Subscriber Discussion

Death In Hospital: Surveillance Operators To Blame?

Here is a recent case out of Canada where a man died in the emergency room after a 34 hour wait. People are questioning why the surveillance camera operators didn't notice this guy dying over in the corner. They were live-monitoring, but they had the cameras focused on people who they felt could be security risks, specifically three drunk people across the room. Even other people in the ER noticed something was wrong with the man and alerted some staff. The incident is still under investigation.

So what is the right way to do hospital security like this? Are the guards at fault for failing to notice? Or should the nurses have been checking more often? Or something else?

Here is the video footage from the wait:

CBC has a play-by-play to go with the video.

It's too easy to blame someone else. A room full of patients and staff and someone is blaming a security officer that is responsible for the well being of a patient. If the management defined that the surveillance officres role and responsibilities is to have medical qualifications to monitor patients thru the surveillacne system, then yes blame them but I doubt this is in the job definition.

but I doubt this is in the job definition

I will say that patrols through the waiting area are in the job description and it is the Security Officers job to know who is in his/her waiting room.

My question is answered below.

I'm not saying that the security's job is medical, I'm saying they need to know who is in there for the purpose of sleeping/coming out of the cold or to possibly steal.

You should not have people in your hospital that don't belong. Security should be aware of who belongs/doesn't belong. Clearly this person was thought to be intoxicated. That "thought" should have been passed on to the next (security) shift so that they could check on the person. If he was intoxicated, slept it off then he should have been gone before the end of the next shift.

"The triage aide writes something down on a piece of paper and Sinclair wheels himself into the waiting room, where he stayed for the next 34 hours, vomiting several times as his condition deteriorated, before he was discovered dead."

34 Hours!?

The problem isn't the camera operators... it is the friggin wait time. Geez...

I'm going to respond on the questions you posed and then I'll provide my opinion on this type of situation.

1. "Why didn't the surveillance operators notice the guy?" My guess (and it is only a guess from experience) is that the surveillance operators see this scenario on a daily basis/ daily occurrence. You cannot imagine how many drunk people come in to an ER and pass out. This is not the only location they are monitoring so if other things are happening within the facility, their focus may be on that. Many times, the operators will not bring up a camera unless there is a situation going on so that they can focus on other areas of the facility such as the parking lots.

The security staff on the other hand should have noticed the guy bent over in his wheelchair PARTICULARLY if they thought the person was intoxicated and sleeping it off. Why? Because that is how some drunks die... they restrict their own airway, choke on their vomit and smother in their drunken stupor. So I blame security staff for not being more vigilant in their patrols. Mind you, it is not rare to have people waiting hours upon hours in an emergency waiting room. People think they should go to the ER because they have a tommy ache. The key word here is that it is an "emergency" room... not an alternative to your regular doctor. (sorry, that is a sore spot for me.) People are seen by medical staff based on medical priorities and/or, what happens to come in by ambulance. Consider medical staff shortage, real emergency medical concerns i.e., heart attacks, etc. or a sudden rush of patients with severe traumas from an accident which often dictates priority, medical focus and adds to the wait time.

2. "So what is the right way to do hospital security like this?" Security staff patrols assigned to ER/waiting room should be familiar with the people in those rooms. The admission clerk and the Security Officer should be communicating concerns.

In this particular situation, the ER staff were alerted to the man in the wheelchair (and it appears) yet did not check on the man. At the bare minimum, the clerk should have asked the Security Officer to check on the man at that point. As you can see from the video, the Security Officers stood around quite a bit. It's called "patrols" not "stand-arounds".

3. "Are the guards at fault for failing to notice?" Yes, they should be ALERT to everything. They were too complacent in their duties.

4. "Or should the nurses have been checking more often?" Yes, they should have checked on the man, or they should have communicated to someone else about the concern and had them check on the man. When the man's name was called (was it?) to be seen by the nurse, she should have walked around the waiting area to ensure the person had not fallen asleep and not heard her/him, checked back in a few minutes to ensure the person had not gone to the bathroom or out for fresh air, etc.

