21st Century Security and CPTED, 2nd Edition

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20

Designing Safe

Healthcare Facilities

Hospitals and Medical Facilities

Anthony Potter and Randall I. Atlas

Hospitals are unique environments for several reasons. First and most important: Nobody wants to go

there. People who come to hospitals are sick, injured, addicted, and/or mentally ill, or someone they love

is in that condition. They generally do not care about the hospital’s rules and restrictions; if they come to

the emergency department (ED), they want to be seen now. They do not understand that patients are tri-

aged and seen based on their medical condition; they want to know why they have been sitting in a wait-

ing room for hours while someone else comes in and is seen immediately because they are complaining

of chest pain. They do not understand why they have to leave their sick loved one and move their car to

a distant parking lot, or why the entire family cannot go back to the treatment area or the patient’s room.

They do not understand that federal law often prohibits them from being given any information

about their loved one. They have questions, and frequently no one can give them answers because

of federal rules governing patient privacy (the Healthcare Insurance Portability and Accountability

Act [HIPAA] of 1996).

Hospitals also present unique security challenges. They are open for business 24-hr. a day

and in most cases have not been designed to provide a secure perimeter restricting unauthorized

access. The current trend toward open visitation has resulted in visitors entering and leaving at

all hours, with cost containment limiting and in some cases eliminating visitor controls. The

large majority of hospital employees are female, frequently working long shifts that end after

dark. When they head for the employee parking lot (usually the most distant parking on cam-

pus) or public transportation, they are tired and not paying attention to their surroundings and

potential threats. Older urban hospitals are frequently located in declining, high-crime areas (see

Figures 20.1 through 20.5).

One hospital security director characterized hospitals as “Hotels where the guests can’t lock

their doors, and there are plenty of drugs.” Hospital patients are vulnerable to all types of criminal

attack, from assault to theft. Newborn babies are especially vulnerable to abduction by women who

CONTENTS

Types of Healthcare Facilities ........................................................................................................376

Security Standards in Healthcare ................................................................................................... 377

Assessing the Risks ........................................................................................................................ 378

Planning New Facilities ................................................................................................................. 381

Renovation and Expansion of Existing Facilities ..........................................................................390

Balance of Power ...........................................................................................................................390

Consequences of Doing Nothing ...................................................................................................392

Next Steps ......................................................................................................................................393

Appendix: Healthcare Security Risk Assessment .......................................................................... 394

References ...................................................................................................................................... 400

374 21st Century Security and CPTED

FIGURE 20.1 Patients often sit in a room with no distractions and under high stress and anxiety.

FIGURE 20.2 Task of getting updated information on loved ones is daunting.

FIGURE 20.3 Visitors should be checked in and have to patiently wait for information.

375Designing Safe Healthcare Facilities

desperately want a baby of their own. No crime is more feared or has worse consequences for a

hospital than an infant abduction: the publicity is devastating, the legal consequences are expensive,

and the security director is inevitably red.

Then there is the “dirty little secret” that no one wants to talk about: drug theft! Not by intruders,

but by the hospital staff. Drug charting, diversion, and substitution are problems facing every health-

care facility and can have serious if not fatal consequences for the patient who did not receive his

or her prescribed dosage.

A recent addition to the security problems facing hospitals is the deluge of mentally ill patients

caused by the closing of mental hospitals in many states. The resulting shortage of mental health beds

has resulted in these patients being left in primary care hospitals for days and often weeks until a bed

is found, during which time they receive limited and sometimes no appropriate care. Most hospitals

do not have the specialized facilities or staff required to effectively treat these patients. Funding for

their care and for the facilities to care for them is increasingly limited in today’s economy.

Hospitals were once thought of as sanctuaries for the communities they served. This is no longer the

case, if it ever was. Every crime that occurs in a community will sooner or later occur in its hospitals.

Today’s hospitals must be designed or recongured, equipped, and staffed to deal with this new reality.

FIGURE 20.4 Signage tells visitor the ground rules but the only thing on their mind is medical updates.

FIGURE 20.5 Emergency room security staff is often overworked and unfocused. I caught this ofcer sound

asleep in the ER.