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Going Beyond the Use of Force in Healthcare - Podcast

Going Beyond the Use of Force in Healthcare - Podcast


Going Beyond the Use of Force in Healthcare ” 

Host: Lisa Terry

Guests: Jill Weisensel, M.S., Tony York, CPP, CHPA, Robert Whiteside, CHPA, and Thomas Smith, CHPA, CPP.

To watch the podcast discussion of this video, click here.  

Download The Transcript Here- “Going Beyond Use of Force in Healthcare"

On this episode, Lisa Terry is joined by Jill Weisensel, M.S., Tony York, CPP, CHPA, Robert Whiteside, CHPA, and Thomas Smith, CHPA, CPP.

In this episode, the panel discusses various topics related to healthcare security, particularly focusing on the use of force in healthcare environments. They introduce themselves, sharing their career journeys and experiences in the field of healthcare security.

The conversation delves into legal and ethical parameters surrounding the use of force by security officers in healthcare settings. They touch upon how healthcare security officers should be treated as part of the healthcare workforce and follow established policies and procedures. The panel emphasizes the importance of proportionality in the use of force, training, and ethical considerations such as respecting the dignity of individuals, minimizing harm, transparency, accountability, and cultural sensitivity.

The discussion also hints at the influence of regulatory agencies like OSHA, the Joint Commission, and the Center for Medicare and Medicaid Services in shaping workplace violence prevention programs and guidelines for healthcare organizations. It concludes with a consideration of the importance of collaboration between security and clinical care teams in managing situations that require the use of force.

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Lisa Terry: All right. Welcome to our Confidence and Conflict podcast. I'm Lisa Terry, your host. And I am joined by four of my very esteemed colleagues today, Tony York, Robert Whiteside, Tom Smith and Jill Weisensel. Today we're going to discuss a subject that has long been important to many of us going beyond the use of force in health care. And it should be a reasonable and appropriate discussion.

And I want to thank everyone for joining us today. And before we get started, I wanted to share on behalf of this amazing panel and their dedication to our industry and to the International Association of Health Care, Security and Safety. I am making a donation to the IAHSS Foundation because of the foundation's valuable research that I've used many times over the years.

Education, the scholarships, recognition of our security heroes and much more. I want to encourage all of you to consider doing the same. So to get us started, I would like to ask our panel members to tell us a bit about who they are and their career journey. So, Tony, if you'll start us off.

Tony York's Background

Tony York: Well, thanks, Lisa, and thanks for the generous donation and the time to spend with these wonderful folks.

I know you talked about each of us, and I feel like it's so instrumental to the journey I've been on. You know, a lot of people that know me know that I was hired into this space many years ago by a gentleman that was our first president of the National Association of Hospital Security by the name of Ross Carling, who has long been a mentor to me and so many others, and a very influential voice.

And he also sort of helped me understand how important it was to give back and to really continuously raise up our professionalism. So my journey has been that of a health care security professional from right after my university studies to doing internships with North Carolina Baptist Hospital, which is part of Wake Forest and Atrium. Now. But, you know, I moved to Colorado and joined a firm that was owned by the hospitals here that specialized with a shared service approach.

That was where we were able to see security delivered in just a volume of different entities from level one trauma centers all the way to hospitals that were single, had single rooms that were for emergencies and so many things in between. And it gave me a just a1a passionate pursuit to say, how do we continue to really create a safeness in these environments?

But more important as anything is how do we educate others on this important role That is the essential nature of a health care security professional, the officers, the leaders and everyone in between that is really contributing to quality patient outcomes. That journeys driven me for all to give back. I've done the writings that I like to do and being a part of such an important industry, it's a it's the most fulfilling job I think I could have ever taken on.

And it's something that still gives back every day. Thanks, Lisa.

Lisa Terry: Awesome. Thank you, Tony. I'll move over. Robert.

Robert Whiteside's Background

Robert Whiteside: Hello. I'm humbled to be in the presence of all of you because I have learned so much from everybody on this panel. So, yeah, my my journey really started a long time ago with college getting a degree in anthropology, which early on gave me an appreciation for people and it's kind of carried me through a career in law enforcement.

And then I started at a small county owned hospital in Hendersonville, North Carolina. And then from there I hopped over to Mission Health in Asheville, and I spent almost a decade there. And then in 2019, I came to Duke. I did also have a small foray out to the West Coast, and I worked at Oregon State Hospital, the hospital where they filmed One Flew Over the Cuckoo's Nest.

