Crowded hospitals, criminal patients a 'recipe for disaster'

Monday, September 12, 2011

YARMOUTH, Maine—In November 2010, a prisoner in Santa Cruz, Calif., who’d been brought into a local hospital for an MRI scan, overpowered his female corrections officer, Tasered her with her own Taser, stole her gun, and escaped. The fugitive was later recaptured, but the incident was widely reported in the press and shined a spotlight on a major issue for hospital security directors: how to properly handle criminal patients and potential escape attempts.

There's a squeeze going on in U.S. hospitals. More mental health patients are showing up at emergency rooms and staying longer in the hospital beds, Bryan Warren, senior manager of corporate security at Carolinas HealthCare System and incoming president of the International Association for Healthcare Security and Safety, told Security Director News. As a result, ERs are crowded and the wait times are longer. Add criminals–known as "forensic" patients—to the mix and you have a "recipe for disaster," Warren said. "The longer they wait, the more opportunity there is for them to either formulate an escape plan or make good on one."

There is no comprehensive national system in place to collect data on forensic patient hospital escapes, so it's not possible to track whether the number of escape attempts have increased, Warren said. So, to better understand the issue, the International Healthcare Security and Safety Foundation commissioned a study on the issue, which was released this summer. The study highlights the issues that led to incidents involving forensic patients and provides recommendations for hospitals to better handle those situations. "Education more than anything is what I hope that other hospital security directors get out of this [study]," Warren said. "A forensic patient can happen anywhere at any time, regardless of geography or the size of a facility. So we need to be prepared for it."

With no national database of reported forensic patient incidents, the study was forced to pursue escape events that were reported in the media. A total of 99 cases of hospital escapes by forensic patients were documented between April 1, 2010, and April 1, 2011. To compile the study, its authors interviewed 253 individuals involved in the incidents, including local law enforcement officials and hospital security staff.

Some of the study's results:

•    Ninety-four percent of escapes were by male prisoners.

•    Nearly 79 percent of the escapes took place while the prisoner was in custody of law enforcement and 21 percent occurred while they were in custody of hospital security.

•    A majority of escape attempts (39.4 percent) took place in the clinical treatment areas, followed by the restroom (29.3 percent), outside the hospital (17.2 percent), and in the ER (14.1 percent).

•    In 62 percent of cases, the prisoner's restraints were partially or completely removed.

In most cases, the study found, the escapes were a result of a failure to follow proper procedures and policies. "There was a number of facilities–a surprising number–that simply said 'we're not prepared if something like this were to occur,'" Warren said. "They really don’t have any plans, any policies or procedures on what to do about [escapes]."

The study includes the following recommendations:

•    Develop and/or use standard procedures and policies for managing prisoner patients. The IAHSS has basic guidelines for handling prisoner patients.

•    Implement training for appropriate hospital staff and law enforcement and corrections officers. 

•    Consider on-line training courses for law enforcement and corrections staff covering essential security elements required for providing security of prisoner patients. A good example is the on-line training offered by Florida.

•    Healthcare facilities that care for large volumes of prisoners should evaluate risks, weigh need for additional security measures and conduct prisoner escape drills.

•    Document and track incidents involving forensic patients in order to identify causes and better prepare through enhanced security measures.

Warren recommends that security directors, or those responsible for hospital security, take an all-hazards approach to the issue. "You know what—this might never happen," he said. "But they need to drill. Not every other week, but at least once a year. I think a drill on an escaped prisoner is a worthwhile effort because it lets everyone know what their role and responsibility is and you'll get a lot of lessons learned because a debriefing after a drill like that is invaluable for tweaking and fine-tuning your procedures."

The study also recommends lobbying for a federal law that would require all hospitals to report incidents of crime in their facilities. It would be similar to the Clery Act, which requires all colleges and universities to report crime on campus. "You cannot hope to effectively resolve an issue that you are not aware of, and with such significant underreporting of these types of situations, escape attempts from hospitals by forensic patients as a subject has not gotten the attention that it deserves," Warren said. "If healthcare facilities were required to report such issues, then they would have a much better chance of being addressed properly."


During an escape of a prisoner being treated in a medical facility as a security officer my only duty at this time will be to maintain the safety of staff, patients, visitors. The act of trying to capture the escapee should soley be that of law enforcement.