C.o.P.s and Cops: Train Your Off-Duty Law Enforcement Officers or Else
Hospitals often employ off-duty law enforcement officers as supplemental security, but many may be doing so at their own risk. Any person employed by a health-care facility must learn about CMS’ Conditions of Participation (C.o.P.s), as well as the proper application of patient restraints and use of restrictive interventions.
There are several areas in which the education of off-duty law enforcement personnel will help to insulate a hospital from being found deficient in regards to Centers for Medicare and Medicaid Services (CMS) Conditions of Participation (C.o.P.s). Topics may include a description and brief history of CMS, C.o.P.s; the survey process; patients’ rights; standards for restraint (acute medical/surgical care and behavior management); and interpretive guidelines as related to weapons and handcuff usage.
Another important issue that should be communicated to personnel is the Emergency Medical Treatment and Active Labor Act (EMTALA) rule. EMTALA deals with the failure of a health-care facility to provide initial medical screening, stabilization of emergency medical conditions and safe transfer for individuals and women in active labor seeking emergency treatment. It has several triggers, which can be set in motion by security personnel (imagine a patient being trespassed and removed from the property before he or she can be medically screened).
The roles and responsibilities of security (full time and PRN staff) and clinical staff need to be clearly communicated regarding restrictive interventions and patient interactions that have the potential to impact CMS regulations. Such training should include applicable policy reviews; least restrictive uses of force as related to health-care interventions; and the security/off duty law enforcement officer’s role in communicating with emergency department care team members.
Should any off-duty law enforcement officer be expected to assist in patient restraints, he or she must be educated and assessed in the proper application and removal of facility-approved medical or behavioral restraint devices. The officer must also understand the justification for employing such interventions.
Using Weapons in Hospitals Can be Tricky
All off-duty law enforcement personnel who will be working in health care should be specifically educated on a campus’ existing use of force policy. They should be trained on how lethal and less-lethal weapons are affected by the CMS Interpretative Guidelines for Patients’ Rights Standards (as updated in 2004). These guidelines state that “CMS does not consider the use of weapons in the application of restraint as safe appropriate health-care interventions.” Additionally, “CMS does not approve the use of weapons by any hospital staff as a means of subduing a patient to place the patient in restraint/seclusion.”
Weapons are then defined to include “pepper spray, nightsticks, Tasers, cattle prods, stun guns, pistols and other such devices.” The standard also considers “handcuffs, manacles, shackles and other chain-type restraint devices” as law enforcement restraints. The use of any such weapons or restraint devices are considered appropriate only in response to a criminal activity. Any perpetrators should be turned over to local law enforcement.
This can prove to be a challenge, especially if off-duty law enforcement employees are employed by an agency in the facility’s jurisdiction. Are they acting as health-care security or as police? Was it a criminal activity or a patient restraint that turned into a criminal activity? Where was the demarcation between the two?
These are the tough questions that will be asked of all involved. Therefore, everyone needs to be well versed in what is and is not acceptable regarding the aforementioned items when dealing with a patient. Bear in mind, a “weapon” does not have to be deployed to create a breech of C.o.P.s. since psychological harm is viewed by CMS as being just as serious as physical harm. The mere threat of a weapon’s use could be sufficient to prompt an investigation.