RISK Alert March 31, 2016 Patient Dies After Falling from Hospital Room

RISKAlert   No. 843, March 31, 2016

A Maine patient, hospitalized with a severe brain injury after a motorcycle accident, climbed out of a 6th floor window in the hospital and fell to his death at 5:10 pm on March 29th.

Paul Cady, 43, from Hollis, Maine, had entered the hospital on March 9th, after a motorcycle accident, and had been in a medically-induced coma for a period of time following the accident.  His family emphatically stated he was not trying to commit suicide, but that he was only trying to get home to his family.
Portland, Maine -- 03/30/16 -- Paul Cady, as seen in an undated photo provided by his daughter, Miranda Cady. Paul Cady died Tuesday evening after falling from his sixth story window at Maine Medical Center in Portland. Courtesy photo

Recently, hospitals have recognized the value of fresh air and ventilation, but as a Life Safety issue, the amount that the window opens has been regulated by CMS, the Centers for Medicare and Medicaid.  Studies that shown that windows provide a positive effect on both healing and on patient satisfaction, whether the windows can be opened or not.

Registered Architect Gene Wells of Marshall Erdman & Associates, a leading national health care design and construction firm, offers the following: “In today’s hospital, huge efforts are being made to create a healing environment for patients and their families. A non-institutional approach lessens the stress level for people who already have too much stress and leads to better outcomes. Patient’s rooms, in particular, are often designed to reflect local culture, connect with nature or create a hotel-like environment. Operable windows can be an integral part of this atmosphere.

Lessons Learned:

1.  Patient falls from hospital windows are extremely rare in the United States.
2.  This type of incident can create a potential liability issue for healthcare organizations.

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Risk & Security LLC
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caroline@riskandsecurityllc.com

RISKAlert Case Study #841 – Physician Shot & Killed in Metairie

Dateline:  March 25, 2016 – New Orleans, Louisiana

A local Doctor was shot and killed by a patient while he treated others in his office near East Jefferson General Hospital in New Orleans yesterday.

The 73-year old shooter walked into the doctor’s office, and killed the doctor with a single shot to the head.  He then ran out of the office and into a Wendy’s restaurant.  Jefferson Parish Sheriff’s Office deputies were nearby and they responded and chased the shooter into a nearby Wendy’s restaurant, where the shooter killed himself by putting the gun in his mouth and pulling the trigger.

The doctor, 75-year old Dr. Elbert Goodier, a urologist,  was treating patients at the time of the shooting.  Colleagues said that Dr. Goodier was a very kind and popular physician.  The shooter’s family said that the shooter had been treated by Dr. Goodier in the past.  While the shooter did not have a criminal background, his family said that he had suffered from mental illness in the past.

Dr. Goodier had practiced for 50 years in the New Orleans area, according to East Jefferson General Hospital.

According to Wendy’s employees, a woman was placing her order when the shooter pulled the trigger as the deputies advanced on him.   The man’s body remained inside of Wendy’s more than an hour after the shootings. Yellow police tape cordoned off the parking lot and the hospital’s exit lanes. Some workers and patrons were also still in the building as of 4 p.m., speaking with investigators. Outside, other workers, concerned relatives and onlookers watched.

WendysShooter-NOLA

This type of shooting, the Baby Boomer Shooter, is the second attack on a urologist, and one in an increasing number of seniors who attack their physicians.  Another shooter killed his urologist in Reno, Nevada and injured two others before taking his own life. The shooter said had struggled for 3 years with ailments resulting from a botched vasectomy, according to messages he posted on an online support group and a law enforcement investigation.

Lesson Learned :

While doctors have not been a target in the past, they have been shot and killed recently by patients unhappy with medical results.  All hospitals and medical offices should review their access controls systems, based on the increasing, and alarming rate of attacks on healthcare workers.