So I got a good introduction to state psychiatric hospital, you know, issues, whether it's operational issues or budget issues. But I'm at Duke now and then finally beginning to throw my arms around the entire system since, you know, leader leadership here is is in a state of transition. I brought several colleagues from western North Carolina out here with me, and I'm happy to be here at Duke continuing to transform this program into what we want to be the best in the world.

And and that's that's kind of me in a nutshell.

Lisa Terry: Awesome. Thank you, Robert. So, Tom,

Tom Smith's Background

Tom Smith: Thanks, Lisa. I appreciate being able to join this group. It's an interesting set of topics for to say the least. But I'm probably old, the oldest of the bunch here for sure. I've been in health care since 1981, managing health care security programs, including a community hospital in Saginaw, Michigan, a good size inner city medical center in Flint, Michigan.

And then on to University North Carolina health care system here in Chapel Hill. And for the last 20 years or so, I've been working with health care security consultants and purchased the company in 2013 and have been working full time as a consultant doing security assessments for health care facilities, operational assessments, leadership coaching and expert witness services. So I've served on several leadership positions with the agencies of which I think the flagship would include serving on the health care security industry guidelines.

Counsel since its inception, and I reluctantly left that group last year, but still heavily steeped and watching those guys. So they don't so they don't go astray. So you're going to hear a lot on this in this portion of my segments about what are the industry guidelines, because in my mind, that's what that's a standard, that it's a guideline, but it's something that all security programs should should strive to meet.

Lisa Terry: Excellent. Excellent. So, Jill, finally.

Jill Weisensel's Background

Jill Weisensel: Thank you, Lisa. I really appreciate the invite to be here. And like Robert said, and like Tom said, humbled to be here. I've learned so much from everybody on this panel and really welcome the opportunity to be here. So I bring to the table, you know, 20 years experience working in hospital security and health care security and in law enforcement spending most of my career with Marquette University Police Department in Milwaukee, mostly night shift patrol. But there, you know, I had the opportunity to serve as a patrol commander and was responsible for our professional communication skills training, our defensive tactics training and our active shooter preparedness and response, a natural transition for me over to the rest of our training team, where our sole mission is treating emotionally and physically safe environments so it's really been it's been an honor. It's been a journey, humbled to be here and and happy to land where I can. So thank you.

Lisa Terry: Excellent. Well, I'm definitely in the presence of of greatness. And I am so very appreciative of you folks being here. So I guess to start off, if you don't mind, Tony, for the context of this discussion, would you just be so kind as to identify and define use of force in the health care environment? So that and also for us that share where you obtain that definition?

Tony York: Yeah, certainly Lisa and Tom sort of set this perfect stage for me, right? You know, we talked about the access health care, security industry guidelines, and one of the very earliest guidelines was the security officer use of force and I'm dating all the way back, I think, to 2007 when the the council at the time really tackled the issue.

But the concept was the amount of physical effort that is used to compel cooperation and compliance that is really beyond regarding touch. And so when you think about that and you break that down, it's not just being hands on or putting somebody in handcuffs or something like that, right? It is the presence of the individual that is really saying, now I'm really helping someone get cooperation, but they're using the physical touch of the individual to do that.

And, you know, it's really interesting how all of us in this space, probably if we're sitting on an airplane at some point in time, tell somebody, what do we do for a living, that what it means and how often that physical touch has to be utilized. Right. The health care security industry is not an observed report only industry.

And if I could tier with anyone who is watching with us right now is we have to understand, yes, we never want to do that until it's a means of last resort. But there are times where it does require that of the health care security officer. But the IAHSS has been very consistent. We review that guideline every three years, Lisa.

And as a result of that a few years ago, that guideline now and that particular definition found itself into something the IAHSS participated in, and that was creating a new industry glossary of terms. And that's where that particular definition can be found on the IAHSS website.

Lisa Terry: Excellent. Excellent. So OSHA has taken a much stronger stance in recent years requiring that health care facilities must have some sort of workplace violence programs to protect staff.

And they have been leveraging hefty fines against those who do not have those programs. And of course, in January of 2022, many of us know that Joint Commission actually issued some new and revised requirements to for health care organizations specific to their workplace violence programs and prevention efforts. Then last year in November, the Center for Medicare and Medicaid Services issued a memo regarding workplace violence in hospitals, and they emphasized that they will enforce the regulatory expectations that patients and staff have a safe environment in which care is delivered.

Now, it should be noted that security is charged most of the time in protecting staff, patients and visitors. However, CMS places significant restrictions at times on those security officers when he or she may be protecting a staff member from a patient or protecting a patient from another patient. And I've heard some individuals say that it's as if these two federal agencies conflict at times.

