Public Safety at Hospitals: Are You Safe?

 By Kristine Crane

When the distraught son of an elderly woman undergoing cancer treatment at Johns Hopkins Hospital in Baltimore opened fire on his mother's surgeon in September 2010, shock, panic and a total lockdown of the hospital set in. The surgeon recovered, but the hospital staff was traumatized.

Hospitals are places of healing, but they are also public institutions -- not unlike the mall, airport or school. That opens them up to the same types of security issues that increasingly plague public environments.

"Securing a hospital is very different. It is meant to be a welcoming place," says Gabor Kelen, chair of emergency medicine at Johns Hopkins University and director of the Center for the Study of Preparedness and Catastrophic Event Response. "The idea of turning it into Fort Knox is not really doable."

In the aftermath of the 2010 shooting, Kalen and colleagues conducted a study of hospital-based shootings in the U.S. between 2000 and 2011. Searching through media and other reports, they identified 154 incidents -- a little more than half of those inside hospitals.

"When you think about all the kinds of shootings in the U.S., 90 in 12 years is almost nothing," Kelen says, adding that almost none were random acts of violence. Most took place either in the emergency room or patient rooms and were motivated by a grudge, suicide or intent to euthanize an ill relative.

"If you're a patient and are going to be shot, it's going to be by a relative who wants to put you out of your misery," rather than as a victim of episodic violence, Kalen says.

[Read: Your Rights as a Hospital Patient.]

Patient-Generated Violence on the Rise

What is instead increasing at an alarming rate in hospitals is violence perpetrated by patients themselves -- typically, mental health patients or the elderly.

"I was a cop in D.C. for 10 years, and I've got nothing on an emergency department nurse," says Kevin Whaley , the director of security at the George Washington University Hospital in the District of Columbia.

Patients will bite, hit, pull knives and even turn to hospital equipment like IV poles to use as weapons against those who are caring for them.

Tony York, the chief operating officer for Healthcare Security Services in Denver, Colorado, which monitors security at hospitals throughout the nation, says there has been an "explosion of patient-generated violence" in the past several years -- both from patients themselves and, often, the people accompanying them to the hospital. "Those are things that have driven this industry immensely," York says.

Whaley adds that in the last year, the rate of mental health patients arriving at the ER has increased 500 to 600 percent because of federal cutbacks in mental health programs. As a result, both hospital staff and security officers have had to adopt a more proactive approach to recognizing potentially violent patients and visitors and taking measures to calm them down.

[Read: 11 Items to Pack in Your Hospital Bag. ]

Safety Measures

"We're an urban hospital in the nation's capitol, so there's a much more heightened level of threat for us," Whaley says. In any given day, their stream of ER patients runs the gamut from international dignitaries to homeless drug addicts, and everyone in between.

At GW, as with most hospitals throughout the nation, anyone who enters has to sign in, state the reason for the visit (if it's to visit a patient, that patient will be called) and show a photo ID. About 130 security cameras are in various locations, such as waiting rooms and cafeterias, but not in patient areas because of privacy laws.

GW doesn't have metal detectors like some hospitals do; nor do they have armed guards inside the hospital. The idea of unarmed guards is to keep guns outside of hospitals, since most perpetrators of violence use guns they've grabbed from security guards (instead of guns they've brought in.) "Some hospitals include police dogs in the waiting room, and that has a certain calming effect," Kalen says.

And usually certain units have heightened security measures: Labor and delivery, the ER, the ICU, and mental health floors generally require swipe cards to gain entrance.

York adds that some hospitals are also being redesigned for heightened security -- with features like bulletproof windows that don't face public roads. "Now it's a matter of thinking about, where do I position a nurse taking vitals?" he says. "How do we now sterilize rooms for potential weapons when we know that the typical hospital environment has a lot of things that can potentially be used in violence?"

[Read: Paint, Write, Sing: How the Arts Help Heal Patients.]

What to Watch For

The average hospital patient -- and his or her loved ones -- should not have to worry about their own safety. They should, however, be aware of a few things:

-- "It's important that patients and visitors recognize how intense the environment is," York says. Hospital visits to the ER, at least, are usually not first-come, first-serve. The sickest patients get priority, so be prepared to wait and deal with that waiting period. "Wait times increase anxiety and the tendency to act out," York adds.

-- "If you see something, say something." Whaley says the same advice to D.C. metro riders applies to hospital visitors. Be aware of your surroundings, and if something or someone looks suspect, report it.

-- Be patient with security measures. Whether it's waiting in line to show your ID or obtaining special permission to visit a loved one on an extra-secure floor, realize that the measures are there for a reason.

"Understand that with security, we are trying to minimize the level of inconvenience," York says. "It's not to make their lives more miserable, but to keep [patients] safe. The health care environment as a whole is still very safe. We shouldn't have people worrying about personal safety when they need to harness their energy to heal themselves."