Feds: MU Hospital Security Officers Would Provoke, Pepper Spray Patients
Nurses and emergency department personnel said security officers’ actions are often inappropriate and lead to escalation.
Federal authorities conducting an unannounced visit to the University of Missouri (MU) Health Care’s University Hospital found violations of patients’ rights, mainly at the hands of security officers.
In Sept. 2020, the Centers for Medicare and Medicaid Services, which provide federal oversight of healthcare facilities, determined the hospital facilitated “an unsafe patient care environment” severe enough to place “all patients at the facility at risk,” reports The Missourian. This classification, called an Immediate Jeopardy, required immediate corrective action from the hospital.
Nurses told investigators that security staff would provoke patients and then pepper spray and restrain them. During a Feb. 2020 incident, a nurse said a 29-year-old patient was brought into the hospital after police found him intoxicated and stumbling outside. Security officers were sent to the room by their supervisor. The nurse said the patient was calm and responded to their verbal orders when security wasn’t present. She repeatedly asked the officers to leave because the man’s demeanor changed when they were in the room.
After ignoring the nurse’s request, eight security officers allegedly cornered the patient and “physically pulled” the nurse from the room. Officers pepper-sprayed the man in the face before pushing him onto the bed. One officer then sat on the patient’s chest while others restrained him. There was no sign that the man resisted or presented a serious threat of violence, according to The Missourian.
During later interviews with investigators, nurses and emergency department personnel said the security officers’ actions were inappropriate provocation and escalation.
“If security had cooperated, the whole event could have been avoided,” a health department investigator wrote after the incident.
In an Aug. 2020 incident, a 24-year-old man with autism was brought into the hospital after he threatened to kill his parents. After his stay, staff from the hospital’s psychiatric division transported him back to his parents in wrist-to-waist shackles. According to the psychiatric center’s policies, those restraints, called W2s, should only be used with patients who are unpredictably or frequently aggressive.
“The staff believed that the patient was safe to transport yet believed that he was aggressive enough to place in W2 restraints,” investigators wrote.
When the patient returned to the hospital, he took screws out of a smoke detector. Four security officers were summoned to his room and told to “handle it” by psychiatric staff. The patient maintained a “defensive stance” while holding the screws. One officer said he would pepper spray him if he didn’t drop the screws. After the patient took a step forward, the officer sprayed him and officers applied a “modified shoulder pin neck restraint.”
Bill Marcisz, a nationally recognized expert in hospital security practices, told The Missourian that the officers’ actions were “not appropriate.”
“You’re a security officer. You’re supposed to be the adult in the room, so to speak,” he said. “And when somebody’s out of control, you being out of control is just adding to the chaos.”
When restraining a patient, Marcisz said security should consult medical personnel.
“The patient is ultimately the responsibility of the clinician, not security. It’s entirely appropriate to have a nurse in the room while the restraint is taking place to give direction in that situation,” he said. “Security is just there to provide whatever support [medical personnel] need.”
MU Hospital Makes Changes
Following the investigation, MU Health Care spokesperson Eric Maze said the hospital changed its policies surrounding patient de-escalation, placing more responsibility on nurses. Security officers now receive Crisis Prevention Institute (CPI) training, which teaches de-escalation tactics.
“Security is now trained in CPI techniques and assists nursing using these techniques with patients except in emergency circumstances where a patient presents a risk of imminent death or severe injury to another patient, staff or visitor,” Maze wrote in a statement. “It puts the nursing staff and the security staff on the same page on how to deal with a patient, so I think it’s better to have clinical and security doing the same thing.”
Based on CPI’s recommendations, Maze continued, nurses now dictate patient and management, meaning they are the first to respond and to use “progressive measures,” starting with the “least restrictive.”