Legal and Ethical Parameters when assisting with patient restraint

So, Tom, I'll kind of bring this question back to you. If a security officer is requested to assist with the restraint of a patient, and physical force is necessary to obtain control of that situation, what are the legal and ethical parameters that should be met?

Tom Smith: Well, I didn't get the easy question first, I guess. But, you know, it's important to note that the specific legal and ethical guidelines can vary depending on the jurisdiction and local laws.

So it's it's really essential. Consult your legal and regulatory advisers as you consider this question for your facility. So I'm going to talk in some generalities here and speak to some resources that I think are out there. But there are several legal and ethical parameters that should be met to help address safety and well-being of everybody involved in the health care environment.

But I personally consider health care security officers as part of the health care workforce and as such, they'reGraphic-1-Going-Beyond-Use-of-Force usually just like any other hospital employee that's been asked to assist in a patient restraint. So and I say usually there there are some exceptions based on hospitals, policies, local jurisdictions, but I think they're just like any other employee. If a restraint has been deemed to be necessary by one of the providers, a qualified somebody that's qualified to order a restraint or seclusion, then security, just like any other hospital employee, helping out with that, the officers have to follow their policies, procedures and training that have been provided.

And we'll talk a little bit about policies and procedures a little bit later and the importance of making sure they align. But here's some some general principles to consider. May law enforcement, security and security agencies in health care use what's called use of force continuum? I'm sure that's not unfamiliar to a lot of people, but it outlines levels of force can be used in escalating situations.

I like to use I like to see the use of force include patient restraint. These these use of force continuum should include what level of forces, including patient restraints. So that way officers aren't receiving some specialized training for non patient situations that includes use of force or patient situations that may include use of force. So I think as much as we can tie those two together, we can end up with less confusion for the officers being trained.

I think it's important to maintain proportionality. The level force should be used that must be proportionate to the threat or the the situation presented by the patient. As we all know, unnecessary, excessive force can lead to legal liabilities. Everyone has a video camera these days, and in most cases the whatever has happened is, is captured by the camera systems in the health care environment, use of force can be legally justified if necessary, to protect yourself or others from harm.

Again, training and policy compliance. Security officers in the hospital. Police should have proper training and the appropriate use of force techniques. And I know we're going to talk about that a little bit later, so I'm not going to touch on it. And then, you know, some of the ethical parameters, you know, use of force should be designed to minimize harm and injuries to patients and others involved.

Unreasonable or reckless actions can lead to legal consequences. Of course. And we'll talk just briefly about that at the end here. But we want to respect for dignity individuals. You know, if we talk ethics, we have to respect people and maintain dignity. Use of force should not involve degrading or humiliating actions, avoiding unnecessary harm that maintain transparency, accountability, transparency and accountability.

Because in my practice, many times I'll find there's been use of force and there's no documentation, there's no no sense of a report or anything of that nature. So I think that every and every occasion where force is used, a report is required or some documentation, you may call it something else, but it needs to be required and de-escalation again, ethically, we have to de-escalate.

First, communication is important with with the staff that are ordering the restraint. And there has to be a two way communication where possible. Sometimes I know what may not be possible. You're called up to assist with something. There's just an all out very difficult situation presenting it, so there may not be time to figure out what happened beforehand.

When you're presented with a situation, when you arrive on a unit. I think during training, cultural sensitivity is also important to making sure that officers realize and understand some of the situations that may present them, that they may be presented with that have some cultural differences. And or individuals with mental health conditions have special needs as well. Medical considerations that doesn't, you know, almost don't have to say that we're in a hospital.

But in the health care setting, physical and mental well-being of the patient should always be a priority. I'm involved in some situations where it's very often security officers are asked to do a restraint and they were never told, oh, by the way, this medical condition might might have something to do with the restraint or you have to be careful.

Their arm, its careful, their leg, and they go to the restraint. And then after the fact, they find out, gosh, we probably shouldn't have, you know, touched that or area or been more mindful of protecting that area. So training is critical and I'll talk about that toward the end here. At the end about training, where let's make sure that that it's done as a continuum, making sure that if we're training on police tactics and law enforcement tactics, that there's some if you do that, that there's some linkage with whatever the patient restraint techniques are used.

So that's where I think building that into the use of force continuum is important. So that's the long story short, there's a lot of references that that we can talk to and I'll speak to that at the end.

Lisa Terry: So just a couple of quick follow ups to that. Tom, would you say that the the optimal response would be security and the clinical care team together or I mean, there's many times that officers get called and then staff, clinical staff may step step away?

