To address this issue, a risk assessment of the prisoner should be conducted prior to him or her being admitted. Obviously, someone who has been arrested for DUI or a misdemeanor poses less of a risk than a murder suspect. However, Warren provides this warning: forensic patients can be unpredictable.
"Even if the person hasn't been convicted of a heinous crime, you never really know what is going on with him," he says. "Perhaps they have other warrants that the police are not aware of at that time. Perhaps that person feels cornered. You never know what their response will be."
4. Lack of appropriate facilities
Before an inmate is admitted, the medical facility must ensure that his or her treatment room will be clear of furniture, objects and medical equipment (such as IV polls) that can be used as make-shift weapons. Unfortunately, most hospitals, but especially smaller ones and those in rural areas, don't have appropriate areas designated for inmates. In those cases, security personnel should do a clean sweep of the room or rooms before the inmate is admitted to the hospital.
There are some hospitals that do have well-secured areas designed specifically for forensic patients.
"In Greenville, S.C., through federal grants and other resources, they were able to create a secured mantrap entrance into a portion of their emergency room for law enforcement to use with inmates," says Warren. "It includes a walk-through metal detector and radios that enable police to communicate with hospital security while they are on site. The furniture is either bolted down or can't be used as a weapon or barricade. All of these things have been taken into consideration in that wing. It's an example how preplanning, architecture and getting security involved in the front end before they do an addition or renovation can be an outstanding compliment to the emergency room."
5. Law enforcement officers not paying attention to details
Some inmate handling errors defy explanation.
"I have witnessed or my officers have witnessed police officers who left their radios in the room with the forensic patient unattended," says Morgan.
"They have uncuffed a patient in their custody and left the room to go on a break, and it was one of our security officers who found the patient uncuffed on the bed," he adds. "Leaving forensic patients unattended is absolutely something that should not be done."
6. Not recognizing that situations can escalate to active shooter incidents
The tragic shooting death of Montgomery Regional Hospital Security Officer Derrick McFarland in 2006 is a prime example of how forensic patient handling can go terribly wrong.
He was shot and killed as he attempted to assist a Blacksburg, Va., Police Department deputy who had been overpowered by an inmate. During the struggle, the forensic patient took the officer's gun and turned the weapon on McFarland. After shooting him, the suspect fled the hospital on foot where he shot and killed another police officer on the campus of Virginia Tech.
Warren and Morgan both say that hospitals must not let their guard down and focus only on the healthcare issues of the inmate.
"A lot of facilities have the ability to lockdown and keep people out, but sometimes we don't do as good a job when they are already inside and something occurs," adds Warren.
He recommends hospitals explore ways they can compartmentalize the emergency departments and other areas designated for forensic patients to prevent prisoners from escaping, potentially leading to either an active shooter incident or hostage situation.
IAHSS Prisoner Patient Security Guidelines
Maryland's Model Guidelines for the Security of Prisoners for EMS and Hospital Settings
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