The information below comes from the statement of deficiencies compiled by health inspectors and provided to AHCJ by the Centers for Medicare and Medicaid Services. It does not include the steps the hospital plans to take to fix the problem, known as a plan of correction. For that information, you should contact the hospital, your state health department or CMS. Accessing the document may require you to file a Freedom of Information Request. Information on doing so is available here.

PATHWAYS OF TENNESSEE, INC 238 SUMMAR DR JACKSON, TN Feb. 15, 2017
VIOLATION: GOVERNING BODY Tag No: A0043
Based on policy review, review of hospital documents, review of personnel files, medical record review and interview, the hospital failed to ensure the Governing Body assumed responsibility for contracted security services, ensure appropriate policies were developed and implemented on how to deal with accelerating patient situations and failed to train all contracted security officers on appropriate methods for dealing with accelerated patient situations. The failure of the Governing Body to assume responsibility and provide oversight of all its contracted services resulted in the death of Patient #1.

The findings included:

1. The Governing Body failed to assume responsibility for all its contracted services, failed to adequately train contracted security personnel and failed to ensure patient and staff safety.

Refer to A 083
VIOLATION: CONTRACTED SERVICES Tag No: A0083
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**

Based on policy review, review of hospital documents, review of personnel files, medical record review and interview, the hospital failed to ensure the Governing Body assumed responsibility for contracted security services, failed to ensure appropriate policies were developed and implemented for patient situations that were accelerating and failed to train all contracted security officers on methods to deal with these situations. The failure of the Governing Body to ensure contracted security personnel were adequately trained on appropriate polices for dealing with accelerating patient situations resulted in the death of Patient #1.



The findings included:

1. Review of the hospital policy "Code Silver" revealed, "PURPOSE: To establish emergency procedures for staff to follow in the event of a person using or brandishing a weapon on the hospital campus. Scope: Areas affected by this policy included [name of Hospital #2] and the affiliates located on its campus... Definitions:...Code Silver Exterior- report of a person(s) using or brandishing a weapon outside of a [name of Hospital #2] building but on the [name of Hospital #2] campus...Exp. [example] 'Code Silver Exterior [name of Hospital #1]'...POLICY:1. In the event of an individual, on the [Name of Hospital #2] campus, using or brandishing a weapon, the hospital will institute procedures to minimize the risk to our patients, visitors and staff by evacuation, facility lockdown and/or 'shelter in place' procedures and by assisting law enforcement in locating the suspect. 2. An incident response team will be dispatched to a safe area near the incident. Their primary responsibilities will be to evacuate and secure the area from unnecessary traffic and provide information to law enforcement ...PROCEDURE... 4. Incident Response Team: a. Upon notification of Code Silver, the incident response team (including all Security personnel and Engineering Management staff) should report to the Security Command Center to be briefed on the situation. b. Response team will be dispatched to the incident location. c. Establish a perimeter. d. Clear the area of all possible bystanders and do not allow anyone to enter until relieved by law enforcement or the situation has been resolved...f. Maintain communications with Incident Command. g. take direction from law enforcement and Incident Command. h. The Incident Response Team should not try to bargain with or make any promises to the perpetrators or engage in a rescue attempt...6. Law Enforcement (upon arrival to the facility): a. Will assume full responsibility for managing the situation b. Will need full cooperation (and assistance) from hospital staff...e. Hospital staff should expect law enforcement officials to: 1. Be fully armed (shotguns, rifles, handguns). 2. Dressed in appropriate attire including external bulletproof vests, helmets and other equipment. 3. May use pepper spray or tear gas in order to control the incident..." There was no documentation in the policy that law enforcement may use firearms to control the incident.