Tom Smith: Yeah, there's absolutely most hospitals have lots of different staff with different capabilities. And I think a behavioral health response teams are very popular and I advocate every single assessment I've almost ever done in the last ten years. Says if if hospitals don't have one or the organization doesn't have a behavioral health response team, that's the way to do it.

It should be a multidisciplinary approach to restraint and seclusion and de-escalation and and that requires lots of training and togetherness. And who is going to be on the team? Again, there's a there's another wonderful guideline that's just been released this year on implementing behavioral health response teams or BERT teams. So I would refer those looking at this to look that one up.

And if you don't have one or even if you have one of the teams, look at the elements that are in that guideline and let's let's make sure that your team includes and incorporates the guideline items that have been pointed out at least

Lisa Terry: Excellent.

Tony York: If you think about a few things from what Tom just said. It really is old school when you really think about the security officer should be basically hand in the back door pulled and being expected to just manage that patient disruptive situation and isolation.

Right. And and if you think about it, I think it speaks to how we as security professionals have to educate the clinical care teams themselves about how to best use those services, how to establish the expectations that really govern the relationship between the two. And in there, so many of the clinical care professionals I've come across over the years that they don't understand that the actual authority being bestowed upon the officer is actually provided by them. It is their license.

Lisa Terry: Absolutely. Absolutely. So I'm going to move over to Rob and I have a couple questions for you, Robert. And one of them kind of is is with reference to the question that is just as Tom does, does this does the I guess the the legal and ethical parameters change if this is a hospital police officer that responds to assist with that restraint of a patient?

Robert Whiteside: Yeah. And thank you, Tom and Tony, for those comments, because you laid the foundation for what? What? I was going to speak to here. Well, let me let me give my perspective through the lens of where I come from and particularly through a Duke lens, how we do things here. I'll say first that we strive here to keep police out of patient interventions, and that is to avoid various issues having to do with violating someone's rights, people, people perhaps perceiving that they're under custody or in custody of a police officer.

But let's say a few years back when when this stance was less a cultural issue here. Well, by that I mean where police did get a little bit more involved. When we engage with a patient, whether it's security or police, then we engage as part of the care team. And again, Tom and Tony have already alluded to this.

We get our authority, whether it's a police officer or whether it's a security officer, sworn or non sworn, we get our authority to act as in that care team from the licensed practitioner, a doctor, a nurse, etc.. And and we take our directions from them. And that's and again, Tom and Tony, I've already alluded to this. That's the key difference between a patient and a non patient intervention is that with a patient intervention, it's led by a medical team member and we participate as a part of the care team in a in a collaborative manner and we have a full, fully active BIRT team here in our Duke facilities.

And so when we respond, we respond as security, a psychiatric clinician, health supervisor, a nurse, at least those people and and there may be more than one security because sometimes, as we know, it takes, you know, a certain amount of muscle to to to to physically, you know, kind of and therapeutically manage a violent patient. But nonetheless, it's the medical team member who leads it.

And like Tony said, a lot of times it's more so the medical professional who's less than informed about that point, then it is our own team. And so we have to, maybe even in the moment, professionally remind them that that, you know, what would you like us to do? We're here to keep everybody safe. We actively work not to be left alone with patients.

And again, that's that's kind of a reinforcement of the team approach. And in my in my experience, we have to kind of constantly educate our medical team on this, on this point, less so our team, because we educate people on our team from from the date of hire moving forward. Now when we engage with a non patient, while CMS does have some language related to the use of weapons on a patient, visitor or even staff, the regulatory guidelines stipulate that they expect it to be handled as a law enforcement matter and law enforcement is involved.

And that and that always occurs when like say like last night when we had a drunk visitor in the parking lot, that's a security led operation. You know, we don't even we don't even notify medical of that. We handle it and we drive it and we involve law enforcement. So from a CMS perspective, that never kicks in regulatory issues.

But as everyone has spoken to so far, when we're involved with a patient, the regulatory guidelines kick in and and Tom said it well, you know that the patient has rights. We need to treat the patient with dignity and respect. And I would say the same about non patients, too, really. And I would add that really, regardless of who we're dealing with, we're we're we're entering the situation already, striving to create a non escalating environment.

We're striving to not go hands on. And if we do go hands on, we're striving to do it in the with the least amount of force as possible.

Lisa Terry: Excellent. One thing that I just I have to say, after listening to the three of you talk about this, this discussion that we're having right now really highlights how how much more important it is to have training for our health care, security and health care police versus those municipal law enforcement or even those a campus many of us have have worked in all of those fields.