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RISKAlert Case Study # 840, Dead Body in the Pickup

Dateline:  February 17, 2016

A Florida Man Shot his Neighbor to Death, Put the Body
in the Back of his Pickup Truck and Took It to his Lawyer’s Office

A Fort Myers, Florida man shot his neighbor to death during a struggle before loading the body into the back of his pickup truck and driving it to a lawyer’s office, according to the News Press of Fort Myers, Marshall claimed he shot the neighbor
in self defense.

Lawyer Robert Harris, said that John Marshall (the shooter), walked into his Fort Myers law firm claiming he had shot and killed neighbor Ted Hubbell in self-defense and had the body outside in the bed of his pickup.

The shocked attorneys called 911 and Marshall  spent hours at Harris’ office before finally leaving for the hospital around 10:30 p.m. that night.  Marshall had a swollen lip, missing tooth and what appeared to be two broken thumbs.

Death Investigation

According to attorney Robert Harris, John Marshall
wrestled a gun away from neighbor Hubbell and
fatally shot him earlier Wednesday. Harris said late
Wednesday that Marshall will not be arrested,
because he shot in self defense.
Lessons Learned:

1.   Avoid fights with neighbors.

2.   If a fight seems unavoidable, call 911 and wait for police in a safe area.

3.   Do not transport a body to your lawyers office in the bed of your
pick up truck!

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Nurse Commits Suicide, Fires A Single Shot to the Head, Locked in a Hospital Restroom at Valley View Hospital, Glenwood Springs, Colorado

A hospital staff member reported Eric Knurr dead in a bathroom stall a round 11:30 a.m. Monday, morning, August 4, after maintenance had to be called to unlock the door to the men’s restroom off the emergency department.  

The former male nurse, identified as Eric Knurr, had been formally admonished by state regulators for brushing a patient’s teeth until they bled, and also slapping the patient, who was in restraints at the time of the incident in 2005. He had applied for a job at Valley View Hospital in 2012, but was not hired.

  • In January, 2014, a man locked himself in the hospital bathroom at Cherokee Medical Center in Iowa, and committed suicide.In August, 2013,   62-year-old man committed suicide in a public bathroom at the Veterans Affairs hospital campus at Fort Harrison, Montana, after locking the bathroom door and killing himself with a single shot.
  • In August, 2013,   62-year-old man committed suicide in a public bathroom at the Veterans Affairs hospital campus at Fort Harrison,
    Montana, after locking the bathroom door and killing himself with a
    single shot.
  •  In August, 2012, a similar incident happened at an Oklahoma  hospital, when a Oklahoma State University employee committed suicide in a public restroom off the emergency room.

LESSONS  LEARNED:
(1.)  Hospital staff should IMMEDIATELY report any locked bathroom door in a public restroom.  In several of the incidents, housekeepingdidn’t want to bother securitywhen they found the bathroom door locked, so they waited another two hours before reporting the problem, and by then it was too late.

(2.)  Not having any form of metal detection allows people to bring guns into hospitals, lock themselves in bathroom, and commit suicide.  Metal detectors or wand detectors can prevent a tragedy.

CHECK OUT:
     In December, 2010, The Joint Commission Issued a Sentinel Event
Alert on Suicide Risk Outside Psych Units i
n Hospitals, including medical units, surgical units, and emergency departments.  (http://www.jointcommission.org/assets/1/18/SEA_46.pdf).

“It is noteworthy that many patients who kill themselves in general hospital inpatient units do not have a psychiatric history or a history of suicide attempt – they are “unknown at risk” for suicide.   Compared to the psychiatric hospital and unit, the general hospital setting also presents more access to items that can be used to attempt suicide – items that are either already in or may be brought into the facility – and more opportunities for the patient to be alone to attempt or re-attempt suicide.

“This Alert presents strategies that can be used and suggested actions that can be taken by general hospitals to help better prepare their staffs and their facilities for suicidal patients and to care for both their physical and mental needs. Suicide has ranked in the top five most frequently reported events to The Joint Commission since 1995. The Sentinel Event Database includes 827 reports of inpatient suicides.  Of these events,  14.25 percent occurred in the non-behavioral health units of general hospitals (e.g., medical or surgical units, ICU, oncology, telemetry),  8.02 percent occurred in the emergency department of general hospitals and 2.45 percent occurred in other non-psychiatric settings.”              

