Securing Forensic Patients in the Public Hospital Setting: Part 1

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

The liaison should ensure that hospital administration and security have the contact information for the key correctional facility personnel. This includes the direct telephone numbers for the warden or jail director, the medical director of the correctional facility, the company that performs the utilization review function and a contact at the correctional facility that will receive the inmate upon return. Periodic meetings should occur between key hospital representatives and those of the correctional facility. This ensures that lines of communication are kept open and any changes in contacts, procedures, or processes are shared. Prison and healthcare administrators must have continuous dialogue to identify conflicting issues that impact the care of forensic patients and the safety of other patients and staff.

Case Study: John Hilton, Director of Security at a major medical center was shocked when he discovered that the patient in room 63251 was an unescorted inmate on community furlough. Unfortunately, he discovered it only after the inmate had assaulted one of the hospital physicians who gave him a diagnosis he didn't want to hear. It seems the inmate had a personality disorder characterized by violent outbursts. He had been doing so well at the detention facility that the correctional staff felt he deserved to be on medical release.

Tip #2: Make sure your hospital has a "Forensic Patient Policy" or a "Care of Patients in Custody of Law Enforcement Policy", and that all correctional facilities using your hospital have a copy. Even more importantly, make sure your staff is familiar with the policy.

Most correctional officers providing security for forensic inpatients are receiving over-time pay, and providing security for their patients becomes very cost intensive in terms of productivity and budget for the correctional facility.

As a means of reducing these expenses, facilities often place pressure on physicians to discharge forensic patients back to the correctional facility as quickly as possible. Other times they will provide one correctional officer when two would be more appropriate. In addition, they will send certain inmates to the medical facility unaccompanied by any correctional officers. Indeed, I have seen them send a "community furloughed" inmate to pick up another one from a hospital at discharge.

Hospitals should also determine their approach to the care of trustee or community furloughed forensic patients. Many correctional facilities do not want to provide correctional officer coverage for these patients. Often, the patient is sent to the hospital for care unaccompanied by officers and left to their own recognizance. It is not uncommon for these patients to begin acting out and harassing nursing staff. If this occurs, the hospital security director or supervisor should immediately contact the correctional facility and demand correctional officers be assigned immediately and remain with the forensic patient until he is transferred back to the correctional facility.

Depending upon the crime and the level of security, a forensic patient may have one, two or as many as four correctional officers at any given time. A female correctional officer should always accompany female inmates, even if other officers are male. Make sure that it is well understood by the correctional facility and the hospital staff that hospital security personnel will not provide coverage or relief for correctional officers accompanying forensic patients. Under no circumstances should the hospital assume responsibility for the security of forensic patients. Indeed, should an inmate patient attempt to escape, no hospital staff members should ever attempt to stop or apprehend the inmate. They should only try to ascertain the direction the inmate is taking and keep staff and visitors out of the way.

Budget cuts at the Federal Bureau of Prisons has led them to employ contract guard services to provide security coverage for certain classes of their inmates requiring acute care hospitalization at civilian facilities. Hospitals serving this population should ask for the qualifications and for any firearm certifications for the security guards accompanying Federal inmate patients.