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Based on observation, interview, and document review, the hospital failed to protect and promote patient rights for 6 of 15 patients (P3, P4, P5, P6, P7, P8) when a security guard restrained P3 using a taser energy weapon (TEW) a law enforcement weapon and handcuffs a law enforcement tool, and security guards abused P3, P4, P5, P6, P7, P8 by using intimidation tactics when displaying and or activating a taser energy weapon (TEW), displaying REPULS, a chemical spray, both law enforcement weapons toward patients as a de-escalation technique.

As a result of these failures, the deficient practices resulted in an immediate jeopardy (IJ). The hospital was found out of compliance with Condition of Participation Patient Rights at 42 CFR 482.13.

The IJ began on 5/14/24 when a security guard restrained P3 using a taser energy weapon (TEW) a law enforcement weapon and handcuffs a law enforcement tool when P3 was causing a disturbance with physical and verbal threats during a behavioral health crisis. Additionally, P3, P4, P5, P6, P7, and P8 were abused when security guards used law enforcement weapons for de-escalation. On 5/23/24 at 4:15 p.m., the hospital's Chief Operating Officer, the VP of High Reliability, the System Program Manager of Regulatory and Accreditation, the System Clinical Educator, and the Nursing Director for the Emergency Departments were notified of the IJ. The IJ was removed on 5/30/24 at 6:00 p.m., when an acceptable removal plan was verified, it had been implemented; however, the hospital remained out of compliance with the COP of Patient's Rights at 42 CFR 483.13.

The IJ was removed on 5/30/24 at 6:00 p.m. when the hospital had submitted and implemented an acceptable removal plan. This included review of policies, providing face-to-face training to all clinical and hospital staff of proper patient de-escalation techniques and appropriate use of law enforcement weapons, re-education focused on appropriate use of force, using the least restrictive measures, and utilizing the hospital's behavioral emergency response team resources. This was verified through observation of shift huddle training, interview, and document review.

Findings include:

See A-0145
The hospital failed to ensure patients right to be free from abuse in the form of intimidation for six of six patients (P3, P4, P5, P6, P7, and P8) when multiple security guards displayed their taser energy weapon (TEW), one security guard also displayed his REPULS, a chemical spray, both law enforcement weapons, at patients and patients were told to get on the ground to gain control of patient behaviors during a behavioral health crisis.

See A-0154
The hospital failed to ensure a patient right to be free from restraint by use of a taser energy weapon (TEW) a law enforcement weapon and handcuffs a law enforcement tool for one of eight patients (P3) who was tased to gain behavioral compliance and handcuffed to be placed in custody during a behavioral health crisis.

Based on document review and interviews, the hospital failed to ensure patients right to be free from abuse in the form of intimidation for six of six patients (P3, P4, P5, P6, P7, and P8) when multiple security guards displayed their taser energy weapon (TEW), one security guard also displayed his REPULS, a chemical spray, both law enforcement weapons, at patients and patients were told to get on the ground to gain control of patient behaviors during a behavioral health crisis.

Findings include:

P4 presented to the adult emergency department (ED) on 11/20/23 at 1:18 p.m. via ambulance for significant behavioral changes. P4's diagnoses included acute psychosis, opioid dependence with opioid-induced psychotic disorder with delusions, and aggressive behavior.

A security report, dated 11/24/23, indicated on 11/23/23 at 9:07 p.m. in the ED, security guard (SG)-G responded to P4's room for a behavioral health crisis. The report indicated while in the room, P4 verbally threatened and postured towards SG-G, who responded by drawing his TEW and pointing it at P4 with verbal directives to back up. The report indicated P4 did not respond well, and SG-G indicated he pushed P4 backwards, and then drew his chemical spray to gain behavioral compliance. The report indicated P4 then complied and was secured back into his room without activation of the TEW or chemical spray.

