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Legal Perspective on Proactive
Hospital Security Management - don't
wait until it's too late!
David Goldberg
General Counsel, Peninsula Health
20 October 2014
Agenda
Duty of Care
Patient Rights (and Responsibilities)
Proactive security measures
Clinically led Restriction or
Denial of entry
Search
powers
Contract
management
Additional risk issues
Confidentiality Hospital in the
Home/CommunityConfiscation of
weapons/drugs
Industrial relations
Duty of care
• Duty of care issues
– Other patients
• Public liability
• Negligence
– General public
– Staff
– Contractors
– The violent patient
Vic: Employers must provide a safe working
environment for their workers and that a
workplace under the control of the employer
is safe and without health risk, so far as is
reasonably practicable
NSW: Employer, so far as is reasonably
practicable, to provide a safe and healthy
workplace for workers or other persons by
ensuring a safe systems of work, a safe work
environment, etc..
Penalties can be financial or criminal
National Healthcare Reform Agreement
• “eligible persons are to be given the choice to
receive, free of charge as public patients,
health and emergency services… on the basis
of clinical need and within a clinically
appropriate period” (clause 4)
Patient rightsPatient responsibilities
Charter of Patients’ Rights - comparison
• “You have the right to feel safe from any form of
abuse whilst using public health service facilities” -
SA Health Charter
• “Providers have a right to be able to provide care and
treatment free from intimidation, coercion,
harassment, exploitation, abuse and assault.” – NT
Patient Charter
NSW Vic Qld WA SA Tas NT ACT Private
X X X X X
Clinically led proactive security• Planned Code Greys
– Peninsula Health had 2,301 code greys in 2012/13, of which 867 were
planned
– Only 3 code blacks
• Code Greys - Clinical lead – talking to the patient and calling
the shots
• Integrate security considerations into all relevant policies (HR,
engineering, patient treatment policies etc…)
• Management plans
• Consideration to be given about what drugs a patient is on,
environment, which staff to allocate to certain situations
• Follow-up bad behaviour
• Behaviour contracts
Terms, conditions and behaviour contracts
• Terms and conditions need to be “up front”
• May include:
– Patient responsibilities
– Physical violence/intimidation
– Verbal violence/intimidation
– Photography/videography
• Specific terms for certain patients/visitors
Search powers
Search Powers
• Search (and seizure) policy – and, importantly, guideline
– What are we searching for? Are there criteria?
• Can always occur with consent
• Criteria for search without consent
– Proportionality
– At times relevant/essential even without consent due to over-riding
obligation under occupational health and safety law
• Are there less oppressive methods?
• Sniffer dogs
• Metal detectors
• Search wands
Contract management
- Selection of guards
- Good background checks, experience in hospitals
- Ability to review and refuse staff
- KPIs
- Response times
- Reduced restraints
- Communication
- Participation in education
Contract managementKEY
PERFORMANCE
INDICATOR
TARGET FREQUENCY
AND METHOD
OF REVIEW
REQUIRED
ACTION
FOLLOWING NON
COMPLIANCE
PEFORMANCE LEVEL
REBATE
Static Security Service
Emergency codes
including respond Grey
are responded to
within 5 mins where
practical
95% ABC Security to
provide data in
quarterly report
Contractor to provide reasons and exception reports for discussion.
If failure to reach this target occurs once (or more) in the quarter the Health Service will be entitled, at its discretion to a rebate.
Compliance with
requested roster levels
100% ABC Security to
provide data in
quarterly report
Contractor to provide contingency plan and ensure that service notified of any short falls in the agreed roster.
If failure to reach this target occurs three times (or more) in a calendar year the Health Service will be entitled, at its discretion, to a rebate
ED walk through every
30 mins except when
responding to a
code/emergency
incident.
95% ABC Security to
provide data in
quarterly report
Contractor to provide contingency plan and ensure that service is aware when not able to meet target.
If failure to reach this target occurs three times (or more) in a calendar year the Health Service will be entitled, at its discretion, to a rebate.
Provide an incident
table detailing the
number of incidents by
type and trend analysis
100% ABC Security to
provide report
monthly
Report provided no
later than two
weeks past the end
of the month
Complete a monthly
security/lighting audit
of all PH sites
100% Monthly copy of
audit reports
Report provided no later than two weeks past the end of the month
Incident reports
provided within 24
hours of incident. All
major incidents
reported immediately
95% Summary of
data in
quarterly report
Immediate investigation as to why the incident was not reported
If failure to reach this target occurs in the quarter the Health Service may at its discretion withhold X%.
Compliance with
Confidentiality
agreement
100% Reported
incidents of
confidentiality
breaches
Immediate investigation of breach potentially resulting in removal of individual guard
Training
Security staff have successfully completed
Peninsula Health’s aggression management
(RiSCE and AMT) training
Security staff have successfully completed
Peninsula Health’s no lift training
100% compliance ABC Security to provide
data in quarterly report
Additional risk issues
• Confidentiality and the duty of care
– Cannot generally report past or future criminal
conduct unless the organisation reasonably
believes that the use or disclosure is necessary to
lessen or prevent—
• (i) a serious and imminent threat to an individual's life,
health, safety or welfare; or
• (ii) a serious threat to public health, public safety or
public welfare
Additional risk issues
• Hospital in the Home and similar community based
services
– Different security/safety risk issues
– Ensure strong protocols
• Confiscation of weapons and drugs
– Ensure that proper governance exists
– Do you return patient’s drugs to them?
• Industrial relations issues
– ANMF in particular very active on this issue.
Closing Panel Discussion
“A conference is a gathering of important people
who, singly, can do nothing but together can
decide that nothing can be done.”