                 Stay Alert and Encourage Hospital Employee Awareness!

RISKAlert® is a publication of Risk & Security LLC at

What’s Your Active Shooter Risk? How to Assess the Threat.

Just the idea of an Active Shooter in your organization, whether you’re a military base, like Fort Hood, and the Washington Navy Yard, or a school like Sandy Hook, a beauty shop, a cracker factory in Philadelphia, a retail mall, a movie theatre, a grocery store parking lot, or a hundred other places, is a terrifying thought.

I lived about 3 miles from one of the shooting sites, a gas station, used by the Beltway Snipers back in October, 2002.  They killed ten people, totally at random, and critically injured three others.   Both of the snipers were sentenced, and John Muhammad was killed by lethal injection in 2009.

If you lived in the DC area, do you remember how scary it was just to pump gas into your car,  people were huddled against the side of their cars in the gas stations, and hidden by their shopping carts at the local Home Depots.

The fear of the Active Shooter comes from the seeming randomness of the action, which means there’s no way to prevent it, unless you give up, stay home, and hide under the bed all day.

But there are things you can do.  Instead of thinking of an Active Shooter incident as a totally unique situation, it’s really a form a Workplace Violence, Gas Station Violence, Parking Lot Violence and other related forms of random violence.   In fact, the Department of Homeland Security has identified quite a few steps you can take to keep yourself safer if you are in the vicinity of an active shooter (http://www.dhs.gov/active-shooter-preparedness).

Most of the shooters are mentally ill.  Normal individuals do not enjoy planning and killing strangers, and it is usually a last ditch effort, with the suicide of the shooter as the grand finale.   Their actions can sometimes be identified early, and the police can be alerted, or the Human Resources group at work, or even the local Sheriff can intervene before it gets to the actual shooting.

ActiveShooter-Florida

Signs that someone is having trouble negotiating their life, especially if that someone is a gun fanatic, with their living room full of AK-47 assault weapons and hollow point bullets, is not hard to spot, because these individuals often leave lots of warning signs, like:

  • Irrational Posts on Facebook or inappropriate tweets.
  • Threats made against friends and family.
  • A dropoff in personal hygiene, as the person gets more obsessed.
  • Problems negotiating their personal life.
  • Demonstrating signs of isolation and groundless paranoia

Organizations can protect themselves from an potential active shooter through a combination of specific controls that include elements like access control, continuous monitoring of cameras, employee awareness and training programs, clear cut evaluation routes, regular active shooter drills, and hardening of facilities, to name a few.

One of the best preventive measures is to conduct an Active Shooter Risk Assessment, which is similar to other security analyses, except that it is focused on a particular set of threats related to an Active Shooter Incident.   As part of my annual Threat Trend Reports, I’ll be releasing a new set of threat data about the Active Shooter, to help organizations calculate their risk of
having such an incident.   For example, did you know that the number of active shooter incidents has jumped from 1 in 2002 to 21 incidents in 2010?

ActiveShooterIncidentsbyYear

Locations have changed, too, and we found that

  • About 25% of active shooter incidents occur in schools,
  • About 25% in retail locations, and
  • About 37% in workplaces.

In future blogs, we’ll be looking at each element of the active shooter incident, and providing more information to keep your organization safe.

Navy Yard Shooting Highlights Effect of Cuts to Navy Security

Security professionals around the entire were shocked and dismayed when they turned on the news and saw the historic Washington Navy Yard locked down, surrounded by emergency vehicles, and looking for an active shooter.

All the shock, the outrage, the Defense Department reaction, the involvement of the overlapping law enforcement jurisdictions, has apparently been already forgotten by the public, moved to the virtual ‘old story’ pile by the latest news of a mall shooting in Kenya, meeting at the UN, and the politics as usual in Washington DC.

If you graph it online, you can see the dramatic spike and then the dramatic drop-off in interest by the general public. This highlights what the security community has to deal with, in the context of a 24 hour news cycle.