A security report dated 11/29/23, indicated on 11/26/23 at 5:55 a.m. in the ED, SG-H was assisting medical staff with de-escalating P4 when P4 made verbal threats and attempted to kick SG-H. The report indicated SG-H responded by drawing his TEW, pointing it at P4, and giving him verbal directives to get down. The report indicated P4 stopped advancing toward SG-H and in response, SG-H holstered his TEW without activation, and with the help of other staff, used a manual hold to secure P4 back into his room. The report indicated after this point, P4's nurse made the clinical decision to seclude P4 inside his room, and the door was locked.

P5 presented to the adult ED on 1/14/24 at 6:41 a.m. via ambulance for distress following a domestic disturbance. P5's diagnoses included mild intellectual disability.

A security report, dated 1/14/24, indicated on 1/14/24 at 4:49 p.m. in the ED, SG-F responded to a verbal request for help with P5 who was attempting to elope. The report indicated P5 postured multiple times and encroached on SG-F's space, resulting in SG-F drawing his TEW and pointing it at P5. The report indicated P5 called 911 in response and medical staff were able to deescalate the situation and bring P5 back into his room. The report indicated a code 21 (behavioral emergency) was called, and SG-F removed himself as his presence was agitating P5.

P6 presented to the pediatric ED on 1/10/24 at 2:13 p.m. via ambulance for detoxification of Fentanyl use. P6's diagnoses included anxiety, depression, severe opioid dependence, and oppositional defiant disorder.

A security report, dated 1/25/24, indicated on 1/24/24 at 5:12 p.m. in the behavioral ED, medical staff requested help from SG-F with P6 in the bathroom. The report indicated P6 was punching himself in the face and both security and medical staff attempted to verbally deescalate him. The report indicated P6 managed to separate himself from staff and began punching himself again. The report indicated SG-F approached P6 with the intention of initiating a manual hold to prevent further self-injurious behavior, however, P6 began advancing towards SG-F and posturing. The report indicated SG-F drew his TEW and pointed it at P6. The report indicated SG-F gave P6 multiple directives to get on the ground, and P6 eventually complied where SG-F restrained him with a manual hold. The report indicated a code 21 was called and more security staff arrived to assist but were reallocated to manage a behavioral emergency for another patient. The report indicated P6 then contracted for safety, and SG-F released him from the manual hold without further issue.

P7 presented to the adult ED on 12/22/23 at 10:21 a.m. via ambulance for mental health and chemical dependency treatment.

A security report, dated 1/25/24, indicated on 1/24/24 at 10:13 p.m. in the ED, SG-A assisted with a code 21 to manage P7's behaviors. The report indicated SG-A and other security staff attempted to deescalate P7, who was posturing, making verbal threats towards others, and threatening to engage in self-injurious behavior. The report indicated P7 attempted to knee SG-A in the groin, which was unsuccessful, and P7 was given space alone in his room after an as needed psychotropic was administered. The report indicated P7 reacted violently to the mediation and began pounding on the unlocked door. The report indicated clinical staff made the decision to close P7 into his room, which doubled as a seclusion room, and initiate seclusion. The report indicated SG-A entered the room to inform P7 he was being placed into seclusion, when P7 began to charge SG-A and make verbal threats. The report indicated SG-A drew his TEW, pointed it at P7, and turned it on. The report indicated staff were able to close the door and initiate seclusion, resulting in SG-A holstering his TEW.

P8 presented to the adult ED on 4/3/24 at 11:45 a.m. via private transportation from an intensive residential treatment program for significant behavioral changes. P8's diagnoses included antisocial personality disorder, schizoaffective disorder, polysubstance abuse, and agitation. P8 was admitted to the hospital's mental health and addiction services unit on 4/8/24 at 8:10 p.m.