And use of force is use of force is use of force when you're on the street. But in a health care environment, it is it is There is, as you said, Robert, those security led situations maybe where there's a fight or something that is taking place outside where it's very clear how those officers take action. But when it's a patient, it's very different and it's very important.

In-house Security vs Contracted Security Officers

I mean, as you said, we strive to never have to engage, but there are rules and regulations that apply in those very situations. So great information. So, Tony, I wanted to ask you, do you think there is any type of difference, especially since you talked about the first part of your your career and how a proprietary and in-house security officer responds versus a contracted security regarding the use of force situation?

Tony York: You know, Lisa, in a very high level, it should not you know, I've worked in a third party setting a lot, worked for an organization that was owned by hospitals and today working for the power and family of companies. And I can speak to something today that I used to not be able to with the same clarity of, you know, this is a North American issue, right?

I'm seeing security delivered in health care across Canada in addition to the U.S. nowadays with what I'm doing with Paladin. But what's so interesting about this is that, oddly enough, a lot of times as a third party provider, we're held to an even higher standard for the use of force. The training that is expected of us, not typically by the entity itself, the hospital or the health care organization, but by the regulatory agencies, the jurisdictions that are governing the licensure of a security officer.

There are some variabilities to that. The state of California holds the in-house operators to the same exact standard as those that are providing this for a fee. But in saying that it should not have an impact for how the officers are positively intervening on behalf of the clinical care team or the security interventions that Robert just talked about, I think a lot of times it needs to be very well identified and clarified in the contractual arrangement, whatever that Master services agreement is with those entities.

I'm sure Tom would attest. There's a lot of times where that's actually a mute issue, and I think that's where we've evolved a lot as an industry. But I think for those that aren't, it's something that they really want to make certain is very well clear. The training standards. The thing I always like to see is a training standard that is multidisciplinary, that we're not just training a security officer to a to a program that's different than what's happening inside the health care organization itself.

Because, you know, there are times when those clinical care providers are looking at it and seeing that that might be excessive, when it is a technique that is a fully appropriate trained technique, They just haven't been exposed to it. And I think what's important here is that the more that that training is working together and in concert, I think the better the patient outcome.

I mean, when you start thinking about Bert, we start thinking about those responses that we have. What are we really wanting? We wanted to see a positive patient outcome. There are times when I have clinical care providers who don't want to see patients be applied, and I'm not talking about the patient. I'm talking about literally having patients for the circumstance to really resolve itself and allowing for someone to express themselves, to demonstrate they're disruptive selves.

It may not be comfortable. None of us really want to see it, but it probably is the right approach for the individual. And I think when we're thinking about the training, well, we want the third party officer, we want the in-house officer, we want the clinical care providers all basically be operating off that same sheet of music because when that happens, there's a lot of harmony that occurs when it doesn't.

And it sounds like me singing in the choir. It's not a good sound.

Lisa Terry: Agreed. What a great I think something that's really important that you touched on as far as the contractual agreement is, I think it's important that everybody knows kind of where their lane is and that it's very, that that is specified because I think there is a shared liability.

And and it's important that I don't know that it's something that everybody all the the the contract companies out there really delve into and even some of our health care organizations. So thank you.

Tom Smith: So I think, you know, on that point, I was going to mention later that, you know, also who's responsible for maintaining the competencies that should be spelled out in the contract, the who and what is what do they have to be competent in?

What what is their role and what are the competencies and who's going to do that training and maintain and make sure that they're they're reaching whatever level of competency it is, whether it's outside training, whether it's in-house training, and then who's signing on the dotted line that says they're competent to do this, whatever the procedure is, for restraints, seclusion.

Lisa Terry: And would you recommend that a clinician be involved with that as well?

Tom Smith: Yeah, absolutely. If it it depends on who's doing the overall training for the organization related to restraint and seclusion. Normally it's it's someone that's either been a clinician or currently a clinician in conjunction with whoever the training people are that conduct training for the security operation.

Tony York: And Tom, though, the would you say that advice is appropriate regardless of the model being deployed?

Tom Smith: Absolutely. It's the model not the programs.

Tony York: So our model is not the difference. It's it's the leadership of said model and it's the expectations which when a third party, you sometimes get a little more formal because it's a contractual arrangement, whereas when you're working as an in-house operator, sometimes you don't have that.

But that's what we want to have, as opposed to orders are sops and the understanding guiding principles that that would be applied. Oftentimes it could be hospital policy as well. But I think it's important that we we really try to say the information that we're sharing here today. The model is not the difference maker. It's the application of the principles that is really the difference maker.