2. Review of the "AGREEMENT FOR SECURITY SERVICE" dated March 1, 2009 between Hospital #2 [referred to as District] and the Local Police Department revealed, "WHEREAS, The District is a governmental entity that operate [named Hospital #2] and other healthcare facilities...the District desires to maintain security in the emergency department and other areas of the Hospital;... the District desires to engage [Local Police Department], and [Local Police Department] is willing to be engaged to provide additional security in the Hospital...1. Duties of [Local Police Department]. [Local Police Department] agrees to furnish to the District armed and uniformed Officers as requested by the District to provide security services in the Hospital as needed by the District and at times requested by the District. [Local Police Department] agrees to recruit and train officers specifically for this purpose...The recruited and trained officers shall be assigned to the Hospital...2. Obligations of [Local Police Department] and Officers. [Local Police Department] and all security Officers providing services pursuant to this Agreement shall have the following obligations: A...officers shall comply with all state, federal and local laws, rules, statutes, regulations and ordinances, all District polices, and shall cooperate with the Director of Safety and Security and the Security Coordinator for the District...the Officers shall comply with all standards and requirements of the Joint Commission in providing services under this agreement; B...Officers shall, at all times while providing services under this Agreement, maintain a visible, armed presence in the Hospital, Typically Officers will be stationed in the emergency department entry area, but such Officers may be stationed in other areas of the Hospital as requested from time to time by the District or its designees; C. Officers shall respond to calls or requests for assistance from other areas of the Hospital upon request of the District or its designees; D All Officers shall be properly uniformed and armed at all times while performing services under this Agreement; F. While on duty, the Officers duties shall include...securing the premises against theft, malicious injury...and protecting Hospital personnel...against personal injury...Officers shall detain and arrest individuals as appropriate and in accordance with applicable laws;...L. The Officers shall receive the appropriate orientation by the District and shall receive training concerning the District Quality Plus/Guest Excellence programs, the District Compliance program, the privacy and security standards of the Health Insurance Portability and Accountability Act and all other training deemed necessary by the District. 3. Compensation. The District shall pay [Local Police Department] for Officers providing services under this Agreement at a rate of Twenty Six and 50/100 dollars ($26.50) per hour. Additionally the District shall pay an initial fee of $25,440.00 in order to enable [Local Police Department] to recruit and train officers who will be assigned to [Hospital #2] and stationed at the Hospital...4. Term/termination...this agreement shall renew in successive one (1) year increments...5. Right of Dismissal. The Director of Safety and Security for the District...shall have the right to disallow any Officer from providing services under this Agreement...F. Relationship of Parties. It is agreed by the parties that, at all times and for all purposes hereunder, the arrangement between the District and [Local Police Department] and/or the relationship between the District and any Officers providing services under this Agreement is that of independent contractors. The parties hereto and the Officers providing services under this Agreement covenant and agree that they shall not be considered employees or agents of the other. The District shall not have or exercise any control over the methods by which the Officers perform their duties hereunder, except to the extent provided in this Agreement..." The Agreement was signed by Hospital #2's Vice President, the Local Police Department's Chief of Police and the Mayor of the City.

Review of the most recent "AMENDMENT TO AGREEMENT FOR SECURITY SERVICES" dated July 1, 2016, revealed, "NOW THEREFORE...the parties agree to amend the Agreement as follows: 1. The parties agree to delete Section '3 Compensation' in its entirety and replace it with the following: ...3. Compensation. The District shall pay [Local Police Department] for Officers providing services under this Agreement at a rate of Thirty Two and 57/100 Dollars ($32.57) per hour.' 2. The parties agree that [Local Police Department] with [will] provide additional security in Hospital such that [Local Police Department] will maintain as close to a 24 hour, 7 day a week presence as practical and feasible...." The Amendment to the original Agreement was signed by Hospital #2's Interim President, the Local Police Department's Chief of Police and the Mayor of the City.

3. Review of the Job Description for "Law Enforcement" revealed the Contracted Security Officers were supervised by the Director of Safety and Security at Hospital #2. The "JOB SUMMARY/SCOPE OF RESPONSIBILITY" was documented, "Performs all requirements necessary for the safety and security of the hospital campus, including personnel, patients, visitors, and property. Officers shall comply with state, federal and local laws, rules, statutes, regulations and ordinances and [Local Police Department] policies. Officers shall cooperate with the Hospital's Director of Safety and Security and the Security Manager. Law Enforcement shall comply with standards and requirements of the TJC [The Joint Commission]...Officers shall maintain visible, armed presence in the hospital. Typically, Officers will be stationed in the emergency department entry area, but Officers may be stationed or respond to calls in other areas of the hospital campus as requested by Hospital Security...ESSENTIAL JOB FUNCTIONS...All Officers shall be properly uniformed and armed at all times while performing services on the Hospital campus...Use of force shall be in accordance with [Local Police Department] policies and procedures..."

