Securing Forensic Patients in the Public Hospital Setting: Part 1

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

Case Study: Gerald Hammond, Director of Public Safety at a large medical center in the Midwest was caught off guard when he was approached by a JCAHO surveyor during an unannounced visit, and asked for documentation of their orientation and education of forensic staff accompanying inmate patients. He was certain he had never seen that in the JCAHO Environment of Care standards. He was correct. It is found in the Human Resources standards (HR 2.10-8.) Gerald's hospital was found "out of compliance."

Tip #3: JCAHO standards require that correctional officers guarding forensic patients receive orientation and education including procedures for responding to unusual clinical events and incidents, the hospital's channels of clinical, security and administrative communication, and distinctions between administrative and clinical restraints. This "C" standard requires data collection as a means of proving this is occurring.

Hospital security departments should require that all correctional officers stop at a central location (the security office) to receive printed information orienting the officers to the meanings of the various codes (Code Blue, Code Red, Code Gray, etc.,) the RACE and PASS procedures, HIPAA and any isolation requirements prior to assuming their post. Documentation of the orientation, the name of the correctional officer and facility should be kept on file. In addition, the security department staff should make periodic audits of correctional officers to assure that all who guard forensic patients have received the orientation information and are documented.

[Editor's note: In the second part of this article on securing hospitals for forensic patients, Pamella Carter will look at general guidelines for the care of forensic patients and will present a forensic patient bill of rights.]

About the Author: Pamella G. Carter, RN, BSN, MA, ACM, is an internationally recognized healthcare consultant and co-founder of Security Assessments International. Pam is a senior consultant with SAI and director of clinical and regulatory affairs. As a Registered Nurse (R.N.), Pam has over 35 years experience in nurse management, nursing education, home health, occupational health, acute care, and case management. Her expertise includes extensive experience with both CMS and JCAHO regulatory standards for acute care. Pam has consulted on forensic patient practices at the local, state and federal level and is one of the nation's leading experts on the safe care for inmate and forensic patients in the acute care setting. She was one of the first RNs in the nation to be certified as an Accredited Case Manager by the American Case Management Association. Pam has consulted with the United Kingdom's National Health Service for the past several years and is currently working with the NHS on several major projects. Pam can be reached at