Many hospitals are under pressure from within to reduce the number of workplace violence incidents as reported by their staff. Staff has often asked for security to be armed or that police officers are hired to provide security. However, the hospitals use of police for security can have consequences.

Hospitals at Risk

In a recent article posted on The Crime Report they stated that; “At least nine of Vermont’s 14 emergency rooms, including six of its eight hospitals serving rural populations, have been cited by national regulators over the past five years for improperly calling police to help with mental health patients.” They went on to state that: “When hospitals don’t set clear boundaries with police, hospitals can get in trouble with national regulators. Hospitals with multiple bad reports risk losing funding and certification from national and state governments.” Over the years I have personally observed concerns with police officers in the role of security officers for hospitals.

In one case a hospital had employed nothing but current and retired police officers to provide security at their facilities. While the use of such personnel on a smaller scale is not uncommon, in this case it was their end goal. While that in and of itself is not an elevation of the risks it did present some major issues that could result in litigation. Why? Because they never in fact set clear boundaries and they did not require ongoing training based on regulations such as the Centers for Medicare and Medicaid Services (CMS).

Police Officers as Security Officers in Healthcare

The use of police officers in healthcare either hired as employees or under a contract with a law enforcement agency is very common these days. In many cases it is to have the presence of a police officer in the Emergency department (E.D.) during peak times or 24/7. But before a hospital staffs a police officer, they need to set the ground rules.

The major considerations will include, but are not limited to the following:

• What training are the police officers required to have prior to working in the hospital? (e.g. HIPAA, Use of Force, Review of CMS Regulations, The Emergency Medical Treatment and Labor Act (EMTALA), and/or Accreditation standards)
• Will the police officers be armed with firearms, Tasers, pepper foam and all of the other police issued equipment?
• Will the police be allowed to use force? And if so are there limitations?
• What uniform will the police officers be wearing? Hospital issued or their police uniforms?
• Who at the hospital will be responsible for the oversight of the police officers?
• Prior to them being on duty, will your hospital have a means to ensure that their training in areas such as firearms, Tasers, batons, pepper foam, and such is verified and current?

There are numerous questions that could and have come up in the past and they all have relevancy to some extent.

Case in point, in the example earlier stated above the hospital that employed current or retied police officers as hospital security officers allowed them to wear their police uniforms on duty. The interesting thing was that almost everyone had a different uniform on because they came from several different agencies. Even more confusing was that they were hired by the hospitals directly, not through their current or former law enforcement agencies. Oh that is not all, they were also wearing police badges and patches, even those officers that had retired or resigned from their police agency. One security officer even had a Chief of Police badge on his uniform. Folks, I could go on forever giving examples of findings during security assessments but suffice it to say there are numerous risks and possible liability exposures that can result in the mismanagement of police officers working in healthcare.

Police Use of Force

Police officers are trained a certain way regarding the use of force, escalation processes, and responses. They also receive training on self defense and control measures such as handcuffing, pressure points, arm-bars, physical take-downs and such. Even though they have the training, do you want them to use those training techniques on your patients? Can they use them on the patients? I will refer you to 42 CFR § 482.13 – Condition of participation: Patient’s rights; subsection (e) Restraint or seclusion to ascertain by what regulations a hospital will be held to.

As a retired police officer I fully understand that the training that police officers receive compared to that training that hospital security officers receive can be quite different. Yes they both get some of the same training, but when it comes to the application of those training skills the rules can be drastically different.

The point here is that the hospital management has to understand the differences and ensure that they establish the rules in advance as to what levels of force and restraints that a police officer working as a security officer can utilize.

For example, one healthcare system that employed off-duty police officers as security officers had no clue as to what the officers were trained in and how they were using that training. In fact, when speaking to the CEO and Risk Manager I asked them if they knew that the police officers were suing handcuffs, pressure points, and take-downs on their patients the CEO and Risk Manager had that Deer in the Headlights look on their faces. When I asked the security director, who was present during the CEO & Risk meeting, as to what training that he provides to the police officers regarding the use of force in the hospital; he said that he relies on their police training and the hospital provides no further training. At that point I was pretty much certain that there would be several more in depth conversations at a later time between all those present.

So remember, it is up to the hospital to set the terms, rules, and parameters in which the police officers (working as security officers) will be required to follow and then ensure that they have the proper over-sight and evaluation of the actual practices. Plausible Deniability is not a viable defense!