Iowa hospital shooting a reminder of dangers posed by forensic patients

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.

According Caroline Hamilton, president of security consulting firm Risk and Security LLC, it is paramount that hospital security personnel be notified about incoming forensic patients to give them adequate time to prepare.

“To me, all of this is about procedures. If you’re a hospital, you need to have a written policy that says anyone who brings a forensic patient to our facility has to notify security at least 30 minutes before arrival, whether it is by email or by phone,” says Hamilton who also serves on the board of the South Florida Chapter of the International Association for Healthcare Security and Safety. “You’ve got to give the security directory or manager at the hospital a heads up that they’re coming,”  

Additionally, Smith says there needs to be increased lines of communication between security and other departments within the hospital. “Oftentimes, there is a miscommunication between shifts and an inmate may move from one floor to another and the orientation and situation with that inmate may change and that doesn’t get communicated to the floor staff,” explains Smith.

Although some hospitals have been designed in such a way to keep inmates separate from the larger facility, especially those that have high volumes of forensic patients, this can also be accomplished through the development of polices to keep them isolated – treating them at specific times of day or in certain clinical areas, cohabitating inmates when you can to reduce strain on manpower resources, etc.

 “One of the main things that would help tremendously is getting them in a room where there is a camera to record everything. Secondly, a security officer from the hospital should be there too because many of the incidents that I’ve seen lately have occurred because the deputy or the law enforcement officer is there by themselves,” says Hamilton. “To me, the director of security should dispatch one of their security officers there to be a second pair of eyes. A lot of time they wait until the officer has to use the restroom or something like that and then the inmate escapes. Having a second person there would be a big help.”

Smith cautions, however, that hospital security staff should not be providing relief for correctional officers on a routine basis. If a situation arises though where law enforcement is in a pinch, then he says they should do what they can to assist.

Among some of the other recommendations from the IHSS study for reducing or eliminating prisoner escapes from healthcare facilities include:

• Consider on-line training courses for law enforcement and corrections staff covering essential security elements required for providing security of prisoner patients.

• Provide adequate training for appropriate healthcare staff, particularly those who work in emergency departments and in prisoner treatment clinics

• Provide training in prisoner security for healthcare staff who contract with law enforcement and corrections to provide medical care to prisoners

• Consider reviewing corrections custody protocols to reasonably assure an appropriate level of custody for prisoner patients

• Those facilities caring for large volumes of prisoners should evaluate the risks posed and weigh the need for additional security measures, as well as consider conducting prisoner escape drills

In the end, Hamilton says that all inmates know that if they can fake an injury or get to a hospital for any reason, that it is much easier to make an escape attempt from there rather than a jail. “They’re not stupid, so of course they’re going to go for it,” she says.