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The high risks of high-profile patients


Two prisoners on the loose in New York led to a high-profile patient in the hospital 

The high risks of high-profile patients

Two prisoners on the loose in New York led to a high-profile patient in the hospital 

Any hospital safety official who has ever been involved with the admission of a high-profile forensics patient will tell you that securing the facility is no small undertaking. From the moment the ED receives word that the patient is on the way, protocols go into place to create security perimeters, remove other patients from the path of potential harm, and protect the public image of the hospital as hordes of media and concerned family members descend upon it.

“Transferring prisoners from police custody to the busy ED environment is risky,” writes Lisa Pryse Terry, CHPA, CPP, director of Hospital Police & Transportation at the University of North Carolina Hospitals, Chapel Hill in the new HCPro book, Preventing Violence in the Emergency Department. “Healthcare security professionals take incredible responsibility when supporting forensics patients in the ED. Weapons of convenience become a higher threat than with the average population. Another highly-valued skill required for ED security is the ability to collect, manage, and preserve evidence. Evidence must be collected in a way that does not compromise its integrity by preventing contamination and preserving accuracy of findings.”

If you are new to developing a forensics patient policy at your facility, check out the checklist Terry developed for University of North Carolina Hospitals on p. x, one of several she included in her book.

For weeks in early June, officials were on alert to try to capture two men who had escaped the high-security Clinton Correctional Facility in the Canadian border town of Dannemora, New York on June 6.

About 22 days later, after police had fatally shot one of the men and wounded another, law enforcement officials celebrated a hard-earned victory as they announced Matthew Sweat, 35, had been captured and the long manhunt declared over.

But for Albany Medical Center, the job had just begun. Sweat, who was seriously wounded in a firefight with police, was brought to Albany for treatment. Following him were scores of media outlets and squadrons of law enforcement personnel looking not only to help guard against him breaking out again or injuring someone, but to question him about how he and his cohort, Richard Matt, pulled off one of the most daring and complex prison escapes in U.S. history.

Albany Medical Center officials did not return calls seeking comment, and published reports indicated security at the hospital was under the jurisdiction of the New York State Department of Corrections and Community Supervision.

 “[High-profile prisoners] can certainly turn things upside down,” says Christopher Casey, public safety director for Beth Israel Deaconess Medical Center in Boston.

He should know: BIDMC took in as patients both of the suspects of the Boston Marathon bombing in April 2013, as well as 24 of their most seriously wounded victims. A security and logistics nightmare was created when law enforcement brought in Dzhokhar Tsarnaev, following a massive gunfight with police that killed his brother Tamerlan and a subsequent manhunt that shut down the entire city.

“The bomber was brought here in the midst of other factors that created other challenges and made the situation more complicated,” Casey says. “You had the dynamic that the hospital is treating the man who inflicted injuries upon his victims, who we are also treating, so the sit becomes very fluid. He had to be segregated to make sure there’s nothing harmful on him, and people want to get their hands around him, right?”

Things to consider

Protecting a high-profile forensics patient from people seeking revenge for his or her deeds is just one of the things hospitals have to consider when they are brought in to the hospital for treatment.

Weapons. Most hospitals, especially busier urban facilities used to a larger population of forensics patients, have their own security protocols for sweeping patients for dangerous weapons. Smaller hospitals, however, may not have the trained personnel available, and will likely rely on the police to remove weapons from patients on the way in.

The game changes, however, when you are dealing with patients who may be willing to resort to just about anything and use anything available within arm’s reach as a weapon. Sweat was a determined and proven ruthless killer that police sources said would do anything to avoid capture, and Tsarnaev demonstrated no regard for human life by setting off bombs in a crowded environment and engaging police in a huge gunfight. Protocols for dealing with such a person—and keeping weapons out of their hands—must be part of any hospital’s plan for admitting dangerous prisoners.

“There was the thought that we might be bringing in someone who could be a risk or could be bringing [a weapon into the facility] in a bag,” says Casey.

BIDMC has a blended security staff consisting of certified police officers and unarmed security staff who were able to work with Boston Police to help visually screen all ambulances transporting patients into the facility during the bombing crisis. If you haven’t already, Casey recommends making sure you have your local police in for a look around your facility and regular meetings to figure out what role they would play in your facility’s security.

“The important thing is to have a good relationship and previous communication with local public safety partners so when you get in to an emergency management situation, those folks generally have an understanding of the layout,” he says.