My perspective on the event was personal because one of my very best friends was in Building 197 that day, a former navy commander, now a contractor, who went to work at 5 am that morning, and finally returned home at 9 pm that night.  Unlike many shootings, the PCs, smartphones were all up and operational during the event, so people were instantly able to communicate with friends and relatives as the event unfolded.

Rumors ran rampant that it was terrorism related, that there were three shooters, then that rumor switched to two shooters and eventually to only one shooter, Alexis Aaron, a mentally disturbed young man who had previous events of gun violence and yet had a top secret security clearance at the time of the shooting.

If we took a poll three weeks ago and asked people which facility would they judge to be the safest, the results
would probably look something like this:

1. Military Base in the U.S.
2. Hospital
3. Regional Mall
4. Police Station

Unfortunately – this is more like a list of the places where a shooting is more likely to take place.  As all the work in workplace violence statistics shows, a domestic Military Base has been the site of two mass shootings in only the last 4 years.  This includes the twelve killed and eight wounded at the Washington Navy Yard, as well as the thirteen killed and twenty injured at the Fort Hood shooting in late 2009.  That’s an average of 6 killed each year, and 8 injured, and doesn’t take into account any random shootings, training-related injuries, only the mass shootings.

Hospitals have increased in violent incidents every year for the last ten years, and we just witnessed a mass shooting at a Kenyan Mall.

However, the hospital and the mall are both completely OPEN, they want people to come in, they don’t control access at all.  This is what is so surprising about the Navy Yard shootings, the lack of security, lack of enough armed guards, lack of current background checks, lack of metal detectors, lack of retina scanners, and every other usual form of security control.

Speculation is that the key controls were missing because of budget cuts, which means that the Navy made the decision to reduce security controls, instead of cutting other, less critical programs.  The incident makes a strong case for examining the potential Return on Investment for security controls!

Even if the shooter’s background check was “current”, it certainly had not been updated based on his own recent events, and brushes with the police, and, of course, the anger and mental health problems appears again, and is shrugged off as too tough to manage and track.

However, it is a wake up call for the U.S. Navy, the Department of Defense, the U.S. Capital Police, and a variety of other organizations who “Secure” the Washington DC Capitol zone, and it leads to more questions than answers.

Already, the questions are starting about what controls SHOULD be in place for all military bases, and, naturally, re-examining the background check process and how it could be updated and improved.

Let’s not forget this time.


My webinar on Wednesday, September 25, 2013, focuses on what happened that day, and what results from the tragic event, 
(and you can pull up a seat at your PC to watch it live at 3 pm by registering at this link: https://www4.gotomeeting.com/register/299735503.

The Active Shooter Threat – What’s the Right Response? Run Out or Lock Down?

I got to sit in on a security group discussion yesterday.  It includes both security directors and local law enforcement and It was interesting to see how both groups approached the active shooter scenario differently.   Which way is the best?  Is there a best?
For law enforcement officers at both the state, city and county level, they want all doors to be unlocked so that all the occupants of a facility, or a hospital, can get out and run for safety as quickly as possible.   They say that means more people will survive, not get shot, and it works with the natural human reaction to run away from danger.

Some of the active shooter experts in the room said that active shooter situations should be treated like fire drills, because people are used to fire drills, and they know what to do, because they practice fire drills more frequently than active shooter drills.

For the Security Directors, especially of hospitals, they wanted to be able to lock down if there was an active shooter call in their facility.  They felt that there were problems in evacuating quickly, and some were concerned about leaving bed-ridden patients behind while the clinical staff run out of the building.  So they advocated locking down all doors instantly.

While the heated discussion continued for almost three hours – at the end there was no
“BEST” solution.  Each Security Director or Manager will have to decide for themselves which approach is right for their organization.  The important thing is to think it through in advance, prepare people in advance, and take advantage of the great materials that are available to help organizations prepared.

Get more information including videos, training materials, on line courses and more at
http://www.dhs.gov/active-shooter-preparedness.