With all eyes and ears focused on the unimaginable mass shooting of children in Newtown, it was not surprising that the shooting on December 15th at an Alabama hospital received little national attention. That shootout at St. Vincent Hospital in Birmingham – in which the gunman was killed by a police officer and two hospital employees injured – was far from the first incident of violence occurring in a healthcare setting during the past year.
According to Dr. Victoria Mikow-Porto, the principal researcher and writer on the recently-released 2012 Crime and Security Trends Survey underwritten by the Foundation of the International Association for Healthcare Security and Safety (IAHSS, the international organization for professionals in the healthcare security, safety and management fields), 2012 holds the dubious distinction of being the year with the greatest number of fatalities reported by IAHSS members since IAHSS began surveying its members nearly 20 years ago. Eight homicides were reported among member facilities during the year.
Porto explains that the Crime Survey provides a kind of compass to trends as well as provides information identified by healthcare security professionals as critical to their needs in a rapidly changing environment. The data are useful not only to security and safety professionals but also to their administrators, the media and others. The survey can inform and assist in the identification of areas most vulnerable to crime and violence, which crimes are most likely to occur, and resource allocation to remedy these incidents. It helps IAHSS in developing professional training, education, policy and procedures strategies to address the HCFs’ current and future needs. The public and the media can draw upon this background for discussions of crime and violence incidents and their prevention at HCF campuses.
The spike in crime is not isolated to fatalities by violence. The results of the 2012 Crime Survey, which was based upon responses from 208 member health care organizations to an online questionnaire, indicates that HCF crime increased in nearly every category since the most recent survey in 2010, with significant rise in the number of simple assaults, larceny and thefts, vandalism, and rape and sexual assaults. It’s also the highest number of crimes ever recorded in the history of the IAHSS Crime Survey, with 20,515 crimes reported: an increase of 5,524 over 2010.
According to the research evidence, 98% of healthcare facilities now experience violence and criminal incidents. Porto attributes the surge to a number of factors, among them:
*greater access to weapons, particularly guns
*generally 24/7, open access to an expanding number of large and small healthcare complexes
*long, frustrating waits in emergency rooms
*increased size and violence of gangs, and carry over of gang warfare into HCFs
*deinstitutionalization of psychiatric patients who are unable or unwilling to take meds
*increasing treatment of forensics patients who are at high risk for violence
*rise in substance abuse, and easily-accessed hospital pharmacies
“It’s important for the public to know that, by and large, HCF’s are safe places; homicides, while rising, are still considered statistically rather rare events like a school shooting,” she reassures. “When these violent incidents do occur, they impact everyone and make us all afraid.”
Porto points out that the numbers of criminal, violent and aggressive incidents are based on reported crimes, adding that the US Department of Justice estimates that at least half of all crimes go unreported. “If that’s the case, these statistics are truly huge” she says of the 2012 Crime Survey.
While the need for accurate crime statistics is obvious, Porto claims that collection is hampered because of litigation concerns faced by HCFs over potential liabilities. She urges legislation to hold harmless such institutions for the purpose of encouraging comprehensive reporting of incidents, and the standardization of crime definitions to further enhance accuracy.
Although crime, especially violent crime, has been on a downward trend in the US since 1993, the same cannot be said of HCFs. However, with the latest report from the Department of Justice finding the crime rate for 2011 grew by 18%, Porto speculates that “now maybe what’s going on in society at large is reflecting what’s been happening for some time in healthcare facilities.”
The impact of the increased criminal activity is reflected in results throughout the Survey. There were more HCF requests for outside police assistance than in 2010; more security guards with sworn police powers; and an uptick in the number of security and safety professionals hired by HCFs. “It is of special concern that the greatest rise in calls for outside law enforcement assistance was in the category of ‘more than 75 times’ in the past year,” Porto points out.
So what can HCFs do about this trend? Porto highlights a few of the risk factors that she sees trending higher: greater availability of guns, more gang violence being carried over into the hospital itself, and increased numbers of forensic patients being treated by regular hospitals because prisons have closed down or reduced their own healthcare facilities. “It boils down to the same issues as gun violence in general: if we want safer facilities, what do we need to do to make them safer?” Porto asks, adding “just arming more people is not necessarily the right answer.”
When asked what policies can help reduce HCF crime and violence, Porto lists more vigilant surveillance of people entering hospitals, use of restraints on patients most at risk of being violent, metal detectors to reduce presence of weapons, and training in violence de-escalation for personnel in high risk areas, to name a few.
The public has a role to play as well: “What is the public’s choice about improving safety? Metal detectors and purse searches, or an attractive inviting lobby where it’s not quite so safe?” she asks. Cost is also clearly a factor in implementing such initiatives, particularly the more advanced surveillance and alarm technologies that are becoming available.