A new threat to hospitals


A new threat to hospitals

On the back of an increasing number of incidents involving extreme violence in healthcare facilities, Hiscox has launched a product to help its clients mitigate this risk, as Ian Thompson, senior vice-president, Healthcare, at Hiscox explained to HRMR.

“The risk that we’re especially concerned over right now is the lone wolf … somebody with a single weapon being able to carry out wide-scale massacres.”—Barack Obama, August 16, 2011

Insurers have for a long time aimed to innovate and respond directly to the needs of their clients. Against a backdrop of healthcare reforms in the US, this is truer than ever. One insurer—Hiscox—will shortly be launching a solution to a very specific and terrifying threat facing healthcare organizations.

To coincide with the ASHRM Conference in Washington, DC, Hiscox Bermuda is launching its Solo Strike product. In developing this unique product, it is seeking to partner with healthcare institutions who demonstrate excellent risk management and mitigation strategy.

“Our application, wording and pricing are specifically directed at the healthcare market. Solo Strike offers unrivalled focus and comprehensive coverage, with a number of product enhancements to remove any ambiguity in the event of a loss,” says Ian Thompson, senior vice-president, Healthcare, at Hiscox.

The demand for such a product has been growing for some time, but some specific recent cases have highlighted the threat. On July 20, 2012, a gunman walked into a cinema screening of The Dark Knight Rises in Aurora, Colorado, killing 12 people and injuring 58 others. Two months later the cinema owner, Cinemark, was presented with civil lawsuits alleging it failed to provide adequate security. Had measures such as security guards and locked doors been installed, according to the law firm Keating, Wagner, Polidori and Free, “they would have prevented or deterred the gunman from accomplishing his planned assault”.

But how realistic is that statement? As the US awoke to another terrible massacre, is it reasonable for someone going to the movies to expect security guards and locked doors, and are some places, where security can be a challenge because of their open access to the public, always going to be susceptible to this kind of attack?

While not attracting quite the same level of public attention as the cinema attack or other multiple fatality incidents at schools and colleges, attacks of this nature in hospital or healthcare settings are also becoming more prevalent and demanding increased attention.

In the last 12 months alone, a number of attacks have occurred. At UPPH in Pittsburgh, Larry Wayne Robbards displayed a firearm in a hospital treatment room. Robbards then took three people hostage, barricading himself inside before being shot dead by police.

In another Pittsburgh medical facility, John Shick pulled out two semi-automatic pistols and started firing, killing two people and injuring seven before Shick turned the gun on himself. Again in 2012, in Southern California, a gunman seriously wounded three doctors before holding two women hostage for several hours.

These are no longer isolated incidents; shootings of this kind in a medical setting are increasing and, perhaps, it is not surprising.

Hospitals and healthcare providers, which have to provide open access to their facilities, are clearly at risk from a lone attacker who could enter an institution unchallenged. Active shooter scenarios in hospitals generally involve aggrieved or disgruntled individuals acting on personal, rather than political, motivations. Consequently, such incidents are unpredictable, with the root causes ranging from family arguments, work-related disputes, problems over hospital care and mental instability.

The challenge of securing such complexes, which manage a vast throughput of people (many of whom are non-ambulatory), against a solo strike is clearly recognised by hospital operators, which are likely to have a range of security policies and procedures in place. These include pre-employment screening, continuing staff evaluation, local stakeholder engagement, lock-down procedures, visitor and vendor screening, alarms and emergency communications, and internal grievance mechanisms. Despite these precautions, however, there is a sense that hospitals and clinics are by design very open places, and many of the needs of these buildings directly oppose much of what the security measures are designed to achieve.

Johns Hopkins University School of Medicine announced in its September 2012 report published in the Annals of Emergency Medicine, that they recorded 154 hospital-based shootings which resulted in 235 dead or injured people. Campus Safety magazine includes a section on hospital shootings, and reports that such shootings appear to be happening with alarming regularity.

In September 2010, Johns Hopkins itself had a well-publicised event when a doctor was a victim of one of three shootings, leading the report to conclude that “specialised training for law enforcement and security personnel, such as proper securing of firearms, may prove a more effective deterrent to future incidents than investment in expensive or intrusive technologies, such as magnetometers”.

“Such technologies may create a false sense of security, primarily because potential weapons get into hospitals by a variety of channels and because more than 40 percent of all the shootings studied occurred on hospital property outside of buildings.”

Hospitals are places where emotions can run high, they can often house less stable elements of society and they are places where security might be expected. Conversely, cinemas are neither—and yet civil suits have followed. So the message appears clear: hospitals and larger healthcare institutions are a potential soft target for a significant attack from individuals with an agenda very different from what you might expect from a more ‘traditional’ terrorist threat.

“At Hiscox, we believe that responding to emerging threats and risks is central to what we do,” says Thompson. “We often ask clients what risk element concerns them the most and in recent years one thing has stood out—something that is incredibly difficult to risk manage and plan for—a single assailant, a lone wolf conducting a seemingly random, and perhaps motiveless, but deadly attack. While guns are the most likely weapon to be used, it could also be knives, chemicals, explosive devices or even a syringe.”

The new product takes all these risks into account. “In the event of a catastrophic solo strike, despite a healthcare insured’s best efforts to avoid such an occurrence, the events in Aurora Colorado prove that civil lawsuits are today inevitable and one way to manage a risk is to adequately insure,” he says.

“General liability policies simply do not go far enough. A solo strike is a risk they are not designed for and many GL policies demand sizeable retentions, have exclusions for certain weapons or for criminal acts and look for a trigger of a medical incident.”

The damage a lone attacker can cause is significant both in the immediate nature of the attack itself and the longer-term ramifications for hospital reputations and their financial health. “This why Hiscox’s Solo Strike product also offers the services of risk management specialist Control Risks, who will assist in the event of the claim with loss mitigation such as disaster recovery, business continuity advice and crisis management,” says Thompson.

“Healthcare providers cannot lock down their premises and eliminate this growing threat, but they can take additional precautions to help minimise the impact should such an attack occur.”

Threat, Hospitals, Hiscox, Mitigation, Attack, Crisis management