4. Review of the personnel file for Contracted Security Officer #1 revealed a "CONTRACT ORIENTATION CHECKLIST" dated 6/23/16. The Department was identified as [Local Police Department] with a Job Title of Patrol Officer. The required orientation documented was : Health Insurance Portability and Accountability Act, Patient Rights/Advanced Directives, Safety/ Security, Compliance, Employee Health Services, Risk Management and Infection Control. There was no other information provided regarding training and orientation for Contracted Security Officer #1. There was no documentation the Contracted Security Officer had been trained on how to respond appropriately to patient situations that were accelerating and procedures for dealing with the situation. There was no documentation the Contracted Security Officer had been trained on the hospital's Security Policies or Crisis Intervention Training. There was no documentation of patient abuse training or hospital security officer training. There was no evidence Contracted Security Officer #1 received training from the psychiatric hospital.
5. Review of Hospital #2's emergency department (ED) record for Patient #1 documented the patient (MDS) dated [DATE] via ambulance at 4:36 PM with a self inflicted stab wound to the chest. The Triage Nurse Psych Assessment at 4:43 PM, documented, "Suicidal Ideation: Constant with plan Suicidal Safety Measures: Sitter at bedside..." A medical screening examination was performed at 4:38 PM and documented, "The patient presents with a stab wound. The onset was just prior to arrival. Location: Left chest. The location where the incident occurred as at home. The degree of bleeding minimal. Patient presents with a self inflicted stab wound to the chest, in suicide attempt. He used a large kitchen knife. He denies concommitant [concomitant] ingestion or injuries. No prior suicide attempts. No dyspnea, nausea, or vomiting...alcohol use denies...drug use denies...cooperative, flat affect..."

The Computerized Tomography results of the Thorax findings documented a 24 centimeter blade in the left anterior chest wall. The knife was lodged in the subcutaneous fat of the left anterior chest wall and did not penetrate the pectoralis muscle.

At 7:09 PM the ED Physician used slow constant tension to remove the knife and repaired the laceration with 3 sutures. A mobile Crisis Counselor arrived at 7:45 PM and performed an assessment of Patient #1. The patient refused Hospital #1's Crisis Stabilization Unit (a voluntary program) and a safety plan (also known as Crisis Management Plan) was established with the patient. The plan included Hospital #1's crisis hotline and the Statewide Crisis hotline. The patient was discharged home on 11/23/16 with instructions to follow up with Hospital #1 to set up an outpatient counseling appointment.

6. The following day, 11/24/16 at approximately 10:15 AM, Patient #1 presented to Hospital #1. Medical record review revealed he was a [AGE] year old black male with a presenting problem of hearing voices of self harm and a self inflicted knife wound to the chest the day before on 11/23/16.

The Triage screening documented by Psychiatric Technician (Psych tech) #1 revealed, "pt [patient] has a self inflicted stab womb [wound] to his chest. (pt was seen in the ER [ED] last night and was cleared medically) pt says he did that last night to stop the voices he has been hearing. pt says he has been seeing and hearing voices. pt says this started a few months ago." Patient #1 denied having suicidal thoughts during triage. He reported positive use of cocaine, marijuana and to drinking alcohol daily. The patient was accompanied to the intake unit by his father who reported the patient had been up all night walking the streets. The patient reported a poor appetite, rated pain from the stab wound was 7 on a scale from 1-10. A quick dip drug screen result documented he was positive for cocaine and marijuana. Psych tech #1 initiated a referral for a Crisis Counselor to assess Patient #1 to determine whether he could be admitted to the Crisis Stabilization Unit (CSU).

Review of Crisis Counselor #1's documentation revealed, "Pt is a 45 BM [black male] presenting...with his father requesting help. Pt reports poor appetite and poor sleep. Pt reports hearing voices for the past few months telling him to harm himself. Pt reports 4 (24 ounces) of beer daily since he was 15 or 16. Pt reports THC [marijuana] dime sack daily since [AGE] or 16. Pt denies HI [homicidal ideations] Pt reports SI [suicidal ideations] due to hearing voices. Pt reports voices tell him to harm himself at times. Pt stabbed self last night due to voices. Pt reports limited support system. Pt reports increased paranoia. Pt reports he has never had treatment. Pt reports increased depression and anxiety, and per pt's father he has been walking the street all night. Pt denies any withdrawal symptoms at this time." Crisis Counselor electronically signed the assessment on 11/25/16 at 12:30 PM. The Crisis Counselor recommended the patient be admitted to the CSU. The patient was sent back out to the waiting room to await admission to the CSU.