Tom Smith: They both both models require competencies. It's decision making, sure who's doing them and that they get done on the record within the normally it's an annual requirement for restraint, seclusion, but making sure someone's doing that term.

Preventing and mitigating the use of force

Lisa Terry: Excellent. I agree. So I will move on to Jill. You've been quiet, but I would like to really kind of grab a little bit of your expertise and see if you would share your thoughts on preventing or mitigating this use of force that we've been talking about on patients.

Jill Weisensel: Yeah, absolutely, Lisa. And it's going to be hard to follow that discussion. So my interest definitely going to take a pretty hard left turn. I think throughout the course of the conversation, they're talking about a very specific moment in time. It's a moment in time where we've decided someone has made the decision that we have to go hands on, we have to touch, we have to use force, we have to stabilize the situation.

We have to physically stabilize the situation with the goal of reducing, you know, potential injury that could occur if we didn't do something here. And we want to intervene earlier in this cycle. So with that, we know we're witnessing assaultive behavior at risk behavior, and regardless of that, behavior is injurious to self injurious to others. We have to stop it.

And that's the specific moment in time that we're talking about. But we can't we can't stop there and just take a picture of that moment. We have to build a look at that incident as a as a full length film. You know, I think it was Tom earlier said, you know, it is being recorded. We're in the era of the digital tattoo.

We have to go to rewind the incident and look at what preceded it and what preceded that moment in time. And that's really where I think a lot of organizations fail to train. You've now entered the realm of non escalation, and if you don't train in the realm of not escalation, then you're starting your training tape too late.

You've missed. You know, that's really from a prevention standpoint where I look where we as a company and restore our looks in terms of training and in terms of conflict management, you know, our ultimate goal is to prevent and reduce workplace injuries and create emotionally, physically safe environment. So what's interesting about that is most people don't know what non escalation it's and Robert talked about this earlier creating that environment that is not necessary but that's because de-escalation is the buzzword it is few buzzwords in 2015 de-escalation training was being mandated all over the country across multiple industries by different regulating bodies.

Please correct me if I'm wrong, but I've yet to see where anyone is offered grant funding or mandated training for non escalation. So to answer your question, preventing and mitigating, I'm going to say looking at non escalation is going to include the philosophy of treating all people with dignity by showing respect. That's been mentioned throughout the whole conversation today and it also includes a specific set of skills.

So it's going to include all of the things that you can say and do from preventing someone from kind of escalating up onto that ledge in the first place versus de-escalation, which is going to be all of the things we can say and do to bring someone off of that ledge or down. So in the realm of non escalation, when we only run one training, our focus is really on not just what you say, but how you say it and what you look like the moment you set it in.

And how I try that in is I really think that we have to be responsible for the energy we bring into a space. We have to be accountable for who we are in that moment in time, who we bring to the table at that specific moment. And it's not to say that if I do everything right, that it still cannot result in the need to use force, because it could and it may.

We can train how to be more empathetic, use phrases that are non-judgmental and non accusatory, nonGraphic-2-Going-Beyond-Use-of-Force escalatory.  Practice the tone in the delivery so that in that moment we don't get to that point that that might be that trigger for that person that would result in the need to stabilize.

Lisa Terry: And so that's an excellent answer. I think it's it's important to realize though, this should every single person on the care team should have that same philosophy.

Unfortunately, as I said earlier, sometimes security is called in as that last, you know, response kind of come in with the heavy hand. So, I mean, I love that. Excellent. So,

Jill Weisensel: If you would just allow me to. I agree with that completely wholeheartedly. At the end of the day, I would way rather take the extra 30 seconds to a minute in an interaction. That extra 30 seconds or a minute needed to be, you know, trauma responsive, to come forward with empathy, to establish a rapport, listen, be persuasive, rather than taking the extra 3 hours needed to write a use of force report, maybe the extra three days worth of having to explain what happened, supervisors, administrators, even if it was justified, or the extra three years that this could potentially go to litigation.

I mean, it's just an analogy, but I always believe that if we're responsible for the energy we bring to a space, we can help keep everybody safer, both emotionally and physically.

Tony York: Such a great point, too. And sometimes just taking a few seconds just to huddle with the care team. Right. Let's put a plan together. Let's all understand what we're getting ready to do, what we need to achieve and can can make such a huge difference.

I appreciate what you just said, and I hope that there are a lot of clinical care leaders and professionals that would hear that message, because I think that sometimes lost in their scope of work in what they believe is their duties and how to work together and how to utilize the resource that is the security officers themselves.