A security report, dated 4/4/24, indicated on 4/4/24 at approximately 11:50 p.m. in the mental health unit, SG-C responded to a code green (a silent alert sent to behavioral health RNs, psychiatric assistants, behavioral assistants, and security to address a behaviorally escalated patient) for P8's escalating behaviors. The report indicated clinical and security staff were able to deescalate P8 and relocate him to seclusion while he made multiple verbal threats and destroyed property. The report indicated P8 was then moved to seclusion but was allowed to keep multiple personal items that were not appropriate or safe for seclusion. The report indicated on 4/4/24 at approximately 1:15 a.m., P8 was resistant to returning these items, and so security staff reentered the seclusion room with a shield and TEW drawn to retrieve those items safely.

P3 presented to the pediatric ED on 5/4/24 via ambulance for suicidal ideation and agitation. P3's diagnoses included adjustment disorder, autism spectrum disorder, attention deficit disorder, and Wolf-Parkinson-White Syndrome (long QT syndrome). P3 was socially boarding in the ED since presenting at the ED, as family refused to accept him at home due to previous aggressive behavior.

A security report, indicated on 5/14/24 at 7:29 p.m., SG-A was completing security rounds in the pediatric ED when he observed disruptive behavior from P3. The report indicated P3 was walking around the unit with a wet floor sign and verbally threatening staff and was not responding to redirection from clinical staff. The report indicated security intervened and attempted to deescalate P3, which was unsuccessful. The report indicated P3 became fixated on SG-A, dropped the wet flood sign, and charged towards SG-A. The report indicated SG-A responded by pushing P3 away defensively, and when P3 looked angry, SG-A immediately stepped back and drew his TEW. The report indicated SG-A gave P3 verbal commands to get on the ground, which he slowly began to listen to and lingered on his knees. The report indicated while the TEW was still drawn, SG-A pushed P3 onto his hands and knees and multiple security staff moved to secure P3. The report indicated P3 resisted this manual hold and was given multiple directives to stop resisting or he would be tased by SG-A. The report indicated P3 continued to resist, and SG-A attempted to deploy his TEW, but noted a technical malfunction with his TEW. The report indicated SG-A then repositioned his TEW on P3's back and activated it again, delivering a drive-stun shock to P3. P3 stopped resisting, and staff were able to place him into handcuffs. Dispatch contacted 911 and the police department was in route.

Police report dated 5/14/24 indicated the police officers arrived at 9:55 p.m. and were advised P3 had been held in the ED for approximately 10 days for mental health evaluations and possible dissociative identify disorder and had exhibited 4-5 distinct personalities since arriving in the ED. P3 was causing a general disturbance by removing a metal grate from a sink was instructed to remove it which he complied, and later picked up a wet floor sign, swinging it around, was instructed to drop the sign, and did not comply. Security then retained P3 using a the taser. P3 was not taken into law enforcement custody. The police officers left the hospital at 10:01 p.m.

During an interview on 5/22/24 at 10:47 a.m., SG-F stated the TEW is the most effective way to deescalate violent patients. SG-F stated the taser can be displayed or "arched," to deescalate patients. SG-F stated arching is activating the electrical current without deploying the prongs of the TEW, which creates a loud electrical noise. SG-F stated he points the TEW at patients who are charging at him with a weapon. SG-F stated he uses his TEW when he feels his life is in danger and it is not safe to approach patients to manually restrain them.

During an interview on 5/22/24 at 3:48 p.m., SG-E stated security staff are taught to withdraw their TEWs, arch them if needed, and verbally inform patients of their intent to use the weapon. SG-E stated if the behaviors do not stop and the danger becomes more imminent, they can use the TEW on patients. SG-E stated most patients become compliant when staff arch the TEW at them.

During an interview on 5/23/24 at 8:30 a.m., SG-D stated security can pull the TEW, turn it on to activate the aiming lasers, activate the arching mechanism, and deploy the TEW on patients. SG-D stated the purpose of pulling the TEW is to scare the patient and make it clear security staff can hurt them. SG-D stated the TEW can be used on a patient in response to an attempted assault himself or his coworkers.

