Fighting Intrusion of Violence into Hospitals

Jul. 17--Howard County General Hospital is a typical suburban facility, its administrators proud to be known for the cozy maternity suites, the cancer support programs and sophisticated technology.

But they're not so happy about the kind of publicity the hospital has faced in recent weeks: a midnight brawl in the emergency room that ended in three arrests and three injuries; a suspect awaiting drug charges who slipped out and remains at large.

While rare, such incidents have unnerved patients and staff and highlighted the fact that once-sleepy suburban hospitals - like neighboring shopping malls and schools - now have to cope with complex crime and security issues.

"Today, every hospital is at the same risk of exposure to drug and alcohol abuse, domestic violence and psychiatric patients," said Roger Sheets, president of the Maryland chapter of the International Association for Healthcare Security and Safety. "All of it shows up in your emergency room, and your security officer at the front door has to have a better level of training than being told to say, 'Good morning. How are you?'"

For their part, suburban hospital officials say they offer an appropriate level of security given the risks they typically encounter - the occasional unruly patient, emergency room ruckus or specialized needs, such as those posed by psychiatric units.

"The hospital employs security guards, not police officers," said Mary Patton, a spokeswoman for Howard County General Hospital, who declined a request for an interview with the hospital's security director.

Hospital security experts say concerns have escalated at virtually every institution - urban and suburban - in the wake of Sept. 11 and worries about such issues as bioterrorism. Some states, such as New Jersey, have considered sending in "red teams" of undercover agents and contractors to test hospital security.

"Right now, the federal government is trying to determine how lax hospitals are, and I can tell them ahead of time that they're not anywhere near where they need to be from a security standpoint," said Jeff Aldridge, former director of safety at the University of North Carolina Medical Center at Chapel Hill and now a consultant on health care security. "Hospitals want to be an open, warm atmosphere where people can come bond with a patient, but you can't do that anymore."

More cameras

Security measures include sophisticated camera systems allowing staff to monitor hallways and emergency rooms; intensive training for guards, who may be armed in some cases, and equipment that can lock down all of a facility's doors.

But there remains a gulf between the level of security offered at smaller, suburban hospitals and at urban complexes such as the 500-bed Sinai Hospital of Baltimore, the state's third-largest, which handles 10,000 visitors a day.

Sheets, who directs security for Sinai and the three other LifeBridge Health facilities in the Baltimore area, said the 80 security officers at Sinai carry batons and some of them carry guns. Most of the facility can be locked down electronically.

At 187-bed Howard County General, by contrast, security officers do not carry weapons of any kind and only security supervisors carry pepper spray. Howard County can lock some of its doors electronically, but a spokeswoman would not say which ones. At 260-bed Anne Arundel Medical Center, emergency room doors must be locked manually.

"After 9/11, and even more so after Hurricane Katrina, all of us are looking at this issue," Sheets said. "After Hurricane Katrina, one facility went 10 days without help from the outside world. They had to face bands of roving gangsters. They now know how valuable a proficient security force is. Could that happen in Baltimore? Absolutely."

Howard hospital officials are painfully aware of how a security issue can erupt even in a relatively peaceful suburban community.

On a Saturday night in June, for example, an angry crowd of 20 to 30 tried to shove past guards in the emergency room - even trying to climb over the reception desk - in an effort to see a friend who had been fatally shot. Three were arrested, and the hospital had to divert incoming patients elsewhere for a short time.

Last Sunday, a patient who had been brought in after nearly drowning while fleeing police slipped out of an inpatient floor where police had left him to be treated for severe injuries. Authorities had been waiting for him to recover so they could charge him with cocaine possession. He remained at large yesterday.

The pressure is on

Hospital and police authorities insist that they acted properly in both cases. Hospital spokeswoman Patton said the police would have to explain why no one was guarding the drug suspect."If a police officer had been stationed with him, we would have given that officer an orientation, told them how to contact our security, if they needed help, and checked in with the officer on an hourly basis," Patton said.

As for a disruption such as the emergency room brawl, she said, hospital security "would have moved to immediately protect the hospital's patients and visitors and then called police. ... In this instance, the police were already there."

Police spokeswoman Sherry Llewellyn said that police remain on the scene if a patient is expected to be charged with a violent crime. In non-violent cases, police weigh their resources, the suspect's injuries and the expected length of hospitalization in deciding whether to post a guard. In the case of the drug suspect, officers had been instructed to check on him "every few hours" and had been doing so.

"The hospital has a security team, has cameras and has the ability to monitor what's happening in their hospital, including those patients there with detainers," a form that was used in this case requiring the hospital to alert police when the suspect was ready to be discharged, Llewellyn said. "They are not obligated to station a guard 24/7, but they do help us monitor patients' status when we give them a detainer."

Health care security consultant Aldridge said the drug suspect incident reflects the competing pressures on hospitals and law enforcement in smaller communities.

"Police say they don't have the resources to tie up an officer just sitting with the guy," Aldridge said. "But then the hospital says, 'If he's that important, you need to sit with him and take him away in leg irons when he's ready.'"

Even if hospital authorities had known the suspect was sneaking away, they wouldn't have had the right to keep him there, Aldridge added. And he is sympathetic to the challenges hospital workers can face in dealing with criminal suspects.

"I once had a guy come in on life support, and we told the police that they didn't need to stick around because he wasn't going anywhere," Aldridge said. "Well, his girlfriend came in with a butcher knife, cut all of the lines and wheeled him out. He tried to get treatment at another emergency room, with IV's sticking out of him. We got him there.

"They're not rocket scientists."

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