Lisa Terry: Agreed. So, Tom, a question you mentioned earlier that we would come back to this and with your significant experience in various cases concerning health care, security and use of force, would you be able to share with us any lessons that you've learned from some of the litigation series?

Tom Smith: Sure. You know, I call them I've been scarred by a few of these cases where when you're looking at it as a third party and again, having sat in the chair of the hospital security directors and police directors for years, looking at it as a third party and really digging into people's policies and perceived department policies, procedures, what training did they do?

Who did the train, what did the trainers say? Reading their depositions. It can be very painful. And in the end of that doing all that, I have to give an opinion whether you know, what the facts come out. So use of force and patient restraints is it is a typical case. And I don't do hundreds, hundreds of these things.

There's probably five or six a year that that come out. But there are two kinds of cases that I've had more recently in its use of force, patient restraint, and patient elopement. So use of force, patient restraint. I sort of talked about it already. Let's make sure, number one, I'll use this particular organization. They had a pretty good sized hospital with a large inpatient mental health unit and a very active emergency department security department that was pretty well trained.

But when we look at what happened, a patient was injured during a restraint a very serious injury. And when you unpeel the onion of who did what, they had trainers providing training that had never worked in a hospital. They had a law enforcement training, kind of a model that was trained. And then they had the patient restraint, techniques for patient restraint that was training.

There are several training programs out there. I'm not going to go into the types, but if they had an outside training program model that they were using and there was no connection in their policy and procedure and when being deposed, one of the trainers said, well, when when can you use these law enforcement techniques? And she said, well, any time the person disregards our verbal directive and, you know, that's that doesn't fly.

And in the health care setting and that person never worked in a hospital. So it's it's you have to look at those individual cases. This particular case had this they had lots of resources, but they weren't coordinated enough. They didn't have a behavioral health response team. This happened to be against. It's an area of risk where a mental health patient lands on a non mental health floor and those staff members are often concerned and afraid of the patient.

And so and oftentimes they don't have to have any zero training. And that's the case with this this organization, the the charge nurse, the nurse manager, the the nurse for the unit, the floor nurse and the person that was watching the mental health patient didn't have any training in de-escalation, in recognizing, escalating what to do. The nurses on the floor didn't have any training.

They didn't have a behavioral health response team member that could come visit with them when they when they got this patient. I was advocate that your your team come around. If you got one of these patients in a non behavioral floor, go in there and let them know. Here's the here's here's where you are, here's what we can help you with.

Here's how to help manage the patient. So that's you have to tie that together with the policies and procedures. I always ask for what are the administrative policies relating to restraint, what are the clinical policies, and then what is the security policy? And do you think that they ever line up? Probably not. There's a lot of room for real problems.

They were written in different areas by different people. And so I strongly suggest because that those kind of things were, you know, one or two things sometimes will you can overcome those in the court setting, but those will sink your your case if you have one or two or three of those altogether, it doesn't look like you know what you're doing and whether the injuries were preventable or not.

Patient Elopement

If all of those things were in place, it's hard to say, but they're much more likely to not happen if we have those those things in place. Real quickly about patient loading and we're running short on time as is the definition of elopement. But I've had some hospitals will say, you go in there and ask them, how many logs did you have last year and they'll click into their insurance system.

Well, we had 55 elopements from the emergency department and we had 64 for the rest of the hospital. And I'm going, are you serious? In elopement and it's really if you look at the I said, well, what's your definition of a low And I well it's and Amaya you know there's a lot of other things that they do but so be very careful with how you're defining this because when you record that your if you record things as an elopement, the regulator, the CMS, if you have an adverse event that they come in in and want to investigate, if you tell them you've got 150 elopements in the last year, then they start looking at each and every one and you're doing your explaining from a position of weakness. So I even even my definition of elopement is, well, if they get off the floor and you're following up to the accident, if you follow them across town and they're still on site and you bring them back safely, that was an elopement attempt. The system work.

That's that's just my own personal approach because I've been scarred by regulators coming in and talking about to, you know, being fairly of course, all the regulators are reasonable. Right. Fairly unreasonable in these cases. So make sure your policies, make sure you have one, make sure people have training, make sure that the nursing leadership, clinical leadership knows what what the policy is on and have some places have an overhead page, just like an infant abduction instead of infant abduction.

You either they've got a code or code or patient elopement and then they'll they'll give the patient's description. So that's the bottom line. Long story short for me to align your policies, take a hard look at the training, use a approach if if you possibly can. And then look at these operational guidelines that we talked about there, I have a list here that I'll send you, Lisa, but they're just these two topics.