During an interview on 5/23/24 at 10:13 a.m., the regional security manager stated security staff may use the TEW if they are confronted with a violent situation. The regional security manager stated security staff may use their weapons to mitigate threats to themselves or others. The regional security manager stated the use of any weapon is dependent on the scenario and the security staff's judgement.

During an interview on 5/23/24 at 10:44 a.m., the security supervisor stated TEWs, and chemical spray can be used on patients if there is a verbal threat of violence.

An undated training document titled "Duty Gear," indicated all security staff are equipped with handcuffs. Security staff may handcuff patients when medical restraints are not available. Security staff should apply medical restraints to a patient as soon as possible. Handcuffs are not a health care intervention and should not be used on patients. Handcuffs are a law enforcement tool and are not considered a use of force, but a control technique. The document indicated multiple uses of a single taser, and multiple tasers may be used on an individual to control combative behavior. Tasers may be used by security staff if other de-escalation attempts have failed.

An undated training document titled "Use of Control Measures," indicated security staff may arrest another individual if a felony has been committed, or if a person attempts or completes a public offense.

A policy titled "Taser Energy Weapon," dated 12/13/22, indicated security may draw and/or use their taser if "A dangerous or violent subject has a weapon or is aggressively advancing toward the [security staff], and the [security staff] believes that they will be assaulted."

A policy titled "Security Use of Force," dated 2/28/23, indicated security staff are to use the least amount of force necessary to effectively gain compliance from individuals. The policy indicated security staff must act to "return all situations to therapeutic response to a behavioral emergency as soon as possible." The policy indicated security staff may threaten the use of force to gain control over situations and avoid violence. The policy indicated security staff may "compel a subject with the threat of force to gain complain" by drawing their intermediate weapons, tasers and REPULS spray.

Based on document review and interviews, the hospital failed to ensure a patients right to be free from restraint by use of a taser energy weapon (TEW) a law enforcement weapon and handcuffs a law enforcement tool for one of eight patients (P3) who was tased to gain behavioral compliance and handcuffed to be placed in custody during a behavioral health crisis.

Findings include:

P3 presented to the hospital's pediatric emergency department (PED) on 5/4/24 at 6:47 p.m. via ambulance for the suicidal ideation and agitation. P3's diagnoses included adjustment disorder, autism spectrum disorder, attention deficit disorder, and Wolf-Parkinson-White Syndrome (long QT syndrome).

P3 was transferred to the behavioral emergency center on 5/5/24 at 4:49 p.m.

A social work note, dated 5/6/24, indicated P3's family refused to allow P3 back into the home due to his violent and unsafe behaviors. The note indicated the plan for P3 would be to continue looking for alternative placement for P3. The note indicated P3 began socially boarding in the PED until appropriate placement could be found.

P3 was transferred back to the PED on 5/7/24 at 5:49 p.m.

A nursing date, dated 5/11/24, indicated P3 had a good rapport with SG-B.

A social work note, dated 5/13/24, indicated P3 was appropriate for inpatient mental health treatment, and was no longer considered a social boarder. The note indicated staff were seeking appropriate inpatient placement.

A nursing note, dated 5/14/24 at 2:46 p.m., indicated P3 had achieved placement at a pediatric mental health hospital, and would transfer there at a later date.