7. During an interview on 1/12/17 at 11:30 AM, Psych tech #1 was asked about Patient #1 seeking treatment on 11/24/16. She stated, "...on 23 rd [11/23/16]...he [Patient #1] came to the ER [emergency room at Hospital #2]...self inflicted knife [wound] to his chest...10 inch blade..." The Psych tech stated the patient was discharged from Hospital #2's ED and he was sent home on 11/23/16. The Psych tech stated the following day, 11/24/16, Patient #1 presented to Hospital #1 with complaints of hearing voices. She stated she signed him in, performed a crisis assessment, and called for a Crisis Counselor to come and evaluate him. The Psych tech stated the initial plan was to send the patient to [name of another psychiatric hospital] but the Crisis Counselor determined Patient #1 did not have insurance, so she [Crisis Counselor #1] began to work on getting him admitted to the CSU at Hospital #1. The Psych tech stated while the patient was in the triage area/waiting room, "He [Patient #1] wasn't cussing, screaming...nothing to make my radar go off...it was just like a normal day...he was nice...not yelling or fighting..." The Psych tech stated that it was Thanksgiving Day and the hospital had provided a meal for the staff working the holiday. She stated when the Crisis Counselor arrived, she went upstairs to get food for her and Crisis Counselor #1. She stated she returned to the Crisis Triage area with food for her and Crisis Counselor #1 but she had only brought a drink for herself. She stated Crisis Counselor #1 left the unit to get a drink upstairs. The Psych tech stated while she ate her Thanksgiving meal Patient #1 was in the waiting room with his father. Psych tech #1 stated she periodically walked into the waiting room asking the patient and his father if they needed anything and was keeping them informed of the plans to be admitted to the CSU. She stated after she had finished her meal she was seated at the desk in triage area where she could see into the waiting room. She stated, "...No warning...nothing...he walked through the door [to triage area] with a knife...he started to stab me with no warning..." She stated she sustained 105 stab wounds. She stated Patient #1 had been nice and cooperative and, "He didn't give any idea what he would or could do..." When asked if the patient was checked for personal belongings during the assessment, Psych tech #1 stated she asked him if he had anything sharp on him when he initially entered the triage area and he denied having any sharp objects. She stated she was not allowed to search patients.

During an interview on 1/5/17 at 1:18 PM, the Crisis Counselor #1 was asked to recall the events on 11/24/16. She stated she was paged Thanksgiving day about 10:00 AM, and she arrived at Hospital #1 about 10:30 AM. She stated Patient #1 was in the hallway with his father and he was pacing. She stated Psych tech #1 brought Patient #1 into the Triage area. She stated, "I assessed him...I was checking his insurance...it had been less than 24 hours [since he was assessed in Hospital #2's ED] so I was updating his assessment." She stated his presenting problem was hearing voices, not sleeping and aggression. The Crisis Counselor stated she was not afraid of Patient #1. She stated, "[name of Psych tech #1] left me downstairs with Patient #1 to go upstairs and get food [Thanksgiving meal for staff]". The Crisis Counselor stated Patient #1 had some delayed responses due to his psychosis. She stated he had no history of treatment and had denied suicidal and homicidal ideations. The Crisis Counselor stated when she left to go upstairs to speak with the nurse, Psych tech #1 was in the Triage area eating her Thanksgiving lunch and Patient #1 was in the waiting room with his father. She stated the patient was alert and oriented to time and place and knew he wanted help.

