HospitalInspections.org

Based on observation, interviews, review of physical environmental risk documentation, review of hospital policies and procedures, and review of other documentation, it was determined that the hospital failed to fully develop and implement P&Ps to ensure each patient's right to the provision of safe care in the hospital. The hospital's failures included the following:
* A patient's spouse made a verbal threat to shoot hospital staff and was allowed to return to the hospital the next day.
* Failure to develop and implement clearly written, consistent and effective policies and procedures that ensured all patients, visitors, vendors and other people entering the facility were screened for weapons and other prohibited items.

Findings include:
1. The P&P titled, "PHSOR Workplace Violence Prevention" dated "Last Revised 05/2024" reflected:
* "PHSOR is committed to preventing workplace violence (WPV) and to maintaining a safe work environment. As such, PHSOR has adopted the following policy regarding violent behaviors, identifying our expectation for responding to, mitigating, and reporting violence in the workplace."
* "Healthcare workers are at a significant risk of workplace violence from physical and verbal assault (OSHA, 2015)."
* "Workplace Violence (WPV): An act or threat occurring at the workplace that can include any of the following: verbal, nonverbal, written, or physical aggression (regardless of intent or injury); threatening, intimidating, harassing, or humiliating words or actions; bullying ... involving staff ... or visitors."
* "In keeping with our mission and values, PHSOR is committed to providing a safe and secure workplace and an environment free from violence. PHSOR does not tolerate violence. Violent incidents are taken seriously and thoroughly investigated."
* "Administration will foster and support a culture where workplace violence is not accepted, tolerated, nor considered part of the job. It is the belief of administration that caregiver safety and security is essential to and equally important as patient safety."
* "WPV incident reports are collected and maintained on the High Reliability 'Speak up for Safety' Platform. Any caregiver, leader or provider may submit a report. At least one report should be submitted per event ... Workplace violence incidents will be reviewed and investigated to identify opportunities to mitigate risk and support caregivers."

2. During interview on 04/16/2025 beginning at 1120 with DON the following information was provided:
* Spouse of patient was upset about patient care and said "Who do I have to shoot" at RN station on 4L on Thursday night (04/10/2025). The House Supervisor and Security officer came to the unit and de-escalated the situation. Spouse was sent home.
* Spouse returned to 4L the next day.
* Some staff did not feel comfortable having spouse on unit after making verbal threat. CN notified DON.
* DON, Security and House Supervisor all met and agreed to have spouse sign "visitation agreement" that required spouse to check in with security and go through metal detector upon arriving to the hosptital. Also, spouse was to refrain from yelling, posturing at, insulting or threatening members of staff.
* Spouse was allowed to be present from 1900-0700.
* A background check was done on spouse. Security increased rounding on unit.
* DON checked with CN and they felt supported but some staff were still uncomfortable. Three staff members went home early due to feeling uncomfortable. DON was not notified of this until the next day.
* Spouse was appropriate and cooperative after initial event took place. The hospital stated that contributing factors were the spouse was elderly and English is their second language. Spouse denied that they made a verbal threat.
* Patient's adult child began visiting instead of spouse to limit staff discomfort. Hospitalist expedited discharge.
* Patient discharged home on Monday, four nights after the initial incident took place.

* Some staff members were upset that the visitor was let back into the hospital after making a verbal threat which contradicted the P&P above that reflects "PHSOR does not tolerate violence." The visitor went through the metal detection screening station when entering the facility but did not immediately report to the unit. Some staff members were concerned that the visitor could have gone back outside to their vehicle and was bringing a weapon onto the unit.

3. A document titled, "Providence Portland Medical Center (PPMC) Security Services Standard Operating Procedure" dated "Approved: 12/9/22" reflected:
* "Purpose: To prevent prohibited weapons and contraband from entering the hospital."
* "Screening methods include: Walk-through metal detector, Hand-held metal detectors, X-ray machine, Physical inspection of clothing, bags, bacpacks, purses."
* "This Standard Operating Procedure (SOP) applies to Security screening at the Emergency Department (ED) main entrance as well as the ambulance entrance. Main entrance of the hospital. Cancer center entrance."
* "This SOP applies to the PPMC campus, to include the Professional Plaza; Child Center; parking garages; parking lots ..."
* "All patients, visitors and contractors are screened ..."
* "X-Ray Screening Process: All items coming into the building are subject to inspection and/or x-ray (e.g., baggage, briefcases, purses, backpacks, sacks, baby carriers, medical supplies)."
* "All persons who leave and later seek re-entry at any screening station will be screened again."

The SOP is not consistant with the current practices at PPMC.

4. During observation on 04/16/2025 starting at 1000 the following was observed:
* A sign in the parking garage skybridge entrance that reflected:
"Attention Patients, Family and Visitors
Security screening required for all patients and visitors at Providence Portland Medical Center.
The following are not allowed in the hospital and will be confiscated at the screening station:
- Weapons, including guns, knives, and pocketknives
- Narcotics
- Chemical deterrents such as pepper spray
Threats, verbal abuse, or acts of physical violence will not be tolerated and may result in removal from premises and criminal prosecution."
* The entrance from the skybridge does not have any security officers present, a metal detection screening station or anyone directing people that enter to the other entrances with screening staff present.

5. During interview with SM on 04/16/2025 starting at 1205, the following information was provided:
* The ED entrance is staffed for metal detector screening 24 hours a day, 7 days a week.
* The main entrance and cancer center entrances have staff from 0600 to 1900 when there is enough security to staff the metal detectors. After hours, everyone must enter through the ED and go through the screening.
* The ambulance entrance has a wand that can be used for patients entering with EMS and not able to walk through the screening station.
* The skybridge does not have a metal detector screening station.
* There was not enough security staff working today to staff the main entrance metal detector screening station.
* There is limited security staff and not enough security officers to backfill for sick calls. There were 11 officers scheduled for dayshift today and they only have 8 working with 3 sick calls.
* People with blue Legacy [Health System] badges and vendor badges are able to bypass the screening stations.

The facility has entrances that do not have security screening stations and there are times when the entrances that do have screening stations do not have enough security officers to run them. Patients, visitors and other people entering the facility may bring in weapons or other contraband items that could potentially cause harm to themselves or others, including patients.