Forensic patients pose security dilemma for hospitals

May 19, 2015
Experts discuss best practices for mitigating against the threats posed by prisoner escape attempts

In late March, a man accused of a dozen bank robberies in the northern Virginia area sparked a massive manhunt after escaping from custody at Inova Fairfax Hospital in Falls Church, Va. The suspect, Wossen Assaye, 42, was able to overpower a guard keeping watch over him and take her gun after another guard assigned to him left to take a bathroom break. Assaye was later apprehended in Washington, D.C. following a pair of carjackings.

This is just one of the numerous escape attempts made by prisoners being treated at hospitals in recent years. Just last summer, an inmate in Iowa shot and wounded a sheriff’s deputy at Palmer Lutheran Health Center in West Union, Iowa, before turning the gun on himself. According to reports, the inmate was able to grab the deputy’s gun when one of his hands was released during his treatment.

Despite the severity of these incidents and the safety dangers they pose to hospital staff, patients and visitors, Bryan Warren, director of corporate security for Carolinas Healthcare System and past president of the International Association for Healthcare Security and Safety, says that many people have a belief or an attitude that something like this will not happen in their facility.

“It doesn’t matter where you are geographically, it doesn’t matter what kind of neighborhood you are in or really what kind of patient population you typically serve, law enforcement can bring a prisoner into your emergency department at any time. It really isn’t an inner city or an urban issue, it can truly be anywhere,” says Warren. “In fact, I would argue that there are a lot of rural hospitals in smaller towns and sparsely-populated areas that are treating a lot of forensic patients because they may be near prisons or other areas where they are almost infirmaries for the jails and prisons. We have to get our clinical teammates in the mindset that it can happen anywhere and frequently does.”          

Although escape attempts and acts of violence committed by prisoners (commonly referred to as forensic patients) at hospitals across the country have generated a lot of headlines and raised awareness, Warren says that people seem to be susceptible to many of the same pitfalls over and over again. Chief among these problems are poor communication between staff members in the hospital.

“Many times, even in hospitals with policies and procedures and good processes, you still see that lack of communication. You can have a custodial patient and the only way that security finds out about it is they literally stumble across them doing patrol rounds,” explains Warren. “That patient could have been there for hours without any notification whatsoever and I’ve seen that in small hospitals and large hospitals. Everyone needs to work better on communicating when those patients are in the hospital – the nursing staff, the direct patient care team – they need to be speaking with security representatives to make sure everyone is on the same page. That’s not just a good idea, but it is also part of a regulatory issue with their accreditation.”

Another common issue among hospital staff, according to Warren, is that they oftentimes don’t know what they should do when they’re in the presence of a forensic patient. For example, Warren says that some people mistakenly believe that prisoners can demand to have their restraints removed while being treated when, in fact, that is up to the discretion of the law enforcement officer that has that person in custody.

Due to budget constraints, many law enforcement agencies have also turned to third-party guard services providers to transport and oversee prisoners receiving treatment at healthcare facilities. However, if these guards are not trained properly nor have an adequate amount of resources, Warren says that it is simply leaving the door open for more of these incidents to take place.

In 2011, the International Healthcare Security and Safety Foundation published a Prisoner Escape Study which found that the most frequent place for prisoners to attempt an escape from a hospital was clinical treatment areas, which was the case in just over 39 percent of the incidents studied, followed by restrooms at slightly more than 29 percent. As such, Warren says that this fact should be “first and foremost” on guards’ minds when a prisoner requests to use the bathroom.      

Warren says one of the most effective things that the majority of accrediting agencies require healthcare facilities to do to alleviate these concerns is educate forensic patient staff that are going to be transporting prisoners to and from the hospital.

“What we’ve done and, I think is a good idea that others should do, is we’ve proactively taken that information and we’ve gone to the local police departments. We don’t wait for them to come to us with a patient with them. We go to their training facilities, we go to their briefings and we have good liaison and relationships with the jurisdictions in our area and we provide them the educational material so that it becomes part of their routine in-service training,” Warren says. “That way your police and your local law enforcement aren’t seeing it for the first time when their mind is really on securing their prisoner patient and not what you’re handing them.”   

Warren says other best practices include; developing standard protocol and procedures for hospital management and staff; consider pushing out learning materials as it relates to treating forensic patients online; providing adequate training resources for the personnel that are going to be responsible for securing the patient; and having a third-party conduct a risk assessment to help spot potential gaps.

The IAHSS also has a list of best practices hospital security personnel should follow in securing their facilities against the threats posed by forensic patients which in addition to the previously mentioned recommendations include:

  • Designating specific treatment rooms or holding areas
  • Establishing protocol for providing relief for officers guarding patients
  • Designating prisoner patient entry points into the facility
  • Having protocols to verify patient treatment rooms and all areas frequented by the prisoner patient are free of hazardous items (objects that may be used to harm self or others).
  • Providing guidance on the restraints used by the custodial agency (i.e., handcuffs, leg irons, or other devices).

When it comes to in-house guards, Warren says that unless they are sworn law enforcement officers, there is little they can do in the way of providing assistance and cannot, under any circumstances, take custody or responsibility of that person, even if it just to watch them as the officer goes to the restroom.

“What we can do is certainly if the person is attempts to escape, if they are harming the guard or attempting to attack them, you can certainly aid them and assist them,” says Warren.  

As highlighted by some of the aforementioned incidents, Caroline Ramsey-Hamilton, president of Fort Lauderdale, Fla.-based security consulting firm Risk and Security, LLC, says that one of the concerns that has been brought to the forefront is the “quality” of the guards that are keeping watch over prisoners in hospitals.

“It could be law enforcement that brings them in, it could be contract security if it is a patient in a state or federal penitentiary, or it could be federal contract guards. There is no consistency on who is going to be there guarding that patient,” says Ramsey-Hamilton.

Ramsey-Hamilton also points out that all forensic patients are not the same as some could be more prone to violence than others.

“If (the patient) has mental issues and they are in prison because they are violent offenders, if they are schizophrenic or have some kind of diagnosed mental disorder especially then it becomes an even more complicated issue,” she says. “I think that is another thing to think about. All of these people who are ‘forensic patients,’ they are not all the same and have different reasons for coming in. What do you do with those patients? Do you treat them like everyone else or do you move them over to a psych facility or psych bed if you are lucky enough to have one?”  

Perhaps an even bigger issue, according to Ramsey-Hamilton, is the carrying and handling of weapons by guards overseeing forensic patients in the hospital. According to statistics from the Joint Commission, there were 154 hospital-related shootings between 2000 and 2011. Of these shootings, 59 percent occurred in the emergency department. But perhaps more alarming was the fact that in half of these emergency department shootings, the weapon involved was a security officer’s gun taken by the perpetrator.

“Those persons (that guard forensic patients) are often armed, almost 100 percent of them are armed so I think another piece of this is being able to tell them how to handle their weapon and make sure you’re aware of it and everything while they are in your hospital,” says Ramsey-Hamilton.  

About the Author

Joel Griffin | Editor-in-Chief,

Joel Griffin is the Editor-in-Chief of, a business-to-business news website published by Endeavor Business Media that covers all aspects of the physical security industry. Joel has covered the security industry since May 2008 when he first joined the site as assistant editor. Prior to SecurityInfoWatch, Joel worked as a staff reporter for two years at the Newton Citizen, a daily newspaper located in the suburban Atlanta city of Covington, Ga.