By Greg Freeman
EXECUTIVE SUMMARY
Hospital personnel often interact with law enforcement, sometimes resulting in stressful disputes. Establishing a cooperative relationship with police can prevent problems.
• ED staff interact the most with police.
• Many disputes involve HIPAA compliance.
• Established policies and routines can ease police encounters.
Clinicians and hospital administrators may frequently interact with local law enforcement. While most interactions are cordial and uneventful, conflicts can arise over the release of patient information, treatment of patients in custody, and misunderstandings over what both parties can and cannot do. Many problems can be prevented by establishing a good relationship with law enforcement beforehand.
Proactively contacting law enforcement to create that good relationship is key, says Daniel Linskey, managing director of security risk management with Kroll and the former superintendent-in-chief of the Boston Police Department.
“The security directors of the hospitals and the administrators of the hospitals can have conversations with the police that are going to be responding to their facilities and get to know each other by sitting down and having a cup of tea or coffee,” Linskey says. “The goal is understanding each other’s needs, concerns, and issues from that person’s view.”
HIPAA is a frequent sticking point. Conversations between hospital administrators and police leaders can help individual officers and investigators better understand what can and cannot be released, Linskey says. The frustration arises when police think they are making a legitimate request that should be honored and do not understand why the hospital staff refuses.
Physical security on and near the hospital campus also is a concern. Hospitals can improve the safety of their employees and patients by communicating with police about crime and other issues.
“There will be bumps in the road, but the best way to deal with that is to have an ongoing relationship,” Linskey notes. “We sit down and talk with them in Boston. We would try to host a monthly meeting with all the hospitals’ security officials about what they were seeing and how Boston police could supplement their security programs to make sure they were safe and secure.”
Participate in Training
Relationships and trust can improve when hospitals participate in training with law enforcement, such as training for mass casualty events, Linskey says. Boston hospitals participated in such training before the Boston Marathon in 2013, and Linskey says it paid off when the city had to respond. But there were lessons to be learned, and the fact that the hospital and police had a good relationship made it easier to learn from the experience.
“When we shut down the city of Boston, it was quite common sense for me that any doctors and nurses would be able to go wherever they have to go. But when I talked to the hospital administrators afterward and asked what the challenges were, they said yes, the doctors and nurses could go through, but our janitorial staff and our maintenance staff and our staff who cook the meals for the patients — all of them weren’t allowed in. It’s important that you’re constantly getting each other’s concerns from their viewpoint and then respectfully work toward a solution that jointly works for both the hospitals and the police.”
Local police also could help with safety training for hospital employees. Linskey helped one hospital security director realize that while nurses had been required to take active shooter training, many of them completed the video education session on the mobile computer carts they used with patients. Linskey noted the carts do not include speakers, so the nurses checked off the training requirement without hearing any of the video.
In another instance, Linskey highlighted the folly of a hospital requiring visitors to check in and receive a visitor’s badge between 8 p.m. and 6 a.m., but then at 6:05 a.m. no one was a threat anymore.
Learn What Information Police Need
Improve the relationship with police by educating administrators and clinicians on how to better communicate with officers. Linskey recalls an incident in which an emergency physician called the police to say that a patient urgently needed to return to the hospital, so Linskey was dispatched to collect the patient at his home.
“I say, ‘Hey, how you doing? I guess you have to go back to the doctor.’ He’s like, ‘OK, great. Thank you for coming. What should I do with the gun?’” Linskey recalls. “I said, ‘What gun?’ and he said, ‘I was going to commit suicide.’”
Apparently, the physician called 911 and said he needed a patient picked up urgently but did not mention the patient was suicidal with a firearm.
“It was not hospital administration I had to have a conversation with. It was the charge nurse at that emergency room who settled that issue and who put a new policy and procedure in place,” Linskey says. “She educated the doctor and everyone else on what to do when those types of situations come forward and how to communicate more effectively.”
Hospital Strives for Relationship
Leaders at North Shore University Hospital in Manhasset, NY, work to maintain a good relationship with local law enforcement, says John Ferrigno, director of security.
“The executive staff of the administration has met with the higher-ups of our local police department and as many jurisdictions and different departments as we can to develop those open lines of communication and to establish guidelines that we both have to abide by,” Ferrigno explains. “It makes it a lot easier when a situation comes up to know how to deal with it appropriately. I think that takes a lot of the issues out of the equation.”
Chain of custody can be an important issue for law enforcement. With the help of local police, the hospital trained staff on how to maintain chain of custody with items such as bullets, knives, and bloody clothing. Ferrigno says there was no chain of custody form used in the hospital when he first arrived, but now the form is used routinely.
Issues also arise with patients in custody. Seven months ago, Ferrigno instituted a policy requiring ED staff to notify security when a patient is in custody. A senior security officer responds.
“They will go down and speak to the officer to see if they need anything and to give them the guidelines for how to get out of the hospital in case of an emergency. But we’ll also ask him for the safety of our staff if there something that they should be concerned about. Is this a violent crime that this person was arrested for?” Ferrigno asks. “We’ll also ask if they would like us to wand the patient to make sure that person doesn’t have anything secreted on his body that wasn’t found by the officer when they did their search out on the street. It comes back to that communication, to give and take. It helps our staff, but it also helps them to know that we’re there to assist them in their needs.”
Establishing policies and procedures for routine interactions with law enforcement helps police obtain the information they need, says John R. Cook, Esq., assistant vice president of risk management at LCMC Health in New Orleans. For instance, the health system created policies on mandatory blood draws that were reviewed by legal counsel and provide step-by-step instructions for ED staff.
“We have designated people who routinely interact with law enforcement, particularly from public safety. Our leaders in this area at each facility are our go-to persons to interact with law enforcement when they need something,” Cook says. “In turn, they have the ability to reach out to risk management, compliance, or legal, and they have cellphone numbers for each group. These designated persons speak the language of law enforcement much better than a frontline healthcare provider.”
Cook says hospital leaders are not shy about contacting leadership in law enforcement to ensure they are aware of what is asked of their frontline people, especially if they are confused or uncomfortable with a request.
“This open dialogue allows us to often ask what they need, and then we are able to help them get it in the best possible manner so we do not violate patient confidentiality or other rights,” Cook says.
SOURCES
• John R. Cook, Esq., Assistant Vice President of Risk Management, LCMC Health, New Orleans. Phone: (504) 702-3000.
• John Ferrigno, Director of Security, North Shore University Hospital, Manhasset, NY. Phone: (516) 562-0100.
• Daniel Linskey, Managing Director of Security Risk Management, Kroll, Boston. Phone: (617) 210-7471.
Hospital personnel often interact with law enforcement, sometimes resulting in stressful disputes. Establishing a cooperative relationship with police can prevent problems.
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