A security report written by security guard (SG)-A, dated 5/14/24, indicated SG-A was completing routine rounds in the PED when he observed P3 walking around with a plastic wet floor sign and not listening to clinical staff directives to return the object and SG-A then called for more security staff. Registered nurse (RN)-A made multiple attempts to deescalate P3, but P3 felt staff had wrongfully confiscated his personal affects following negative behavior. P3 continued to walk around with the sign and held it up to mimic a gun. The report detailed P3's similar behavior from an earlier point in the shift when P3 had obtained a metal sink grate and was resistant to giving it back to staff, indicating P3 showed a habit of obtaining objects "that could be used as weapons." SG-A recognized P3 from another behavioral crisis he had previously and noted P3 had previously become fixed on SG-A, resulting in seclusion for the safety of others. SG-A believed P3 was a "a behaviorally unstable person" and felt the floor sign could be used as a weapon, which "was not going to be a chance we could take"." SG-A felt verbal threats of violence precede physical violence, and this logic led him to separate P3 from others who were not involved in his care. SG-A then "corralled" P3 into a section of the PED, and instructed RN-A to call for a code 21. The report indicated SG-B began to verbally deescalate P3, until P3 recognized SG-A from the previous interactions and began to aggressively walk towards him. SG-A attempted to give verbal commands to stop and to drop the sign. P3 then dropped the sign, but continued to walk towards SG-A, and SG-A felt P3 "was about to make good on his threats" of violence. The report indicated SG-A used a two-handed defensive hand-check to P3's upper chest to propel him backwards. P3 angry, and in response, SG-A "Immediately and almost without hesitation" stepped backwards, pulled his taser from his belt, "armed it, and pointed it at [P3] while giving him verbal commands to get on the ground." P3 slowly went to the ground and hesitated on his knees. SG-A then pushed P3 down further, and other security staff attempted to bring him to the ground entirely. P3 began to resist, and SG-A told P3 he would tase him if he did not stop resisting. P3 continued to resist, and in response, SG-A placed the taser against P3's right shoulder blade and tried to fire his taser. The taser made a low electrical sound, but did not result in any response from P3, so SG-A moved the taser to P3's lower back and fired it again. The report indicated this second use of the taser "did work in taking the fight from [P3]," and P3 stopped resisting. P3 was then placed in handcuffs and the provider gave medical clearance to discharge P3 to the juvenile detention center but it was later decided to move P3 to the adult ED instead. P3 told security staff that his multiple personalities had been controlling him throughout the incident. The report indicated a police report was filed and this "should satisfy CMS requirements for contacting the police when a law enforcement tool is used on a patient."

A police report dated 5/14/24, indicated hospital staff contacted local law enforcement at 7:34 p.m. to inform them P3 had assaulted a security guard and was being restrained in the hallway of the PED. The police report indicated P3 had been swinging a sign around on the unit and P3 had charged security staff without the sign. P3 was told he would be tased if he continued not to comply and "security restrained him using the drive stun feature of the taser." Hospital staff told the police officer P3's family refuses to have him in the home, and the police advised the hospital to have a Child Protective Services report made for neglect of the child's needs. The police report indicated P3 needed placement in a secure in-patient setting, but there were none available at this time.

A nursing note written by RN-A, dated 5/14/24 at 7:48 p.m., indicated P3 had transferred to a PED bed for milieu management. P3 was walking around with a plastic "wet floor" sign and would not return the sign to staff, knocking it against the unit walls and railings, and security was on the unit for rounding and intervened, calling for additional security on their radio. The behavioral emergency response team (BERT) was contacted, but unavailable due to another behavioral health emergency in the hospital. The note indicated a code 21 was in the process of being called when P3 charged security staff and swinging the plastic sign. P3 kept hold of the sign and was told if he did not drop the sign, he would be tased. P3 did not comply with these directives. P3 then charged security staff again, and security responded by tasing him, which brought him to the ground, and then security staff placed him in handcuffs.

