Use of force by hospital staff
There were 58 complaints reporting use of force by hospital security staff–mostly involving patients with mental health or addiction issues.
What's the answer to de-escalate?
The high frequency of physical and verbal assaults on health care providers is widely documented. Many hospitals now hire security guards or engage private security companies to assist with managing aggressive or violent patients and visitors.
Finding a balance between providing a safe environment for patients and health care workers while ensuring access to care for vulnerable patients who may be prone to aggressive language or behaviour is not a simple matter. The consequences of getting it wrong are serious, given that force may be used in addressing perceived or actual threats.
Failure to train security officers in the use of safe and effective physical control techniques to address combative patients…exposes the health care facility to greater legal risk as well as greater danger to the patient, other patients, visitors and staff.
In years 4 and 5, Patient Ombudsman received 58 complaints that reported aggressive interventions by hospital security staff, including 33 reports of assaults or physical injury. Most of the incidents occurred on mental health units or involved patients with mental health or addictions issues in the emergency department. There was a significant escalation of these types of complaints in 2020/21— more than 70% of complaints about security interventions were received between April 2020 and March 2021. Frustration with delays and public health measures, and general anxiety related to the COVID-19 pandemic may have contributed to an increase in incidents involving hospital security.
Patient Ombudsman is required to give HSOs an opportunity to resolve complaints before we become involved. For the majority of the complaints Patient Ombudsman receives about hospital security, the hospitals had not yet completed their own review. In some cases, Patient Ombudsman was unable to contact or engage the complainant in the resolution process. The resolution process is underway in the remaining cases.
In Ontario, the Private Security and Investigative Services Act, 2005 and related regulations set out the requirements for security guard and security company licensing, training and testing. The Ministry of the Solicitor General has established a syllabus outlining training requirements. Security guards must complete a minimum of 40 hours of basic training when Emergency Level First Aid Certification is included and no less than 33.5 hours when Emergency Level First Aid Certification not included. A review of websites suggests that some of the larger security companies provide additional training for security guards that work in health care settings.
Beyond the basic training syllabus, there are no standardized education requirements for de-escalation techniques, use of force and effective communication with mental health patients and other vulnerable populations.
Patient Ombudsman believes the integration of security guards and use of force is an area that requires additional attention by the health care community. At a minimum, Patient Ombudsman suggests that HSOs:
Have a use of force policy that is sensitive to the patient populations and cultures served.
Ensure all security personnel receive de-escalation training and recognize that use of force is a last resort.
Ensure policies, procedures and training for security encompasses unconscious bias and supports the needs of diverse persons using the hospital.
Document and review all incidents that involve the use of force against patients and visitors to ensure that policies and procedures were followed and identify opportunities for improvement.
Optimize the use of technology in reviewing use of force incidents, for example, CCTV or implementing body-worn cameras.
- Brubaker TW. Use of force in the health care setting. J Healthcare Protection Management. 2015;31(1):73-80.
- George, Constance E. What Might a Good Compassionate Force Protocol Look Like? AMA J Ethics, 2021, 23(4), E326-334.
- Ministry of the Solicitor General, Private Security and Investigative Services Training Syllabus for Security Guards: https://www.mcscs.jus.gov.on.ca/english/PSIS/Training/SecurityGuardSyllabus/PSIS_SG_syllabus.html.
- Schoenfisch, Ashley L. and Pompeii, Lisa A. Security Personnel Practices and Policies in U.S. Hospitals Findings from a National Survey. Workplace Health & Safety, November 2016, 64 (11), 531-542.
- Toronto Star, Two security guards charged with manslaughter in the death of a woman at Toronto General Hospital, December 8, 2020.