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Training, additional insurance may mitigate risks unique to hospitals


CHICAGO — Risk evaluation, staff training and disaster-specific coverage may help health care companies mitigate some of the risk associated with violent events like active shooting scenarios and workplace assaults.

At the 2019 Professional Liability Underwriting Society's Healthcare & Medical Professional Liability Symposium on Tuesday, a panel of industry experts convened to address how hospitals and insurers may devise strategies to better protect their employees and reduce their liability if a situation occurs.

According to the U.S. Occupational Safety and Health Administration, three-quarters of workplace assaults annually occur in health care and social services settings. Among these assaults are active shooter incidents. Between 2000 and 2011, hospitals reported 54 shooting incidents, resulting in more than 230 injuries and fatalities, reported by the National Institutes of Health.

One of the biggest obstacles for health care facilities is they are vulnerable simply because they are open to everyone, said Harry Rhulen, founder of The CrisisRisk Group in Roswell, Georgia, which helps companies identify emerging threats and vulnerabilities.

“It’s a very difficult environment … in the hospital world,” he said. “Health care facilities … have to take (whoever) walks in the door.”

Deb Somers-Larney, the system vice president of security for Downers Grove, Illinois-based Advocate Aurora Health Inc., said hospitals face many vulnerabilities that are unique, such as having many entrances and exits to enable patients to get into the facility and receive care quickly. But hospitals may also have to contend with repeat patients seeking drugs, those in altered mental states, and belligerent individuals or family members. But, she says, the hospital takes significant steps to identify the risks and vulnerabilities that exist and participate in proactive planning with stakeholders to address and mitigate those risks. 

“We refer to it as security hygiene,” she said. “I can’t hire enough officers to keep everybody safe. We collectively have to do it.”

Mr. Rhulen said one problem in some health care organizations is “disaster denial” by administrators who believe an incident won’t happen at their hospital. “Somewhere between 10 and 30 percent of people have drug, alcohol, spousal or financial problems, and a certain percentage (of those) is going to result in violence,” he noted. “Any organization that isn’t doing the planning or training … or don’t receive the budge to do those things, those are the organizations at much greater risk.”

And failing to take mitigating measures can come at a significant cost. When hospitals have an active shooter situation, not only will they incur costs from injuries or fatalities, they can also suffer damage to their reputations and lose business, said Edna McLain, a partner with Chicago-based law firm Tressler LLP.

They also face additional liability exposure. While employee injuries from these workplace violence incidents typically fall into the exclusivity provision of the Workers Compensation Act, Ms. McLain noted that the Bronx County Supreme Court in New York will consider whether an employee injured in the 2017 shooting of seven hospital workers at Bronx Lebanon Hospital can provide enough evidence to sustain a separate injury claim for negligence based on his allegations that the hospital allowed a physician fired for sexual harassment to retain his lab coat and identification badge.

Employers may further protect themselves from these types of workplace violence risks through additional insurance. While a general liability policy may cover an active shooter situation, Mr. Rhulen noted that those policies tend to be triggered by the filing of a claim, that may not take place until much later.

“All of that information that would have been gathered at the time (of the event) is either lost or diluted in some way,” he said. With a policy specific to a disaster situation, he noted that coverage is triggered immediately, allowing for the insurance to get to the victims early, removing anger from the situation and making the settlement process easier. Insurance such as active shooter protection may also cover physical damages, business interruptions and the cost of providing employees and bystanders access to counseling.

While active shooter situations can be a risk, Ms. Somers-Larney sees targeted violence and assaults on staff as more of a risk. At Advocate Aurora, Ms. Somers-Larney says staff is trained on de-escalation techniques, and the clinical teams are empowered to contact public safety if they witness troublesome behavior by families, so that others at the facility can respond and take control before an incident occurs.

An anonymous reporting tool that allows staff to report suspicions, including any indicators that a staff member is in an abusive domestic relationship — which past active shooting incidents have shown can spill over into the workplace — can also have an impact, said Mr. Rhulen.

“Simple apps can be put on a phone and can be extremely effective,” he said. “You’re going to get so much more information.”










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