Hallways video footage from 5/14/24 at 7:28 p.m. was reviewed with the security training manager on 5/22/24. In the video, SG-A can be seen walking around the unit and completing his rounds. P3 was ambulating in the hallways as well with their one-to-one staff assignment, psychiatric assistant (PA)-A. P3 picked up a wet floor sign and began to walk around with it over his head and at his sides. P3 walked in front of the nurse's station near other clinical staff and patients before continuing down the hall. RN-A can be seen with PA-A attempting to verbally deescalate P3 and retrieve the sign. P3 held the sign out towards them with a jerking motion, mimicking a gun. SG-B can be seen entering the unit and engaging in conversation with P3, at which point RN-A and PA-A disengage completely and move back to the nurses' station. Multiple security staff can be seen entering the unit and watching from a distance. P3 then looked at SG-A, who appeared to be giving verbal directives at this time. P3 dropped the sign and quickly walks towards SG-A. SG-A raises both hands and firmly pushes P3 back and away, and immediately raised his taser and turns it on. P3 slowly raises his hands and gets onto his knees where he hesitates. SG-A then walked behind P3 and uses his left hand to push P3 down between the shoulder blades, knocking him onto his hands and knees. SG-B and SG-C attempt to initiate a manual hold of P3 on the ground, however, he immediately began to resist. SG-A and SG-D also assist in the manual hold, with the taser still drawn. The group of security guards struggle for a few moments as P3 moves from his knees to his feet, then back to his knees. SG-E also attempted to assist in the manual hold at this time. SG-A can be seen moving his taser into P3's upper right shoulder blade and holding it there for a moment before moving it to his lower back, at which point the taser goes out of view. Shortly afterwards, P3 stopped resisting and SG-A, SG-B, SG-C, SG-D, and SG-E have P3 in a prone five-person manual hold. While in the prone position, handcuffs were applied to P3 by SG-C. P3 was then sat up by a security guard and is sat on the ground handcuffed while security staff stood around him. Shortly afterwards, the BERT staff arrived and then left without speaking to the patient.

SG-A's body camera footage from 5/14/24 at 7:32 p.m. was reviewed with the security training manager on 5/22/24. In the audio and video, SG-A was heard giving verbal directives to "get down on the ground." P3 held his hands up and slowly complied, lower himself to his knees and hesitating. SG-A responded by walking behind P3 and firmly pushing him between his shoulder blades to knock him onto his hands and knees. SG-B and SG-C then attempted to initiate a manual hold on P3 while SG-A also attempted to assist. The camera footage went dark during this time period and P3 can be heard shouting at the security guards while SG-A verbalized his intent to use his taser on P3 if he did not stop resisting. It was unclear at what point P3 was tased and the handcuffs were applied based on the body camera footage. Eventually, the camera footage showed P3 sitting upright with his hands secured with handcuffs behind his back. P3 was crying and asking what had happened, and saying they did not mean to do anything, it was their other personality, ["Name"]." SG-A then said "You are going to juvenile. You can't threaten people, that doesn't work for us." BERT staff then entered the unit and attempted to assess P3, however, SG-A grabbed their staff by the arm and pushed them away, informing them this patient was in custody and should not be seen. At 7:52 p.m., P3 was taken to the adult ED by security in a wheelchair and the handcuffs were removed.

During an interview on 5/22/24 at 10:52 a.m., SG-F stated all security staff have access to handcuffs, chemical spray, and a taser. SG-F stated the taser can be pointed and "arched" at patients as a warning. SG-F stated arching the taser creates a loud electrical sound but does not deploy the electrifying probes. SG-F stated this sound is used to warn the patient they are not "kidding around". SG-F stated he has displayed his taser and arched it at a patient when they had charged him with a weapon, or it was not possible to approach the patient with just his hands. SG-F stated he has used his handcuffs on a patient for a citizen's arrest.

During an interview on 5/22/24 at 11:14 a.m., the security training manager stated when a taser is pulled from the security staff's belt, the body worn camera is automatically activated. There are two ways to use the taser: to deploy the taser probes, or as a stun weapon by using a drive stun. The security manager stated to deploy the taser, the taser is turned on, which activates lights and laser guides. The taser probes need to be at least 12 inches apart to achieve neuromuscular incapacitation, which causes an individual's muscles to lock up, incapable of moving. If used as a stun weapon by utilizing the drive stun, the probes are not ejected from the taser and the taser creates localized pain at the contact site. The security manager stated the second time SG-A used the taser on P3 was when the drive stun was delivered and P3 likely felt intense localized pain that lasted until the taser was removed. The security manager stated the only contact in the videos between P3 and SG-A prior to the manual holds were when SG-A pushed P3 away. The security manager stated handcuffs were applied to P3 because staff wanted local law enforcement to arrest P3 for assaulting SG-A. The security manager stated she was unsure when this assault occurred and did not see any assault on the footage reviewed. The security training manager stated security can complete a citizen's arrest on a patient if a crime is committed and local law enforcement is called.

