Murder in the Hospital: A Lesson from an Actual Security Event

A tragic event in Virginia is a reminder of the importance of proper hospital security procedures

While cooperation and collaboration on firearm policies and procedures between local law enforcement and hospital security is essential, ultimately it is the hospital that knows best what their needs, issues, regulations and patient populations are. Regrettably, hospital security departments often abdicate their onsite authority to law enforcement agencies which are much less attuned to security in the health care environment.

Developing Appropriate Security Policies and Procedures

Hospital emergency department staff members are often not consulted when planning the security policies and procedures for their area. The physicians, nurses, technicians, clerical and other staff who literally put their lives on the line each day are rarely asked about their perception of their security needs. These dedicated individuals love their jobs, but are often terrified because they are aware of the dangers they face. Consider the types of threats that will enter a hospital on a daily basis:
- patients who have active psychiatric diagnoses
- patients who are acting out
- patients high on drugs or having adverse reactions to illegal drugs and/or alcohol
- gang members with a history of violent behavior
- family members in the midst of abusive situations
- patients and families reacting to stress, pain and grief
- and, of course, prisoners desperate for an opportunity to escape.
All these situations combine to create a highly volatile environment for health care workers.

To respond to such threats, all hospital emergency departments -- regardless of size or location -- should undergo a complete security assessment a minimum of every two years by an experienced healthcare security expert. These consultants know the regulatory requirements, the culture and the issues. They can assist hospitals and law enforcement agencies to develop policies and procedures to protect patients, visitors, staff and officers. While electronic and physical security devices are essential to a good security program, the key is the development and adherence to policies and procedures with consideration of the end users - nursing staff and healthcare practitioners.

Hospital violence is a significant, growing and widespread concern nationwide. Our emergency departments and clinical areas are by no means immune to acts of violence. Emergency medicine professionals know the direct negative impact violence has on the quality of patient care, their employees and staff retention. Emergency medicine providers across the country continue to voice concern for their safety in this volatile work environment.

We will never be able to eliminate the stressors that patients bring with them to emergency departments. However, we can and should ensure the staff and patients working in these stressful environments, as well as the care they provide to patients and families, occur in a safe environment.

In a previous article, Securing Forensic Patients in the Public Hospital Setting: Part 2, the author describes a Forensic Patient Action Plan listing nine of the most commonly identified problems and concerns that arise when dealing with forensic patients. It suggests a plan of action for each problem and shows the individual(s) and/or department(s) that typically have responsible charge for addressing these problems. This plan has been posted on as well as the SAI website. To view or print an action plan for dealing with forensic patients, you can access either the Forensic Patient Action Plan (web/HTML version) or the Forensic Patient Action Plan (downloadable Microsoft Excel version).