Patient and staff security. Your staff will be apprehensive when a high-profile prisoner becomes their patient, and rightly so. Clinical staff at Boston hospitals were credited for showing incredible professionalism for treating the marathon bombers despite the fact that their patients had just attacked the city they lived in, and some of their most horribly injured victims were in the same hospital. And when Boston was placed on lockdown as police searched for the second suspect, there were many unanswered questions.

“Clearly the clinical staff were providing reassurance for patients,” Casey says. “But our employees were concerned and frightened. How many others were out there? Was there still a risk within in the city? His brother is here, so what does that mean for us? Are these lone wolves, or are they tied to a larger group? You just don’t know at that point.”

Reports in the Times Union of Albany indicated Sweat was being held in the hospital's secure ward, where prisoners are handcuffed and shackled to hospital beds. The ward is behind a locked door that is guarded by state correction officers constantly staffing the special unit, which holds about eight to 10 inmates on an average day.

For the folks at Albany, however, it was just another day trying to save the life of a patient—regardless of how infamous he was outside the doors of the facility.

“When you deviate from how you would care from [low-profile] patients, you’re setting yourself up to do things you’re not used to doing,” said Dennis McKenna, medical director at Albany Medical Center, in a published report from WIVB-TV. “The difference in this case is the coordination of the non-medical pieces, the security, of course, being paramount, to be sure that we have the situation controlled and that we’re able to provide the care in a way that’s safe for not only our staff, but for everyone around us.”

Collecting evidence is just one of many things a facility must prepare for when dealing with a high-profile prisoner. Each year, a hospital is required to conduct at least two drills, one that practices a hospital’s ability to escalate and scale down its response to an emergency as circumstances change.

Patients and their families will also be concerned. How would you feel if your mother was being treated in the next room over from a convicted killer who had just escaped a high-security prison? In addition, family members may be angry at the prisoner, and may not understand the moral obligation a hospital has to treat them like any other patient.

“Initially, we identified a ward that was off the beaten path and were able to put [Tsarnaev] there,” Casey says, adding that the large size of BIDMC allowed an entire wing of one floor of the facility to be blocked off for one patient, with a tight perimeter of security. “There needs to be doctors and clinicians, food, etc., and our security needs to know those folk, who belongs and who doesn’t.”

Perimeter security. Controlling who comes in and out of your building is going to be one of the biggest concerns during a highly fluid situation that involves a high-profile patient. You never know who may walk into the facility—gang members or victims’ family members could be looking to enact revenge or free the patient from the hospital. Or members of the media could be looking for a great interview or video shot of the patient for the evening news. Whatever the case, you must have a system in place that allows for the facility to go into immediate lockdown, doors locked from the inside, and security personnel at entrances to screen all people coming in and out of the hospital.

“We weren’t going to forcibly keep people out of the medical center, but we definitely were screening them,” says Casey. “How high will you ramp up security? It has to be based on the risk at the time, and it can ramp up as needed.”

Several layers of perimeter security were in place at the hospital, including federal and state law enforcement officers outside. Security forces inside screened anyone coming and going, and all bags coming into the ED were checked. In addition, hospital officials met with law enforcement every morning and were able to ramp the security presence up or down depending on events of the day.

Media coverage. A high-profile event, especially one that spans an extended amount of time, will draw lots of attention from the media. Many media members will obey the rules of engagement and cooperate with you during a crisis, but if reporters feel like you are keeping them away from the story a few intrepid ones may try to slip through the doors to get a better story.

Many facilities have a plan in place to keep the flow of information coming to the local media (adhering to applicable privacy laws, of course) that includes providing a place for media crews to park vehicles and stage, providing a camera view for live shots and a representative who can provide periodic updates.

From the time Sweat was transferred to Albany Medical Center until he was released into Department of Corrections custody for transfer to a medical prison, representatives provided daily press releases and live reports on Sweat’s condition as well as reassurances that security measures were being taken to protect Sweat as well as the general public.

When to let it go. At some point, the security risk will subside following a crisis, and it’s important to know when to dial it down, both for the well-being of your staff as well as the image of your facility. After the initial media hype surrounding the marathon bomber being treated at the facility, BIDMC officials made the decision not to keep the doors locked up tight. The suspect was captured on a Friday, and after consulting with law enforcement, the decision was made the following Monday to keep a tight perimeter security, while reopening the hospital’s typical entrances and scaling back visitor screening.


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