During an interview on 5/22/24 at 3:48 p.m., SG-E stated if a patient is not complying and the situation is imminent, they are allowed to take out their taser and arch it to gain behavioral compliance and then restrain the patients as needed. SG-E stated tasers can be taken out and arched at patients as a warning to settle them down and encourage compliance. SG-E stated handcuffs may be used on a patient when they have assaulted someone or destroyed property or equipment. SG-E stated P3 did not assault SG-A. SG-E stated SG-A told him P3 had assaulted a nurse in another room, and that is why P3 was being put in handcuffs. SG-E stated the threat of someone assaulting security justifies the use of a law enforcement weapon on a patient. SG-E stated P3 was clearly in conflict with themselves, switching back and forth between personalities, and actively having a mental health crisis.

During an interview on 5/22/24 at 4:03 p.m., SG-A stated on 5/14/24, he was in the PED completing his rounds as a security staff when he noticed P3 walking around with a sign and making low level threats. SG-A stated he radioed to their dispatch center and requested more security staff. SG-A stated after that, SG-B and P3 were talking down the hall when P3 saw SG-A. SG-A stated when P3 saw him, he changed instantly and was focused on SG-A like he had in a previous, unrelated encounter. SG-A stated P3 charged towards him, and SG-A responded with a defensive hand check to create space. SG-A stated P3 then became very angry, and SG-A pulled out his taser, giving verbal commands to get on the ground. SG-A stated P3 started getting down onto the ground, and SG-A pushed him between the shoulder blades because he was going "too slowly." SG-A stated P3 then began to resist, and it took multiple security staff to get him back to his knees. SG-A stated he tased P3 in his upper right shoulder and when it didn't create neuromuscular incapacitation, he moved the taser to achieve a distance greater than 12 inches apart and fired again. SG-A stated it was effective and P3 immediately stopped resisting, allowing them to have an effective five person hold on P3. SG-A stated he used the taser to get P3 into custody, handcuffs were applied because he used a law enforcement tool, which was the taser. SG-A stated he wanted to maintain control of the scene and ensure the safety of others on the unit.

During an interview on 5/23/24 at 8:30 a.m., SG-D stated security can use either their law enforcement weapons on a patient if it's a one-to-one scenario, if there's attempted assault, if the patient is bigger or stronger than you, or if the patient is in control of the situation. SG-D stated security staff can use the taser on a patient if they are making verbal or physical threats. SG-D stated a taser can be pointed at a patient, activated to engage the lasers, and arched to scare the patient. SG-D stated the intention is to warn the patient they are serious, and this can hurt them. SG-D stated when he tried to place P3 in a manual hold, P3 was resistive, and staff were giving multiple verbal directives. SG-D stated P3 fought back until the taser was used, at which point there was no more resistance. SG-D stated SG-A told him to arrest P3 for the attempted assault of SG-A. SG-D stated handcuffs were placed on P3 for the attempted assault of SG-A. SG-D stated any time a law enforcement weapon is used, it is considered a law enforcement action that requires police response. SG-D stated the decision a crime was committed is made by the police.

During an interview on 5/23/24 at 10:05 a.m., medical doctor (MD)-A stated the hospital is struggling to place social boarding patients, and they tend to be aggressive. MD-A stated P3 had escalated multiple times before in the PED and had been manageable with verbal de-escalation and psychotropic PRN medications. MD-A stated if a patient is a danger to others, staff can implement violent restraints in order to ensure safety on the unit. MD-A stated she was unsure how a taser could impact the elongated QT complex of a patient with preexisting conditions.

