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Monday, October 03, 2011  
Posted by: Colleen Kucera
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October 3, 2011 [Glendale Heights, IL] Study Highlights Incident Frequency, Reporting Shortcomings


When Dr. Victoria Mikow-Porto completed a study of the frequency of prisoner escapes from healthcare facilities at the behest of the Foundation of the International Association of Healthcare Safety and Security (IAHSS), even this veteran researcher was surprised by what she found.  In a White Paper commissioned by the Foundation and presented at the recent IAHSS Annual General Meeting in Toronto, she shines a spotlight on a subject that seems in some ways all too common and yet taboo.

She points out that this issue has been lurking for decades. When the Supreme Court agreed with prisoner petitioners in a class action law suit in 1976 (Estelle v. Gamble) that depriving prisoners of medical care in correctional facilities constituted “cruel and unusual punishment,” it did not anticipate a plethora of unintended consequences when it ruled that correctional facilities “must provide necessary medical care to all incarcerated individuals” and “the deliberate indifference to serious medical needs is prohibited.” The ruling resulted in vastly increased medical services provided to prisoners in correctional facilities. But as economies stalled in state after state in the decades that followed, correctional systems downsized or eliminated altogether onsite medical care. This meant that correctional facilities had to turn to public or private hospitals and other healthcare facilities to provide medical care to prisoners.

With the prison population burgeoning from 1.1 million in 1990 to over 2.3 million today (US Department of Justice, 2009), medical treatment of prisoners outside prisons has become an everyday experience. “The Supreme Court decision opened a floodgate that healthcare facilities today are struggling with more than ever,” she says, citing the disproportionately high levels of acute and chronic medical and mental disorders among the prison population, along with the additional burdens associated with aging prisoners. She adds that the public at large has little or no idea of how the increase in numbers of forensic prisoners at healthcare treatment facilities - with corresponding increase in potential for escape - can affect them. “There’s a whole world out there that people don’t see or understand.”

Mikow-Porto found little scholarly research or systematic collection of data on rates of escape incidents in transport of prisoners for medical treatment or while in treatment at healthcare facilities. To collect data, Mikow-Porto, who holds a PhD and MA from UNC at Chapel Hill in the Social Sciences, used a survey and interview protocol she designed with input from the study co-author Thomas A. Smith, CHPA, who is director of Hospital Police at UNC Health Care, and an advisory committee representing the leadership of the Foundation. She employed a convenience sampling strategy to gather information retrospectively and prospectively about prisoner healthcare facility escapes from on-line media sources, and examined each report to ensure there was no duplication of cases. Follow up interviews were conducted with individuals from healthcare facilities and law enforcement representing organizations in which the incidents took place. Media specialists who wrote the stories were also interviewed.  

Mikow-Porto found 99 documented cases of attempted and/or completed prisoner escapes from healthcare facilities reported in the media between April 1, 2010, and April 1, 2011. This translates into about 8.4 incidents per month, or 2.1 weekly. Given that there are no baseline data on prisoner escape data, Mikow-Porto stated that she did not know whether this is a high or low frequency. She admits she was surprised by the extent of the reported problem, however. Mikow-Porto is also convinced the escape statistics may be much higher since she relied on Internet articles that have a short self life and the fact that healthcare facilities, fearing liability, are not required to report such incidents. The researcher finds the situation frustrating: “if you don’t know what’s going on, it’s hard to generate the kind of attention and interventions that will deal with these issues. 

Her research reveals that about half the escapes result in injuries, and in the majority of cases where injuries occur involve assault on correctional or security officers accompanying the prisoner. Also reported were rare cases of injury to hospital staff or other patients, kidnapping of visitors, and car thefts from visitors and third parties living in the vicinity. Two fatalities were documented. 

As she states in her study, the numbers of prisoners who will in the future need medical treatment is escalating. It is critical for those in the healthcare industry who treat prisoners to understand the conditions under which prisoner escapes occur and what can be done to prevent them. 

To mitigate the risk, it’s important to be aware of the vulnerabilities of the facility. Mikow-Porto’s study indicates that locations of escape attempts vary. Of the 99 incidents reported in the media during the research period, 32 prisoners escaped from the emergency room, 21 
from restrooms, 41 from clinical treatment areas and five from the hospital entrance or parking lot. “There are incidents of prisoners escaping through very public areas, though you usually don’t think about prisoners being treated with the general patient population or that they might escape,” she points out.

This issue of who has responsibility for a prisoner patient in a public healthcare setting is sometimes confusing. Hospital security or police staff are responsible for the general safety and security of the hospital, staff, visitors and patients, but prisoners are primarily the responsibility of correctional officers until treatment is completed or transfer to the custody of hospital security staff, following established legal procedures, is made. Mikow-Porto’s study found that breakdowns in communication between the agencies involved in prisoner transport, custody and treatment often contributed to prisoner escapes. 

