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Consider four tips when writing your use-of-force policy

Healthcare Security and Emergency Management, January 1, 2005

When your hospital officials determine the appropriate use of force for its security department, they will likely want a policy covering the issue. Although most security directors agree that the use-of-force policy is difficult to write-in part because of the liability involved with use of force-the following four tips should make it easier:

1. Look at other hospitals' use-of-force policies. If you can track down a hospital in your state with a similar use-of-force protocol, contact its security department to see whether you can view its policy.

The other hospital may have done the homework that determines what is permissible under state law, says Anthony Potter, CHE, CHPA-F, director of public safety for Forsyth Medical Center in Winston-Salem, NC.

"It's always a good idea to see what other hospitals in your jurisdiction have done. It saves you from reinventing the wheel," he says.

Potter shares his facility's use-of-force policy below, but forewarns that security directors can't simply take this sample and plug in their own information. Because laws regarding use of force vary by state, use Potter's policy only as a guide.

Another way to view sample use-of-force policies is to consult the National Law Enforcement Training Center (NLETC).

"This organization is always updating policies," Potter says. "You can receive the latest information on the law and even review court decisions here." Visit NLETC's Web site at www.nletc.com .

2. Be specific. If you allow security officers to carry weapons, spell out the names, makes, and models of the weapons in your policy. Doing so allows the hospital to demonstrate that employees were issued, authorized to use, and trained with specific weapons.

Also include in the policy all the required certification and training that security officers receive. For example, if there is no state law on baton training, you may seek the same training for your officers as local and state police officers receive. This way, if a situation arises where a security officer is accused of using a baton on a patient and the hospital is taken to court, you can point to the policy and to the fact that security officers receive the same training as police, Potter says.

3. Cover the continuum. Your policy should include a continuum that outlines several levels of force, from verbal confrontations to those involving weapon use, if you permit officers to carry weapons. For example, if your security officers carry firearms, the highest level of the continuum would be weapon use. The policy should also detail when and why officers can use a weapon and a general rule about escalating to the next level of force.

The continuum provides an outline and a basis for training officers in use of force, Potter says. "This puts use of force in a framework for officers to understand, employ, and articulate," Potter says.

Additionally, the continuum is an important aspect of your policy because if the hospital gets sued, it illustrates the hospital's standards for training.

4. Seek legal advice. Once you've written the policy, have it reviewed by legal staff, risk managers, and possibly an outside expert who deals specifically with use-of-force law.

Most hospitals use an outside counsel to review the policy because they don't have the appropriate background, Potter says. Remember that any use of force carries significant liability if it isn't done properly, he cautions.

 

Sample use-of-force policy

I. Purpose To establish a hospital policy regarding the use of force by a public safety officer, when necessary, to maintain a safe and secure environment for patient care.

II. Policy At Forsyth Medical Center (FMC), the public safety officer will employ only the minimum level of force that he or she believes to be necessary.

A. One goal of the use of force is to assume control of a situation that threatens the security of FMC by protecting the public safety officer and others in the immediate area from danger, as well as the subject from himself or herself.

B. Another goal of the use of force is to detain a subject for arrest by the Winston-Salem Police Department or in accordance with state law. The public safety officer shall limit force to those instances when he or she reasonably believes that use of force is the appropriate method to ensure the safety of the environment and control the situation.

III. Qualified personnel All public safety officers, including senior officers, lead officers, team leaders, emergency department police officers, and the director of public safety, can enact the use-of-force plan.

IV. Equipment
A. Public safety officers
Every public safety officer will carry handcuffs and a combination flashlight/expandable baton issued by FMC. FMC does not authorize the officer to carry any other weapons. Public safety officers will successfully complete all training prescribed by the director of public safety, including the baton certification course and training to carry and use handcuffs and combination flashlights/expandable batons. All public safety officers will successfully complete a required annual inservice training in defensive tactics, handcuffing, and baton procedures.

B. Emergency department officers Off-duty Winston-Salem Police Department officers employed by FMC as emergency department police officers will carry firearms and other equipment issued or authorized by the police department. Emergency department officers will not use chemical sprays inside the hospital because of the potential for contamination of medical facilities.

