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A new chapter in hospital security.

Upon arrival at the maternity ward, two security officers are directed to labor room six where an enraged husband is assaulting his wife. The security officers subdue the man and detain him until the police arrive. He is arrested and taken to jail. End of story? No.

A distraught woman screams for a security officer to help her. Her husband has taken their terminally ill nine-year-old son out of the medical center, without her permission and against medical advice, because he believes that the doctors and nurses are responsible for his son's illness. The local police are notified. Within three hours the missing child and the father are located and the child is returned to the medical center. End of story? No, it's just the beginning.

Medical centers face similar situations regularly, and each reacts differently. At Kapiolani Medical Center for Women and Children in Honolulu the response is to initiate a special case management plan whenever a potentially dangerous situation is identified.

Developing a special case management plan involves crisis intervention, risk management, and action. The result of all this planning is a systematic, coordinated, written statement that promotes communication and teamwork in potentially explosive situations.

The plan should state the problem, assess the level of risk and potential for violence, and provide an outline to help the involved parties decide what to do in any given circumstance. The plan becomes a permanent part of the patient's medical record unless the patient is not the focus of the problem. In that case, the plan is removed from the record at discharge and filed with the Department of Social Services.

The driving force behind the program is the Department of Social Services. Whenever a potentially dangerous situation is identified, a social worker is assigned to assess the family or patient and to ascertain the level of risk to other patients, staff, visitors, and property. After the assessment, the social worker decides whether or not to initiate the plan. If he or she decides to commence, the first step is to write the plan or call a meeting of all the individuals representing the support systems.

Only recently has security been included in special case management planning and procedures at Kapiolani Medical Center. Previously, security was used only to defuse a volatile situation immediately and provide bulk strength. Security was never involved in planning and was never consulted on a potentially dangerous situation before it went out of control. But security's role has expanded and now the staff is directly involved with patient care.

This evolution was not an overnight occurrence. First, security had to win the trust and confidence of the medical staff and support agencies. With the help of organizations such as the International Association for Healthcare Security and Safety Basic Certification Course, Kapiolani's officers received the training and motivation needed to break out of traditional stereotypes.

A sense of pride, discipline, purpose, and team spirit was instilled in each security officer. Job descriptions were rewritten and a career progression ladder was established. A substantial pay raise added to the motivational spirit.

The security manager's next goal was to prove the value of the security department to the rest of medical center staff. Through the efforts of the security manager, old typecasting was finally put to rest. Now, security is an integral and key member of the special case management planning team.

Security's new duties include accompanying the child protective service team during its planning strategies and interventions and helping care for pediatric-psychiatric inpatients and suicidal patients. These efforts have enhanced security's credibility, image, and status and made the medical center safer and more secure.

To demonstrate special case management at work, let's return to the two cases presented earlier.

In the first case, the husband was jailed overnight and released. The patient's premature labor ceased, and she was admitted to a special care prenatal unit. The husband was given a formal trespass notice to ensure that he did not return to the medical center, and the case was referred to a social worker.

However, the patient said that despite her domestic problems she wanted her husband to stay with her until she delivered the baby. She threatened to leave the medical center if he was not allowed to return. Her obstetrician said that if she left the medical center, she was likely to lose the baby.

The social worker, in consultation with the doctor, the patient, and a security representative, initiated a special case management plan. The plan stated the following:

* The husband could return to the medical center but only under the supervision of a security officer.

* The time the husband could stay was to be limited.

* The husband was required to attend an anger management class.

* The nursing staff was to notify security when the husband arrived at the unit.

* Security was to designate specific rules that the husband must adhere to while at the medical center.

The husband agreed to the conditions and was a model visitor for the remainder of his wife's stay at the medical center.

Although the problem within the medical center was defused, this case has a sad postscript. Within two hours of the new mother's discharge from the medical center her husband stabbed her to death with a kitchen knife. The infant, however, remained safe in the neonatal intensive care unit and was later placed in a loving home by social services.

THIS EXAMPLE ILLUSTRATES HOW A relatively simple case was handled. The second case represents a more complex plan and demonstrates that plans must be flexible to adjust to changing situations.

During this case assessment, the social worker discovered a long history of family instability. The father was reported to have a violent nature and allegedly abused his wife. The father had also threatened to kill the attending physician if his son died. Even more alarming was the discovery that the father possessed several firearms.

A conference including all involved parties was convened to establish a special case management plan. The first priority was to determine if the medical center should allow the father to remain with his child. Given that the child was terminally ill and expected to die within one month, the management team members had to decide if, based on mere allegations, they should deny the father the right to remain with his child until death.

Security reported the facts of this case to the local police and obtained a background investigation of the father. Given the satisfactory results of the police background check and the terminal condition of the child, the team decided to allow the father to remain with his child under monitored and restricted conditions.

On the first night, the father screamed profanities at a nurse and had a serious verbal confrontation with his wife when she attempted to calm him down. Security intervened and placed an officer in the room for the remainder of the night.

By the second day, the nursing staff had become intimidated by the father's behavior. No one wanted to go into the patient's room while the father was there. So the plan was amended to provide a security officer around-the-clock. The security officer accompanied the medical staff into the room whenever the patient needed care. The presence of the uniformed officer seemed to have a calming effect on the father.

In two weeks the patient's condition stabilized, and he was sent home. The discharge provided a well-deserved rest for everyone involved. However, the patient was readmitted two weeks later. The mother expressed fears that the father was even more hostile toward the medical staff--the physician in particular.

After meeting to discuss the situation, the doctor, the social worker, and the security manager decided that more restrictive measures were needed. The security manager gave the father written notice that he would be searched whenever he departed and returned to the medical center. He was also told that the room would be searched periodically, and he was warned not to interfere with the medical staff. Finally, the father was asked to refrain from having domestic arguments with his wife while in the medical center.

These rules remained in effect and were successful as the patient's condition deteriorated. As death approached, tension among the staff increased dramatically. In the room with the child were his parents, grandparents, several aunts and uncles, the physician, the social worker, several nurses, and three security officers.

When the child died, the father screamed for everyone to leave the room, including his wife. As everyone backed out, he quietly asked one of the security officers to remain.

The door remained ajar so those outside the room could see the father sitting by the bed sobbing while embracing his son's body. The security officer gently kneaded the father's shoulder, as if giving him strength with a touch. From all the people there, the father chose a security officer for support.

Donald F. Dawson, CPP, is manager of safety and security at the Kapiolani Medical Center for Women and Children in Honolulu. He is a member of ASIS.
COPYRIGHT 1992 American Society for Industrial Security
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 1992 Gale, Cengage Learning. All rights reserved.

Article Details
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Author:Dawson, Donald F.
Publication:Security Management
Date:Jun 1, 1992
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