INTRODUCTION

Violence in the healthcare setting has been escalating for the past several years across the globe. As early as the 1990’s, researchers were trying to verify the data and propose strategies to address this disturbing trend.[1] According to the US Department of Labor, the rate of serious workplace violence incidents over a ten year period was more than four times greater in healthcare than in other sectors of private industry. In fact, healthcare accounts for nearly as many serious violent injuries as all other industries combined. It is likely that many more minor assaults, threats or verbal abuse go unreported.[2]

The Occupational Safety and Health Administration (OSHA) has taken a much stronger stance in recent years, requiring healthcare facilities to have workplace violence programs to protect staff and leveraging hefty fines against those who do not. However, protecting staff by using weapons, which includes handcuffs, may be construed as a direct violation of the Centers for Medicare and Medicaid (CMS) conditions of participation which direct the allowable treatment of patients. This contradiction puts healthcare facilities, and especially security officers who are on the front lines, in a precarious situation to try to meet the requirements of both federal agencies while providing a safe environment for staff, patients and visitors.

This article will explore:

  • The prevalence of handcuffs as a tool in healthcare
  • The regulatory environment that governs the security officer’s right to detain, the patient rights related to handcuffs, and staff’s right to protection from violence
  • Patient management including prisoner patients, medical patients and substance abuse/behavioral patients
  • Best practices to prevent situations requiring handcuffs and respond when they are unavoidable

PRESENT STATE

Healthcare security officers employ a variety of tools to help promote a safe environment. These tools may include handguns, K9s, conducted electrical weapons (CEW; such as a Taser®), Oleoresin Capsicum (OC or pepper) spray, batons and handcuffs.  There is heated debate presently regarding these tools and whether they have any place in the healthcare setting.  The most controversial is firearms for which there are many documented cases of unarmed patients being shot by officers or patients gaining control of a firearm worn by a police or security officer and then causing harm to themselves or others.[3],[4],[5]  Handcuffs are somewhat less controversial and are commonly available in the healthcare setting. A 2014 survey of 340 hospitals found that 96 percent of these facilities had security departments that carried handcuffs, with approximately two thirds reporting security personnel had the authority to restrain patients.[6]

The term “handcuffs” can be used to describe a variety of forensic restraints including handcuffs, hinge cuffs, rigid cuffs, thumb cuffs, shackles, manacles, flex cuffs, zip ties and other similar devices.  The Merriam Webster definition is “a metal fastening that can be locked around a wrist and is usually connected by a chain or bar with another such fastening – usually used in plural.”[7]

The principle reason for handcuffing a person is to maintain control of the individual and to minimize the possibility of a situation escalating to a point that would necessitate using a higher level of force.[8]  However, in the healthcare setting, there are many unique circumstances to consider in evaluating whether their use is necessary or appropriate and what is reasonable.  In addition, handcuffs themselves can cause injury when they are excessively tightened or are applied to a person who has been injured.[8]   For these reasons, utmost caution should be used in considering their use.

[1] Beech, Bernard and Phil Leather.  “Workplace violence in the health care sector: A review of staff training and integration of training evaluation models.” Aggression and Violent Behavior, vol. 11, August 2005, pp. 27-43. Elsevier, doi:10.1016/j.avb.2005.05.004.

[2] Occupational Safety and Health Administration. “Preventing Workplace Violence in Healthcare.” Retrieved September 9, 2018 from https://www.osha.gov/dsg/hospitals/workplace_violence.html

[3] Kelen, Gabor D., et al. “Hospital-Based Shootings in the United States: 2000 to 2011.” Annals of Emergency Medicine, vol. 60, no. 6, 2012, pp. 790–798 e1.  DOI: https://doi.org/10.1016/j.annemergmed.2012.08.012

[4] Lord, Steve.  “Geneva hospital standoff ends with jail inmate dead: Officials.”  Chicago Tribune.  May 13, 2017.   http://www.chicagotribune.com/suburbs/aurora-beacon-news/ct-geneva-delnor-hospital-police-standoff-20170513-story.html

[5] Rosenthal, Elisabeth. “When the Hospital Fires the First Bullet.” The New York Times.  February 12, 2016.  https://www.nytimes.com/2016/02/14/us/hospital-guns-mental-health.html?_r=0

[6] Schoenfisch, Ashley L., and Lisa A. Pompeii. “Security Personnel Practices and Policies in U.S. Hospitals.” Workplace Health & Safety, vol. 64, no. 11, 2016, pp. 531–542. https://doi.org/10.1177/2165079916653971

[7] https://www.merriam-webster.com/dictionary/handcuff

[8] “Civil Liability for the Use of Handcuffs: Part I – Handcuffs as Excessive Force.” AELE Monthly Law Journal, Civil Liability Law Section, October 2008. Retrieved on September 9, 2018 from http://www.aele.org/law/2008LROCT/2008-10MLJ101.pdf