V. Procedures

A. Use-of-force continuum
When faced with an incident that may require the use of force, a public safety officer should assess the situation and determine which of the following alternatives will most effectively bring the situation under control with the least amount of injury to everyone involved. These alternatives are listed in order below, from the least severe to the most drastic. A public safety officer must never use a greater level of force than necessary without first exhausting all less severe alternatives or reasonably believing that any lesser degree of force would be ineffective.

1. Level one-Presence: Presence is defined as psychological force established by the public safety officers' arrival in the area, and symbols of authority, such as the police uniform. The public safety officers' positioning, stance, and reaction times may control confrontations and facilitate officer safety.

a. Calling for backup: The prompt appearance of additional uniformed public safety officers frequently brings situations under control. Backup may include the emergency department police officer on duty or local police. Public safety officers should refrain from initiating contact until adequate backup has arrived, unless immediate action is required to preserve human life.

2. Level two-Verbal direction and control: Use of conversation, advice, commands, or instructions by public safety officers to control or deescalate a confrontation describes the level of use of force. Public safety officers should use the Crisis Prevention Institute (CPI) Nonviolent Crisis Intervention techniques when appropriate. Verbal direction and control are the most desirable use-of-force options.

a. Verbal compliance: After obtaining verbal compliance, the public safety officer may escort nonpatient subjects either off the medical cen-ter campus or to the public safety office to be detained for police arrest.

3. Level three-Physical control: Use of physical contact includes touching, assisting, grabbing, and manipulating joints. Contact may include an officer using his or her hands or handcuffs. Public safety officers should use handcuffs only when a subject is detained for arrest and when the public safety officer reasonably believes it is necessary to control the subject's movement for the safety of patients, visitors, staff, or the officers involved, and to facilitate a search for weapons.

4. Level four-Impact weapons: Level four use of force includes the expandable baton in accordance with recognized training methods to impede the subject's movements and to protect the public safety officers and others from assault and serious body injury.

a. Patients: Public safety officers must limit the use of force against patients to the defensive techniques taught in the CPI Nonviolent Crisis Intervention Course.

i. Handcuffs: CMS considers handcuffs a law enforcement restraint device that is not a safe or appropriate healthcare restraint on patients. Public safety officers must not use handcuffs to restrain a patient in lieu of authorized clinical restraints applied under the supervision of a physician or nurse in accordance with hospital policies and procedures. The police department and other law enforcement agencies may use handcuffs to detain someone under arrest in accordance with state laws. The only exception to this rule is when a public safety officer reasonably believes it is necessary to prevent patients from creating risk of serious injuries or death to themselves or other people, and no other means are available to do so.

2. Expandable baton: CMS does not consider the use of weapons (e.g., the expandable baton) to be safe, appropriate healthcare interventions, and their use is not appropriate in the application of restraint or the initiation of seclusion. Public safety officers must not use the expandable baton to threaten, intimidate, or strike patients. The only exception is when a public safety officer reasonably believes it is necessary to stop patients from causing serious injuries or death to themselves or other people, and no other means are available to do so. If an officer uses the expandable baton on any person in the medical center (e.g., patient, staff, visitor) to protect people from harm, handle the situation as a criminal activity, and the officer will be turned over to local law enforcement.

B. Discretion: The use of handcuffs and the expandable baton is always discretionary, based on the public safety officer's assessment of the situation and the perceived threat to the public safety officer and others.

C. Use of force: The public safety officer will immediately notify the director of public safety whenever a public safety officer or an emergency department police officer uses any level of force beyond level two. This includes any situation in which the expandable baton is extended but not used. This does not apply to assisting in the restraint of a patient under clinical supervision.

VI. Documentation
A use-of-force report will include every use of force beyond verbal compliance, other than the restraint of a patient under clinical supervision. When a person is removed from the medical center or escorted off the medical center campus and the officer uses no force, the public safety officer will include a statement that no force was used in the appropriate report.