It looks like there's about 15 operational guidelines that the IAHSS has produced that have something to add to and are good, good guidance as people are developing policies and procedures and trying.

Lisa Terry: Awesome. And Tom, to your point, responding to an elopement is a whole nother discussion on use of force and the legalities that that kind of

Tom Smith: it's related

Lisa Terry: it's different but it is I mean it's definitely related but we could have a whole nother podcast just talking about that.

Tom Smith: But that is absolutely very appropriate to that point. A lot of places will say, Well, how far should we leave? How far should we chase somebody? That's a lot. I said, Well, I really don't care but have a policy on it and follow your policy because some places will say, I've had legal I've had our our hospitals attorneys say, Tom, if you can safely follow them, you know, over to the next town and bring them back safely, we want that.

I heard other people say you step one foot off the property and you're we don't want that. Well, I had a case that involved a patient who eloped, ran just across street, climbed up the cell tower and jumped off the cell tower and killed themselves. Well, it didn't look very good that the security team ran out to the property line and stopped.

Now, there's an argument that you can make. Okay, If we go across, leave the property and something happens back on the property, then we're responsible. But I don't care. As a consultant and an expert witness, have a policy and make sure you you abide by the policy.


Lisa Terry: Excellent. This has been an amazing amount of information. Great. And I just want to give everybody one more chance.

Is there anything else that you want to leave our listeners with? Anyone?

Robert Whiteside: Lisa, let me let me add something that actually Tony made me think of it, and then Tom fleshed out a little bit more. But, you know, when we when we have our medical team members and our security team members need to be training the same way together, or ideally, when we when you have team members who are not trained, who are mis trained, poorly trained, or who are trained, a different system, then say what the other department is using, then we have worse patient outcomes, we have more regulatory challenges and we have more opportunities for injuries to the patient and to the staff. So that's something that is kind of a kind of an issue to always be on the lookout for, because it seems to be always present. But training in one single program together as a BERT team to me is is has great, great value to help a health system meet the regulatory guidelines, keep staff safe and happy, and have the best patient outcomes.

Lisa Terry: Agreed.

Tony York: Yeah, I would add, Lisa, just in the role and responsibilities of how we keep these organizations safe is evolving and it's never shown. It's more central nature than it is today, and I think that's going to continue. But I also believe that we have a role, especially those of us that are in the practitioners space for security and protection is how are we educating others, bringing attention to what right looks like.

The guidelines, I think are really set up as a best practice and we've heard that threaded throughout a lot of our conversations today. I think it's important that we continue to have the conversations because I feel like our nursing staff members are probably more scared today than I've ever seen them in my 30 years of being in the space.

And I think what we want to try to do is make certain that we are doing what we need to do to help keep them safe while balancing the importance of patient safety. Those interventions. I think oftentimes we're getting involved late as as part of security, but when you really start unpacking it, what do we find that the nursing staff member didn't have any education in our education of nursing and doctors, etc.?

If you look at their formal education, it's not happening. We're not teaching, not escalation, de-escalation, aggression, management inside of nursing schools. It's interesting to talk to the nursing school administrators who are saying we don't want to because we're afraid we're going to lose people from joining the profession. Our doctors aren't getting this training as well. And I think that's where the onus is upon the health care organization.

And those of us are protecting it to make certain that we understand that that's the challenge that we're facing. So I think this is a multifaceted issue. Use of force is something that will happen no matter how much we try to keep it from occurring. We have intentional and we have unintentional violence that is happening inside of our health care delivery system every day.

I can only imagine the events that have happened since we started this conversation just here in the last hour. But it's important that we take it, and I think we've got to continue to really be focused in on how do we do everything we can to prevent and then when we need to respond, how do we do that with the least amount of force necessary.

But it's reasonable. It's appropriate. And to Tom's perspective, as I've heard him say many a time over my career, it's also defensible. So thanks.

Lisa Terry: Excellent. Excellent. This has been amazing. I want to thank you, number one for your wisdom sharing all of your wisdom and your experiences with not only each other, but also our listeners. And I hope that I get this group back again soon. So thank you.

Tony York: Thank you, Lisa.

Robert Whiteside: Thank you.

Tom Smith: Thank you.

Jill Weisensel: Thank you, Lisa.

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Lisa Terry

Lisa Terry / About Author

Lisa’s experience includes decades of leading healthcare and university police, security and emergency management programs. She has spent the past 10 years providing consulting, training and security vulnerability assessments to hospitals across the country.