5. "Or something else?" Working in a medical facility like this requires teamwork and communication. Security staff should always be aware of potential problems, and should make it a point to check in with staff to ensure everything is okay. Medical staff should depend on Security staff to assist them not only with patients but possible issues with visitors or suspicious activities. They should be encouraged to alert staff of concerns and not brush those concerns off because it "may be nothing". Better to be safe than sorry.

Establish a facility-wide communication that encourages staff members to alert security to any and all concerns. This is very important for a security program. Security staff cannot be everywhere and encouraging medical/non-medical staff members to be their eyes/ears will help in keeping the facility safe and secure.

As a former Security Manager, I know the up time and down time of staff... many times I sat down for 30 seconds at lunch and had to run to a call or barely had time for a bathroom break. But also many times I ate my lunch at a leisure because it was so quiet. With respect to this incident, I sincerely hope that the security program and the ER admissions procedures were re-evaluated to ensure this type of incident does not occur again. There are a lot of lessons to be learned here that can be taken and placed in other parts of the facility. As far as I'm concerned, it turned out to be a wake-up call for the Director of Security and the Nurse Manager of the ER.

Sorry for the long post.

Margarita, thanks for the thoughtful insights! It's great to hear your real world experience.

I am curious - what if - and this is a hypothetical - the hospital defined its responsibilities that security only considered security issues and the nurses dealt with health issues? Does this happen? Would that make sense?

Either way, it seems the hospital is at fault, right? It's just a question of who should have been monitoring for this?

Fascinating discussion.

Thanks John. As for your question, I'll try and explain what my expectations were of my security staff (45 Security Officers).

As a Security Officer, you come across many situations and people. It's your job to be curious about who/why people are in your waiting room/hospital. And, a Security Officer should be able to quickly assess if the person is ill, drunk/under the influence or mentally ill. But this takes approaching the person to see if they need assistance. It's a fact gathering task. Does this person have a legitmate reason to be there? Is there someone that can be called to take them home if they are intoxicated? Does the person need immediate medical attention, are they drug seekers or do they really need to have their meds refilled? You get many patients who are off their meds and present with mental health issues. It's a quick fix but your staff have to know and be trained to recognize this. Security staff have to be well trained to work in a hospital. It is a whole different world and a complicated one at that.

As for security, a hospital is an easy target for thieves both within the facility and the parking lot. Many people come to the hospital to get out of the cold, beg for food/money, steal medications/prescription pads, get a bed to sleep on and so forth. Believe it or not, we used to regularly get coats stolen from staff members by people walking in from the cold. It isn't that you don't want the person to have a place in which to warm up, but it's more what they do when they are there, and often, it's the limited space they take that a real patient should have.

Also, a lot of the times, real patients don't want to be sitting/waiting next to a drunk or a homeless person who smells. Imagine having a sick child sitting next to a drunk. These people take up room in the waiting area and steal if the opportunity arises. So imagine you're sitting there waiting to be seen next to a drunk or homeless person, you get up because the nurse or clerks calls out to you and you're distracted to the valuables you have with you. It's a tempting opportunity to the person who hasn't had food or a drink.

And to clarify, the jobs are defined or should be. Security does security and medical staff do medical stuff. But that doesn't mean that they don't alert each other to situations or take the initiative to check things out. If you were patrolling and you found a guy laying outside somewhere, do you just walk by because it's a hospital and therefore could be a medical issue? Not really. You check it out. Same thing with a guy that has been sitting in a waiting area for longer than a shift. You might expect to see the same people at the start of your shift, but truly by the end of your shift you should have inquired as to the legitimacy of that particular person.

Personally (from the limited read I had) I believe both groups were at fault. The Security Officer was asked to check into it, which he should have. The nurse/clerk was asked to look into it, which they should have. It would have taken no time to walk over and ask the guy if he was ok. Imagine what could have been avoided if only someone cared enough to go beyond their perceived job description.

