Crimeproof your practice: How to improve office safety

In February, David Glener, MD, was seriously injured after a would-be patient came to his office, caused a disturbance in the waiting room and struck the Port St. Lucie, Fla., pain management doctor with a walking cane.

"This has ruined my life," said Dr. Glener, who has undergone two surgeries to repair a torn rotator cuff in his right shoulder. "I have not been able to do procedures. I am struggling to see patients. I can't sleep well at night, and I might be facing a legal battle with disability -- not to mention the psychological issues associated with being a victim." The alleged assailant was arrested on aggravated battery and breach of peace charges, but has not yet been convicted.

Dr. Glener is not alone. Other doctors and their staff members have been the victims of crimes in their offices, some of which have drawn a high profile:

• In June 2007, Dawn Denize Wright, a receptionist at a San Diego doctor's office, was fatally shot at her desk by a man who initially greeted her with a bouquet of roses. Wright's boyfriend, also the father of the 3-month-old fetus she was carrying, has been charged.
• In October 2006, David Cornbleet, MD, was stabbed to death after office hours in Chicago. Police say a former patient has admitted to killing the dermatologist because a prescribed acne treatment had caused impotence. Authorities in the United States have failed to extradite the former patient from the French Caribbean island of Guadeloupe, where he is in jail.

Admittedly these kinds of attacks are rare, yet experts say the cold reality is that no practice is immune to crime. For all the admonitions that physicians protect themselves and their practices against identity theft and other privacy-related crimes, doctors also need to address security issues they might face in their offices, experts say. Physicians need to assess their risk, develop a security plan, train employees -- and purchase and install security systems that can help to mitigate the potential dangers.

No statistics exist on exactly how many crimes are committed at physician offices, but the crimes have included robbery, theft, arson, vandalism and bomb threats.

"While hospitals give significant attention to security, smaller medical practices do not. But smaller practices are exposed to many of the same risks and they should get a handle on what those risks are -- and how they can deal with them," says Andrew Adams, a senior health care consultant with Beacon Partners Inc., Weymouth, Mass.

The starting point

Although exposure to crime risk is pretty much universal, before implementing a security program, physicians should determine where they stand in terms of safety. To assess their risk, physicians need to consider factors such as:

Location: Is your practice located in a high- or low-crime area? To answer this question, consult with building management or a landlord to review any past crimes in the building.

Local law enforcement agencies should be able to provide an evaluation of the type and rates of crime in nearby office buildings and in the immediate area, according to Ralph Witherspoon, CEO of Witherspoon Security Consulting in Fairview Park, Ohio.

Drugs: Does your practice stock and distribute prescription medications? Even if your practice does not dispense drugs, is there a perception that drugs are available? Experts say some specialists might be targets for drug addicts seeking to get unwarranted prescriptions.

"We get a lot of drug seekers because obviously we are used to prescribing drugs for a long period of time. And they can get violent when they don't get what they want. When you don't give someone narcotics, they can get very angry," Dr. Glener says.

Dr. Glener's office has a locked door between the waiting area and the exam area that must be unlocked with a buzzer. The day he was attacked, Dr. Glener said he stepped outside the door because he felt his receptionist was threatened. A patient who Dr. Glener said he refused to take because he only wanted medication was loudly complaining about what he believed was an outstanding bill from the physician.

Dr. Glener, after being injured, said he went to his office and got his gun, holding the alleged assailant at bay until authorities arrived.

Office property: Physicians should inventory their equipment -- from computers to diagnostic devices to office supplies -- to determine its dollar value. "Some specialists have equipment that is very valuable, and that should be considered," says Stephen Bonnell, director of small business sales for ADT Security, Boca Raton, Fla.

In addition, Bonnell recommends that physicians consider intellectual property as well.

The game plan

After assessing risk, physicians need to develop a security management plan, according to Adams.

The American Medical Association encourages all health care facilities to adopt policies to reduce and prevent workplace violence and abuse. In addition, under the Occupational Safety and Health Administration Act, employers -- including medical practices -- are required to take reasonable measures to provide a safe workplace for employees.

"Every physician practice needs to a have a good, well-thought-out security management plan in place to protect everyone in the office -- from the physicians to the employees to the patients and other visitors," Adams says.

While developing a security management plan initially might appear daunting, there's no need to reinvent the wheel, experts say.

"Start by reaching out to other offices that you have a relationship with to see what they are doing. It's also a good idea to consult your professional associations to see if they have any guidelines in place for what you should do," says Robert Siciliano, CEO of StreetSafeSecurity.com in Boston.

In addition, physicians and office managers do not necessarily have to put together long, complicated plans, but simply should spend some time addressing security issues to come up with a basic blueprint.

"Take some time to sit down as a group and walk through what might be some of the most prevalent situations. Is gang violence likely, or is it likely that an old boyfriend might pose a threat to a staff member? What are some of the situations that you as a group are likely to encounter?" Adams says.

After identifying situations, the plan should spell out exactly how to handle various scenarios, delineating action steps designed to avert danger. The plans also should outline communications protocols, giving staff members the ability to know who to call in various situations, experts say.

The training

Security plans are not even as valuable as the paper they are written on if physicians and staff members don't understand them, though.

"If you have a security plan in place and don't do any education, then, of course, it won't do much good," Adams says. He recommends that medical groups conduct security management training at least annually.

Such training should focus on making sure that all staff members are aware of the security policies and protocols and have a grasp of what to do and how to communicate in various emergency situations.

Basic conflict-resolution training also can go a long way toward diffusing difficult situations, according to the security experts.

Such training can provide staff members with the ability to use the right words and body position to diffuse potentially dangerous situations.

Witherspoon asserts that staff members can avert many potentially dangerous situations simply by always displaying a caring and courteous attitude.

"Front-office staff should be hired for their attitudes and the way they handle patients. A smile from the receptionist can go a long way in calming people down" he says.

The protective equipment

After assessing security risks, some physician practices might decide they need to purchase -- or need to discuss with their landlord about having the landlord purchase -- security equipment that can help to safeguard their practices, from cameras to access control systems, from panic buttons that immediately alert police to alarm systems.

Of course, as practices consider security systems, they frequently wrestle with budget issues.

"You have to balance everything out when trying to come up with what you want to spend on security. You have to weigh the probability of occurrence against the potentially negative outcome," Witherspoon says.

Siciliano agrees. "It really does boil down to a cost-benefit analysis. If you are a small office in the middle of a small town and have never really had any real incidents, then maybe a small investment in a small camera and basic signage will do the trick."