SECURITY IN HEALTHCARE FACILITIES

The use/misuse of Security Officers in dealing with persons displaying

challenging behaviours

Cairns and Hinterland HHSService Profile

The Cairns and Hinterland Hospital and Health Service (CHHHS) is responsible for

the delivery of Health Services in a geographical area of 141,000 square

kilometres ranging from Cairns to Tully in the south, Cow Bay in the north and

Croydon in the west.

The HHS outer western region encompasses extremely remote communities.

The CHHHS supports a population of 283,197 which is forecast to grow by 9% by

2026, with the highest level of growth occurring within the in the 65 and over age

group. Tourism is a key industry and contributes to a relatively high transient

population. It is estimated that 9% of the population are Indigenous Australian,

compared to 3.5% for Queensland as a whole.

The CHHHS delivers health services across the continuum of care and also

provides services to the Torres and Cape Hospital and Health Service. Some

higher level acute services are provided outside the CHHHS area in Townsville or

Brisbane.

Security Labour costs 2013/14

Item Cost

Total Security Labour Expenditure $3,335,167

Security FTE funded amount $1,900,972

Expenditure over FTE funded amount $1,434,195

Overtime Amount $ 223,787

Total overspend $1,434,195

Human Resources

January 2008

12 Full-time employees (FTE)

2 Casual employees

External Security Providers (needs basis)

October 2014

16 FTE

1 x 0.5 Part-time

33 Casual employees

External Security Providers (needs basis)

Static Guards

Primary purpose at Cairns Hospital is:

The protection of persons who are at risk of self-harm or the isolation of persons who present as a risk of harm to others.

Used for:

voluntary and involuntary clients under the provisions of the Mental Health Act 2000 (Qld)

admitted persons who are subject to provisions of the Guardianship and Administration Act 2000 (Qld)

persons requiring treatment who could be subject to a common law duty of care

Case Study 1

Young man with a condition that falls under the umbrella of autism spectrum disorder. Subject to an order under the Guardianship and Administration Act.

Welfare stakeholders Appointed Guardian

Parents

Disability Services

Public Housing Authority

Queensland Health

Queensland Police Service

Case Study 1 (cont’d)

The issues

Understands the difference between right and wrong but has no boundaries

History of violence

History of damaging property

Latent paedophile

Current situation

Facing several criminal allegations of assault and criminal damage

Homeless

Confined to his room at the hospital for 365 days to date

24/7 Static Guard presence

Case study 1 (cont’d)

Outcomes

Confinement has led to increased agitation

Frequent damage to room and contents

Assaults on staff

Weight gain due to lack of exercise

Costs

Damage approximately $15,000.00

Food and accommodation – not specified

Clinical care – not specified

Security approximately $55,000 per month

Case Study 2Elderly man suffering dementia

Is alleged to have shaken an elderly person in a nursing home

Actions may have led to the death of that person

Awaiting trial but subject to determination of “mens rea” and fitness to plead

Subject to the Guardianship and Administration Act

In-patient because he cannot be placed locally.

Stakeholders

Appointed Guardian

Public Trustee

Family

Legal Representatives

Queensland Police Service

Queensland Health

Case study 2 (cont’d)

Situation

In-patient for 15 months

No overt acts of verbal or physical aggression

Guard presence is for duty of care

24/7 Static guard presence (cost approximately $55,000.00 p/m)

Removal of static guard presence brought threat of industrial action by other staff

Patient is allowed to leave the premises and cannot be detained if he refuses to return.

Case study 3 Older male who attends three times a week for treatment over the past 8 years.

Volatile and verbally aggressive (threats to harm)

No physical aggression

Moved from satellite sites to Cairns Hospital because of behaviour

October 2012 interaction with a nurse led to the imposition of a security escort to and from treatment

No risk evaluation for security need. Demand by Executive Mgr.

Security escort still ongoing pending decision by Executive.

Cost of escort absorbed in operational budget.

Applicable law

Guardianship and Administration Act 2000 (Qld) Permits treatment without consent Permits use of reasonable force (Sec. 75) to enable that treatment

Criminal Code Act 1899 (Qld) Permits use of force to prevent continuance, repetition of a breach of

the peace and to detain and/or remove the person (Sec. 260) Sec. 546 – arrest without warrant.

Work Health and Safety Act 2011 (Qld) Obligation on all employers and employees to ensure there is no harm

to others in the workplace.

Duty of Care (Common law) Obligation to ensure no harm comes to others.

Case Study 1Use or misuse of security?

The person was admitted to the hospital due to a lack of suitable accommodation.

Restraint for the purpose of treatment, complies with the GAA.

Restraint to prevent harm to others (assaults, damage etc.), complies with the CCA.

Restrictions on liberty to prevent him accosting children, complies with the ‘duty of care’ provisions under common law.

Each instance also complies with the OH&S Legislation.

What authority do we have to deprive him of his liberty in other circumstances?

This matter has now been referred to the Minister for Health and other Government Departments have renewed their efforts to find suitable accommodation without a requirement for a security presence.

Case Study 2Use or misuse of security?

In 15 months as an admitted patient, the dementia sufferer has displayed no sign of aggression and yet staff insist on a guard presence regardless of need or cost.

There is now a need to conduct another risk assessment and probable cause to escalate the matter to the Executive for determination on removal of security from this patient.

is now a need to conduct another risk assessment and probable cause to escalate the matter to the Executive for determination on removal of security from this patient.

Case Study 3Use or misuse of security?

The outpatient has been complying with the agreed behavioural agreement for 24 months. Professional opinion suggests the security escort should have ceased after 3 months.

This matter has been escalated to the Executive for determination.

Conclusion

Risk evaluation to determine guard presence should be carried out at varied stages:

1. Time of admission (mostly perceptual but also based on known history or reputation of the patient)

2. Subsequent detention and/or relocation

3. Weekly/monthly in the case of prolonged retention as an in-patient