Hi All,

Please read this article, entitled “Cops Are Illegally Detaining and Hurting Mental Health Patients.”

It raises very important issues with which I’ve personally witnessed health systems struggle for years.

This article highlights the very important subject of how to manage behavioral health patients (really any patient who exhibits volatility or violence) with available hospital resources.  And what exactly are the most fitting resources for hospitals in this management issue, namely, Law Enforcement or Security?

The first situation in this article involving Mr. Michael Mozdzierz is a good example.  Suicidal statements would have required a medical (not criminal) intervention.  Thus, efforts should have occurred to keep him in a medical setting, as he may have been an imminent threat to himself and perhaps others too.  But…”efforts should have occurred to keep him in a medical setting” need not (and should not) include the use of police defensive tactics (i.e., a tackle and an arm-bar-takedown) against Mr. Mozdzierz.

It’s important for everyone to take note of the paragraph:

“State regulators who later investigated the incident agreed. ‘There was no evidence of additional hospital staff being alerted to respond and assist with the management and redirection of [Mozdzierz],’ the regulators wrote in their report. ‘…Patient was not in custody of law enforcement, but remained a patient in need of psychiatric services and hospitalization.'” 

This is exceptionally important from various perspectives, including legal, regulatory, reputational, and human.  Criminals are criminals.  They should be managed by Law Enforcement personnel. Patients suffering from behavioral health issues are, however, not criminals; they are patients.  They should be managed by medical personnel, with necessary support from well-trained, patient-centered, Healthcare Security personnel. 

The paragraph above also points to the cultural issue in healthcare in America, and especially related to the behavioral health crisis.  There remains a blind-spot for many of  those who provide medical care to patients suffering with behavioral health issues where they way too often are too comfortable with relegating management of the patients to a department (Law Enforcement or Security) who are perceived as, and even expected to be, the “strong hands.”

Being morally and physically strong is necessary, and is helpful in managing very physically aggressive patients.  The problem is not, however, with strength.  It’s with (as the paragraphs says: no “additional hospital staff being alerted to respond and assist with the management and redirection” of patients suffering from behavioral health issues.  In other words, as it is a patient intervention, and not a criminal intervention, it is, first and foremost, medical staff who need to be responding, with appropriate backup and assistance from well-trained, patient-centered Healthcare Security personnel.  The problems are created when this marriage of disciplines fails to be a standard part of normalized operations in the management of patients suffering from behavioral health issues (really any patient who exhibits volatility or violence).

Throughout this article, there are references to violations regarding the CMS Guidelines of Participation.  There is a robust section in those guidelines regarding Law Enforcement actions in a healthcare setting.  Common violations include use of mechanical restraint devices (i.e., handcuffs), inappropriate tool use (e.g., taser), and use of intimidation (i.e., just being in a police uniform) to force compliance (e.g., to get a patient to take medication).  Those familiar with CMS surveys also know that surveyors care little if the Law Enforcement personnel are employed by the hospital or if they are local agencies responding to the hospital’s call for service.  In other words, your local responding Law Enforcement agency has no greater “right” to violate CMS guidelines (e.g., handcuff, use of a Law Enforcement tool on, intimidate, etc.) than your own employed Law Enforcement personnel.  It’s important to remember that these guidelines (e.g., handcuffing, tool use, intimidation, etc.) also apply to non-sworn Healthcare Security personnel.

Let me add a note about tool use.  A colleague and I (Javier Bravo) and I once ran a professional Healthcare Security operation for a large health system.  We had it built into the program that seasoned Healthcare Security Officers, the best of the best (all of whom were in leadership roles), carried tools that included a taser.  There was the predictable administrative pushback on why we needed such a tool.  Even this article cites inappropriate taser use by Law Enforcement.  It’s important to remember, though, that the issue is not the tool, but it’s inappropriate use in patient interventions.  However, proven over a decade, we had an excellent track record of NOT inappropriately using tools, including the taser.  But for the very rare times during which we had to deploy the taser (or handcuffs) and use it to manage a patient (one illustrative case being the patient who was brandishing a large knife and threatening to stab a nurse with it), it was used according to training and all CMS guidelines of participation were met (e.g., the patient was medically discharged, handed over to Law Enforcement, and transported to the local detention center).  I share this about tasers and handcuffs, as, in today’s American healthcare milieu, we must consider all possibilities and take reasonable measures to train staff for those (whether they be common or rare).

The issues then include:

1. We have a behavioral health crisis in the United States, with far too few resources.  People are, therefore, coming to our ER’s in need of help.  This is often overwhelming to hospitals, and emotionally trying for staff.
2. There is a training gap in healthcare in that, still today, new Nurses are not receiving, as a standard part of their education (e.g., few receive much, if any, training in Nursing school), sufficient training in conflict communication and organizationally designated training in crisis prevention & management.  By the way, Nurses need conflict communication training more than Healthcare Security personnel, as they rightly spend way more time with patients.  Far too few people seem to take note of this.  Conflict communication for Nurses should rapidly evolve so that it becomes an expected competency, with regular, quality training just as Nurses receive for any other skills they use to manage patient care.
3. Ill-trained Healthcare Security staff can contribute to (though they’re not the root cause factor) to medical staff fear.  This situation contributes to medical staff looking to Law Enforcement staff to “take over” when patients become unruly and seemingly unmanageable.
4. Agree with the standards or not, CMS lays out what is expected, and indeed what is required.  Being cited on issues can cause substantial regulatory, legal, financial, reputational, and human consequences.
5. According to me, way too many otherwise well-intentioned administrators opt to use Law Enforcement staff because they’ve never witnessed the performance of well-trained Hospital Security staff.   Having never seen them, it’s too easy to believe that they don’t exist or can’t be created.
6. Training programs having to do with crisis prevention & management must be as complete as possible.  In other words, some are excessively insufficient (thinking that all violence can be managed with a feather), while others (and this is where Law Enforcement usually figures) are excessively heavy and bring a hammer to every intervention.  With the former, staff gets injured way too often and severely and trust in the training program evaporates.  With the latter, patients are injured (or worse) and their rights are violated.

This is a crisis that faces all hospitals in the US, to one degree or another.

Safety is everyone’s business.

Farewell!