During an interview on 5/23/24 at 10:13 a.m., the regional security manager stated the threat of violence is grounds for use of law enforcement weapons on patients. The regional security manager stated whether a taser or chemical spray is used on an individual is dependent on the security staff's judgement at that time. The security manager stated he was part of the use of force reviewed and felt the hospital's processes were followed and there was no wrongdoing on the hospital's part.

During an interview on 5/23/24 at 10:44 a.m., the security supervisor stated no individual corrective action was taken with SG-A following this incident. The security supervisor stated no policies or procedures have been revised related to this incident. The security supervisor stated self-defense and the threat of violence are justification to use either the taser or the chemical spray on patients.

During an interview on 5/23/24 at 12:23 p.m., the Chief Nursing Officer (CNO) stated the incident on 5/14/24 was reviewed in multiple stages and teams, including herself, the VP of Operations, a mental health advanced practice registered nurse (APRN), patient safety specialists, security, and clinical staff. The CNO stated P3 was placed into handcuffs for the immediate safety for the entire unit. The CNO stated their interdisciplinary team felt they could not have maintained safety of the unit in any other way. CNO stated she did not know why the hospital five-point restraint was not used and would have to review the video again.

During an interview on 5/23/24 at 1:25 p.m., RN-A stated the PED has violent restraints (four- or five-point restraint) to use on patient, and they are used as a last resort. RN-A stated she had worked with P3 on 5/14/23 and the days leading up to it where he had multiple behavioral escalations, requiring staff intervention and seclusion. RN-A stated P3 had picked up the floor sign and was holding it like a guitar and refusing to give it back to staff. RN-A stated she offered PRN medications to P3, but he also refused. RN-A stated she tried to call the BERT team, but they were busy with another patient on a separate unit. RN-A stated she could hear P3 escalating and was about to call a code green but decided to call a code 21. RN-A stated before the code 21 team could arrive, she heard a security staff state "I am going to tase you." RN-A stated she was only able to see part of the event because she was on the phone trying to get a hold of resources. RN-A stated she felt these security interventions were appropriate because P3 was "bigger than the staff," and they were worried he could hurt someone.

An undated training document titled "Duty Gear," indicated all security staff are equipped with handcuffs. The document indicated security staff may handcuff patients when medical restraints are not available. The document indicated security staff should apply medical restraints to a patient as soon as possible. The document indicated handcuffs are not a health care intervention and should not be used on patients. The document indicated handcuffs are a law enforcement tool and are not considered a use of force, but a control technique. The document indicated multiple uses of a single taser, and multiple tasers may be used on an individual to control combative behavior. The document indicated tasers may be used by security staff if other de-escalation attempts have failed.

An undated training document titled "Use of Control Measures," indicated security staff may arrest another individual if a felony has been committed, or if a person attempts or completes a public offense.

A policy titled "Taser Energy Weapon," dated 12/13/22, indicated security may draw and/or use their taser if "A dangerous or violent subject has a weapon or is aggressively advancing toward the [security staff], and the [security staff] believes that they will be assaulted."


A policy titled "Security Use of Force," dated 2/28/23, indicated security staff are to use the least amount of force necessary to effectively gain compliance from individuals. The policy indicated security staff must act to "return all situations to therapeutic response to a behavioral emergency as soon as possible." The policy indicated security staff may threaten the use of force to gain control over situations and avoid violence. The policy indicated security staff may "compel a subject with the threat of force to gain compliance" by drawing their intermediate weapons, tasers and REPULS spray.

A hospital policy titled, "Handcuffs," dated 8/8/23, indicated any time an individual is handcuffed in a citizen's arrest by security staff, the individual must be transferred into local law enforcement custody. The policy indicated patients may be placed in handcuffs as a healthcare intervention when immediate restraint is necessary, and no other appropriate restraints are available.