“I just read a recent story where someone at a hospital signed off that the hospital was taking custody of a prisoner. The prisoner then just walked off when his guard left him at the door. Neither the correctional nor the hospital staff person followed correct procedures in this case,” explains Mikow-Porto. She also points out that if a prisoner escapes, most healthcare security personnel are unarmed so they take risks if they pursue prisoners. In her view, this demonstrates how important it is that forensics protocols are designed to address all elements in safe medical treatment of prisoners and that procedures are in place and followed, -- just like for disasters or fire drills, -- and that better interagency cooperation is needed.

President of the Foundation Board Ed Stedman echoes Mikow-Port’s observation. “It’s important to fund a study like this. Each healthcare institution deals with having armed law enforcement officers within their faculties, and each one has their own procedures. Meantime, law enforcement authorities are in charge of the patient and have their procedures. It’s important to try to mitigate issues between the two.”

He adds, “Escape while on the property can create a serious incident. Institutions are grappling with this and look to us for guidance. Our members have to know what’s going on 
nationally so that they can make better judgments to administer their operations.” He points out that there are municipal, state and federal political issues involved while safeguarding staff, patients and visitors while within the facility and when the prisoner is transported. 

The public might well wonder how prisoners who are in shackles and handcuffs can escape. Sometimes they have accomplices; sometimes they get restraints removed for a medical procedure like an MRI, or to visit the restroom, and then escape. The study found that 62% of the cases, the restraints had been completely or partially removed. 

Examples of Escapes/Typical escapes – this whole section seems out of place under restraints. These are examples from the articles I collected. I think a header would make this clearer. There was the instance where a handcuffed prisoner stole his guard’s SUV; another where the handcuffed prisoner just walked out of the hospital naked. (He was apprehended outside the entryway by a suspicious security guard.) The scariest one, though, to Mikow-Porto was the recent case of a prisoner overwhelming his police escort, using her taser on her and stealing her gun which he fired at a person who tried to intervene, and then entered a preschool across the street and took a teacher and forty children hostage before releasing them and escaping into a nearby neighborhood.  

Mikow-Porto’s study includes a number of recommendations to reduce or eliminate prisoner escapes from healthcare facilities. Some address improvements to physical plant and equipment, such as placing video cameras on security staff and installing panic buttons. Others point to the need for funding to increase numbers of security personnel as well as the number of hospital professionals with sworn police powers. 

Most important suggestion, in her view, is formalizing standard policies and procedures to be followed by hospital security staff and outside corrections officers to ensure the right procedures are in place and followed by all the agencies concerned. Personnel working in emergency rooms and in prisoner treatment areas should be trained in these protocols and procedures. 

She also believes that accurate reporting of the number of escape incidents is crucial to heightening awareness of this issue among those who control the purse strings, including healthcare administrators. She cites the Clery Act, passed by Congress in 1990, which requires that colleges and universities disclose crime statistics as part of a campus security report published annually. Mikow-Porto advocates a similar approach to mandate reporting by hospitals of all criminal incidents, including prisoner escape, while adding certain liability protections. “We can’t do our best without knowing what’s going on and who’s being treated. We need to ask what happens, why, what are the likely outcomes, and how prisoner escape can be prevented in future.”

Mikow-Porto is not an alarmist: “I have great respect for the people who work in hospital security and corrections. They do a great job and these are relatively rare instances — but they do occur with greater frequency than we’d like to see.” 

 “If we are more transparent in reporting, if the general public is more aware that these incidents occur, then,” she continues, “we can ensure that action is taken to address this topic in a more open manner, with agencies cooperating with one another, and with procedures that are clear, well understood and used.”

Mikow-Porto’s study, “Frequency of and Conditions under which Forensic Prisoners Escape from Healthcare Facilities,” will be published later this year in IAHSS’s Journal of Healthcare Protection Management. She is the author of the IAHSS 2010 Crime and Security Trends Survey published last year in the Journal and has been commissioned to update that Survey in 2012. Other IAHSS Foundation-supported educational initiatives include project grants and scholarship programs.

About IAHSS 
The International Association for Healthcare Security and Safety (IAHSS) is the only organization solely dedicated to professionals involved in managing and directing security and safety programs in healthcare institutions. Training and credentialing are the hallmarks of the organization, which offers certification programs for all levels of security personnel.  With over 1,900 members worldwide, IAHSS provides members with a useful network of professional peers who share their commitment to security and safety.  

“Leading excellence in healthcare security, safety and emergency management”

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