Don't privatize public safety

An SF General EMT speaks out

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Four weeks ago, surgeon Dimitry Nikitin walked out of Florida's Orlando Regional Medical Center to his car and was shot dead by a disgruntled patient who then turned his gun on himself and committed suicide. Last September, a doctor at Baltimore's Johns Hopkins was shot and killed by a patient distraught over his mother's terminal diagnosis.

There is an epidemic of violence in America's health care facilities. Many of the scenarios are familiar — the news is full of stories of combatants in gang fights following wounded rivals into hospital emergency rooms to finish them off. But the full depth of the problem is largely unreported and extends to hospital wards, clinics, and long-term care facilities

A recent report from the U.S. Department of Labor based on 2009 statistics says health care providers rank third in the likelihood of being assaulted on the job — just behind police and correctional officers. In 2009, there were 38 assaults per 10,000 nurses aides.

Despite this troubling trend, the San Francisco Department of Public Health is asking the Board of Supervisors to approve its proposal to replace institutional police officers in some public health facilities with low-paid private security guards.

Here are two reasons this is a profoundly bad idea.

1. Health care is a stressful environment and growing more stressful every day.

As the providers of last resort, public hospitals and clinics often face a perfect storm of patients who are involved in violence, alcohol and drug abuse, or are suffering from untreated mental illness. But even outside emergency wards, health care workers must work up-close with patients and family members pushed to the breaking point by an overburdened delivery system.

As health care costs spiral, public health budgets shrink and access to high quality care dwindles, many hospitals and clinics are reporting assaults by patients and family members upset by long lines, half-day waits, and unaffordable care.

According to a September report by CNN on rising violence in health care facilities, violence caused by patients' frustration with health care services is on the rise.

"People are just tired of waiting, or they are just angry that they're not getting the care they feel is acceptable," nurse Rita Anderson told CNN. "Instead of saying something, their response is yelling, hitting, screaming, and spitting."

2. Well-screened and trained security officers reduce health care violence.

According to a study on reducing violence in hospitals by the National Crime Prevention Council, three top strategies for keeping health care facilities safe include reducing patient wait-times through well-organized and managed patient processing; controlling facilities through locked wards, staff ID badges, and security cameras; and hiring carefully selected and well-trained security personnel.

Currently, San Francisco's hospitals and health care facilities are protected by highly trained San Francisco Sheriff's deputies and institutional police officers. The Department of Public Health wants to replace some of these officers with private security guards.

But the private security industry is notoriously bad at screening recruits and plagued with turnover, in part because of low salaries. As a result, the use of private security creates unsafe working conditions for employees who deal with difficult or violent patients, such as those in San Francisco's psychiatric emergency wards.

Unlike institutional police officers, private security guards cannot make arrests. Instead, they must involve the San Francisco Police Department, accumulating costs that quickly defeat the budget savings of using low-paid private guards to do work that should be done by highly trained officers.