May 14, 2018

A year after a Harrington incident, few hospitals have implemented enhanced security

Security guards (from left) Sidone Santos, Jonathan Evangelou and Jose Matias of the company Securitas stand waiting a visitor at UMass Memorial Medical Center's Memorial Campus.

After a Harrington Hospital nurse was stabbed by a patient last June, the hospital wasted no time in taking a new safety measure. It installed metal detectors at its emergency department, becoming what it says is the first hospital in the state to do so.

"Initially, I think the public was apprehensive, but since then I think it's sort of become the norm," said Harry Lemieux, Harrington's vice president of support services and chief information officer.

The hospital that successfully helped Harrington nurse Elise Wilson recover from the stabbing, UMass Memorial Medical Center, took action, too. It installed metal detectors at its emergency departments last year at its University and Memorial campuses, and this spring conducted active-shooter training.

"It was one of our own, and that hit the staff really hard," Candra Szymanski, UMass' associate chief nursing officer for emergency services and critical care, said of the attack on Wilson.

Nearly a year after the incident, Harrington and UMass are among the few hospitals in the state to have shored up security, particularly in screening people who enter emergency rooms. No other Massachusetts hospitals appear to have taken steps as UMass and Harrington have, based on WBJ's research and interviews with the hospitals and nurses associations.

Doing it their own way

The Massachusetts Health & Hospital Association said it doesn't keep track of such actions by its members.

"Massachusetts hospitals prioritize the safety of their patients, staff, and the general public within the hospital setting as an ongoing part of their missions," Anuj Goel, vice president of legal and regulatory affairs for the association, said in a statement.

"MHA member facilities are considering and exploring a variety of security measures, including metal detectors where appropriate," Goel said. "Hospitals continually work to balance safety concerns with the need to ensure timely access to all emergency and medically necessary services, given each facility's unique settings and resources.

In Boston, Tufts Medical Center and Floating Hospital for Children said it has taken several steps, including tripling its public safety presence in its emergency department and inpatient psychiatry units. It now has more than 20 sworn police officers at the hospital, who have the ability to make arrests.

Staff training for responding to aggressive behavior and crisis prevention has been expanded, and meetings each shift in the emergency department include public safety officers to discuss patient safety, Tufts said. The hospital said the increased measures weren't taken in response to any particular incident.

One notorious incident in 2015 at Brigham and Women's Hospital in Boston did spur discussions about security needs at hospitals. A surgeon, Michael Davidson, was shot to death by a patient's son. Hospitals said in news reports afterward adding tighter security was a complicated challenge, with so many entrances and staff, patients and visitors coming and going.

The Brigham declined to comment for this story. Other area hospitals didn't return messages seeking comment.

Health workers at higher risk

The Massachusetts Nurses Association helped craft legislation last year, named Elise's Law after the Harrington nurse, to require healthcare employers to hold annual safety risk assessments, and to develop and implement workplace violence prevention plans based on the findings. That legislation has not passed, despite a favorable report out of the Joint Committee on Labor and Workforce Development, according to the association.

"This has become really – with Elise and other incidents – an issue of great, great concern," said David Schildmeier, the association's spokesman.

The association is pushing for changes in nurses unions' contracts to include better staffing levels, training or even exterior lighting – all aimed at making hospitals safer for staff.

"Too many hospitals are not taking it seriously enough, or they could do more," Schildmeier said.

Last month, the Massachusetts Medical Society announced a policy opposing so-called concealed carry reciprocity, federal legislation in which all states would have to recognize concealed-carry permits from other states. Massachusetts has among the strictest gun-control laws in the country.

Healthcare professionals are slightly more likely to be victims of workplace violence, according to a 2011 U.S. Department of Justice report, which appears to be the most recent comprehensive study of its kind. In all, 5.1 workers out of every 1,000 were reported victims, compared to 6.5 percent for health care. For mental health professionals, though, the rate spiked to 20.5 percent.

A 2012 study by the Annals of Emergency Medicine found emergency departments were the most common site of hospital shootings (29 percent of cases), followed by parking lots (23 percent) and patient rooms (19 percent). Hospital employees represented one out of five victims.

While hospitals haven't yet adopted measures such as metal detectors broadly, Harrington has hosted six to eight other area hospitals wanting to see how the improvements have gone there, Lemieux said. Harrington's main Southbridge campus and Webster campus have both installed emergency department detectors.

"There is no one-size-fits-all solution for every hospital or campus," he said.

More at Harrington, UMass

Officials at Harrington and UMass said they've had many cases of people carrying pocket knives or similar objects into a hospital without realizing it. Szymanski called the number of pocket knives found pretty astounding, but said there have been relatively few issues.

Harrington has been looking into whether to expand security restrictions across the whole hospital. Visitors to other areas of the hospital don't need to go through a metal detector.

Photo | Courtesy
A metal detector was installed at Harrington Hospital in Southbridge just weeks after a nurse there was attacked by a patient.

"That's an area that's ripe for discussion, something we talk about often," Lemieux said. "That's where the challenges come in from a logistical standpoint."

In the meantime, Harrington and UMass have both expanded emergency staff training, including active-shooter training. At UMass, training exercises included advising staff on when to shelter in place, when to run or when to fight back against an attacker. All staff are required to participate in what has become an annual program.

Like with security access, hospitals make for complex cases in dealing with such incidents.

"Hospitals are very unique because we can't just have everyone evacuate," said Gina Smith, the director for UMass' emergency management and preparedness program. "The plan has to be very simple. We're focused on the first eight to 10 minutes until help arrives."


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