Securing Forensic Patients in the Public Hospital Setting: Part 1

Creating workable security policies to deal with this 'invisible population'

James Dean convinced the correctional staff at the local jail that he was spitting up blood. He had only a week remaining on a 60-day sentence for forging a check on a former employer. Since it wasn't a violent crime he was sent to the local emergency room for evaluation accompanied by unarmed detention officer. James needed X-rays, so the officer removed his handcuffs and remained outside the room while the films were being taken and developed.

The detention officer was engrossed in conversation with one of the nurses when, suddenly, the inmate rushed past them and was running at full speed through the hospital clad only in a hospital gown. He made it out the door and into a staff parking lot where he attempted to steal the automobile of an arriving employee. The detention officer and a hospital security guard with his gun drawn were in hot pursuit when the security guard stumbled and fired the gun. The bullet narrowly missed the employee's head, but struck the fleeing inmate. Sound too far fetched to be true? It actually happened.


Many community hospitals, medical centers and teaching hospitals today admit a patient population that is rarely publicized, sometimes unacknowledged, and often not sufficiently monitored. These public facilities are usually as ill equipped to provide secure areas to care for forensic (inmate) patients as the hospital staff is to deal with them.

As budgets are cut and prisons become more crowded, penal institutions are increasingly faced with providing constitutionally mandated healthcare to a population that is often among the highest at risk for serious untreated medical conditions. Huge numbers of prisoners have problems with mental health, substance abuse or personality disorders and have often been excluded from healthcare. The lifestyle and habits of individuals who often end up in the correctional system generally does not include healthy habits and preventive care. Thus, by the time they enter the system their bodies are responding to years of drug and alcohol abuse, smoking, and lack of consistent treatment for many chronic as well as acute diseases. Infectious diseases are rampant with HIV, hepatitis, TB and drug-resistant bacteria commonly occurring. While many correctional systems have medical facilities to handle routine healthcare, they are strained to provide the more complicated and involved care these patients require. As a result many are transferred to public hospitals.

Unfortunately there is no primer for either hospital security or medical staff to use in caring for these patients. Many community or university hospitals do not have secure prison wards or units. This article provides some general guidelines that should be taken into consideration by all hospitals that admit forensic patients.

Tip #1: Have a hospital staff member who acts as the point person for correctional facilities.

This individual may or may not be the security director, but it should be consistent. It is not at all unusual for a hospital to have forensic patients from multiple correctional facilities at one time. This means that the patient could be a federal inmate, an inmate in a state prison or one from the county jail. Each of these facilities will very likely have different rules and regulations for handling and guarding their inmates. The actual care of these patients probably won't differ for the medical and nursing staff, but the hospital liaison should know the differences and identify the channels of communication.

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