The security operators were doing their job which was security, first and formost. When working in a enviroment like that you would become accustomed to the type of people entering that area in all states . As you are not a nurse,doctor or such your responsibility is in the job you are doing at hand. 34hrs? how many security work shifts have occoured within that time,with different staff coming on not knowing who is in the waiting area?But if you were working 8hrs a day there, wouldn't you say something if a person had not been attended to after that time?

"Mind you, it is not rare to have people waiting hours upon hours in an emergency waiting room."

There is a difference in a few hours and 34 hours!

This isn't a security issue at all. This is a serious hospital policy issue.

Coming to a US hospital near you!

Mike, I retired as a security manager from a local hospital after 24 years (yes same department)... I can tell you this is not a new issue at all. Waiting to be seen really depends on what is happening. There are only so many beds in the ER, so many labs to be taken, Xrays and numerous other results that the doctor is waiting before a bed opens up. This is perpetuated by many issues, one of which is the amount of people who go to the ER for non-emergency reasons.

Because it is an emergency room, patients are prioritized with respect to their medical condition/issues at the moment of triage. However, I don't recall seeing this patient being taken back and triaged!

Without having been there and hearing everyone's sides of the stories, which none of us have, my first inclination is the security officers cannot really be blamed. If the only job responsibility drilled into them is "security", then that's all they're going to do. And as long as everything is "quiet" and uneventful, they're not going to worry about much else.

What I see happening, though, is their reponsibilties are going to be broadened to "general situational awareness", where they are going to be required to note how long people are hanging around one spot, even if they are appear not be be a threat.

This situation is like the Kitty Genovese murder. A lot of people saw him vomiting and sitting there slumped and not a one did anything.

Sometimes stuff happens. Of course this will be twisted about in depo or in court and someone probably have to pay. Based on what was seen or not seen and the lack of additional information there really is no way to know. How about an option for whoever designed and installed the system and failed to properly use their crystal ball to plan for every situation that could ever take place or at least failed to spec a 20+ MP camera that would have obviously captured the true fault. Wait, failt detection is an analytic and the responsibility of a VMS.

Did not think this story from my city would make it onto here. There were a large number of failures in this case. Happens to be the busiest hospital in Winnipeg.

I'm not personally close to the case at all, other than the fact I've been in the hospital once or twice and live not far from it, but it's been an on going investigation for quite some time now.

I don't think the security guard is to blame, I haven't done work for any of the hospitals, but I do a lot of work for the clinics and such under the same authority and the security are there for exactly what other have said, security. Keep an eye on trouble makers. I think they're trying to lessen some of the blame from the nurses and doctors who are working (and generally understaffed). When the news was first released a lot of people jumped to blame the nurses, saying they should have checked up on him.

Security should never rely only on video. Active patrols of the emergency department is a must.

I'm not sure how the typical ER handles incoming cases, but it would seem like there should be someone tasked to track how long someone is waiting for treatment. A simple time/dated stamped ticket for each potential patient could be put in one of 24 boxes indicating by it's position in the row of boxes the hour of arrival without regard to urgency of treatment. As patients were treated the tickets would be removed, leaving a easy visual reminder of how long someone has been waiting. If, after 24 hours, they haven't been treated or left on their own maybe they should be re-evaluated?

To that end, do hospitals give wristbands to people who come into the ER? I vaguely recall wristbands being standard practice so they can track people / identify people later. Yes/no?

I think they do issue wristbands, although I'm not sure at what point in the admission process (before triage evaluation, during or after). If these wristbands had RFID built in they could be used to track how long someone was waiting. Another varation, albeit a bit more in the provence of IPVM might use the "object left behind" analytics to detect someone parked in a waiting room for too long.

Without going on a rant about hospitals it is hard to find someone who truly cares about their job and gives every person in the hospital the needed attention. If you have ever sat and watched surveillance camears for hours you know it does not take much to notice something out of the norm like a man not moving.

Then you have the nurses who are over worked and walk around like zombies beacause of lack of sleep.