicide with the officer’s gun. If he would have had two restraints on, he wouldn’t have been able to pull the bed over and disarm the officer.”        

Because Harreld reportedly had a previous conviction on his record for an assault on a police officer, Smith says that should have been evaluated as part of a risk assessment prior to his admittance to the hospital. “There should have been a discussion with the representative of this hospital, typically it is the security leadership, but some hospitals don’t have a single leader in security so then it would have to be some other administrative rep,” says Smith.

While the position of some hospitals is that the correctional facility or law enforcement agency that has custody of the prisoner should bear all of the responsibility when it comes to safety, Smith says that healthcare facilities are still responsible in terms of the overall risk to patients, visitors and staff members.

“Hospitals tend to relinquish control of these situations to the correctional facilities and I don’t think they should do that,” says Smith. “They should look at the guidelines that have been previously established for prisoner patient security; having a multi-disciplinary team, establishing what the policies and procedures are for each hospital, and those rule should include an orientation of security and clinical staff to the policy.”

Because some hospitals have contracts with state agencies and correctional facilities, Smith says there should be procedures written into those contracts for the storage and handling of weapons on the premises. For example, Smith says many facilities require that there be two corrections officers with each inmate and that the officer responsible for being in close contact with the patient not be armed. In those cases, one officer is designated to carry two holsters, one for his own weapon and one for the other officer’s gun.

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