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.”