During an interview with Security Officer #1 on 1/4/17 at 10:52 AM, he stated he did carry pepper spray and had been trained on its use. He stated he had never deployed his pepper spray. He stated he'd been employed for 9 years with the security department. When asked the difference in the Contracted Security Officers acting as security for the hospital and the other hospital security officers, he stated, "[Contracted Security Officers] have a weapon and arresting rights."
He was asked to describe the events of 11/24/16 related to Patient #1. He stated he was in the security camera room at Hospital #2 and heard the Local Police Department dispatch a unit to Hospital #1 related to a 911 call of someone waving a knife. He stated he and Security Officer #2 rode to Hospital #1 together, and that Security Officer #3 and Contracted Security Officer #1 followed separately. He stated when they arrived at Hospital #1, Patient #1's father was standing outside. He stated, "He [Patient #1's father] was on the phone and was hysterical." He stated it was decided that he and Security Officer #2 would enter the front door and Contracted Security Officer #1 and Security Officer #3 would enter the back door. He stated, "We [Security Officer #1 and 2] came in the little door to triage...we seen [Psych Tech #1] on the floor with blood everywhere...he was standing over her like an animal killing his prey." He stated Patient #1 was standing over Psych Tech #1 with a pocket knife in his hand. He stated Patient #1 turned to look at him and Security Officer #2 and they asked him to put down the knife. He stated at that time Contracted Security Officer #1 and Security Officer #3 entered the back door of triage. He stated Patient #1 then turned to look at the back door. He stated Patient #1 continued to stand over Psych Tech #1. He stated Contracted Security Officer #1 pleaded with Patient #1 to put the knife down. He stated Contracted Security Officer #1 had his gun drawn. He stated Patient #1 verbalized something to the affect he was not putting the knife down. He stated 2 Local Patrol Police Department Officers then arrived on the scene and he and Security Officer #2 moved from the triage doorway to make room for them. He stated he heard Contracted Security Officer #1 say, "I need the one whose got the Taser in the front." He stated he heard a pop, but did not see Patient #1 shot. He stated he did not see whether the Taser connected with Patient #1 because he was in the triage waiting room. When asked if there was ever an opportunity to take down Patient #1, he stated, "We tried talking to him...he was prancing over her, cussing, his eyes were just...no words to describe." He stated it was primarily Contracted Security Officer #1 who was asking Patient #1 to put the weapon down. He stated the hospital's security protocol is for the Local Patrol Police Department or Contracted Security Officers to take over and take charge of the scene. He stated, "I think about it every night...what could we have done...I was the supervisor..." He stated Psych tech #1 was asking for help while Patient #1 was standing over her. He verified the Contracted Security Officer #1's primary assignment was Hospital security.

During an interview with Security Officer #2 on 1/4/17 at 1:28 PM, he stated he had been employed with the Security Dept for 2 years. He was asked to describe the events from 11/24/16 when he was dispatched to Hospital #1. He stated he was in the camera room at Hospital #2 when he heard the Local Police Department radio dispatch a unit to Hospital #1 because a patient had reportedly been stabbed. He stated he went with Security Officer #1 to the scene. He stated Patient #1's father was on the steps outside waving them in the door. He stated he and Security Officer #1 entered through the front door of the triage area. When asked what he saw when he stepped into the triage area, he stated, "I saw a hospital ID [identification] badge on the floor covered in blood and a water bottle on the floor." He stated Patient #1 was standing there about a foot away with a pocket knife in his right hand. He stated Psych Tech #1 was laying face down on the floor. When asked what Patient #1 said he stated, "He never said a word...looking straight ahead...we asked him to put the knife down..." He stated Contracted Security Officer #1 and Security Officer #3 entered the back door and Contracted Security Officer #1 told Patient #1 to put the knife down. He stated "I can't tell you how many times he [Contracted Security Officer #1] told him [Patient #1] to put the knife down. He stated Psych Tech #1 began to ask for help and to say that she was having trouble breathing. He stated 2 Local Patrol Police Department Officers then arrived and entered through the front door. He stated at that time, he and Security Officer #1 stepped out of the doorway and into the waiting room. When asked who tased Patient #1, he stated Local Patrol Police Department Officer #2. He stated when the patient saw the red dot of the Taser, that's when he lunged toward Local Patrol Police Department Officer #2 with the knife and Contracted Security Officer #1 shot Patient #1. When asked if they had an opportunity to take down the patient, he stated, "...first initial thought was seeing blood and water on floor...in corner, could we take him down without slipping and falling."

During an interview on 1/5/17 at 11:18 AM, Security Officer #3 verified he responded to the scene at Hospital #1 on 11/24/16. He stated he was dispatched by Hospital #2's security office and drove to Hospital #1. He stated when he arrived he was instructed to go to the back entrance with Contracted Security Officer #1. He stated he and Contracted Security Officer #1 entered a back hallway that only staff had access. He stated when he came further down the hallway, closer to the door to enter the Triage area, he could hear Psych tech #1 calling out "Somebody help me". He stated Contracted Security Officer #1 also heard her calling out and at that time he had pulled his gun out and held it pointed toward the ground. He stated they entered the back door and Contracted Security Officer #1 walked in first. He stated, "[Contracted Security Officer #1] walked in stopped and said 'Sir, you need to put down the knife'." When asked to describe what he observed, he stated, "[Psych tech #1] was on the floor, the guy [Patient #1] was standing about even with her feet, her head was toward us...her feet were toward the other [front ] door...[Patient #1] standing up, knife in hand...just a blank stare [on face]." He stated, "He [Patient #1] had a startled fixed look on his face." He stated Security Officer #1 and #2 were standing in the front doorway to the Triage area and were also asking Patient #1 to put the knife down. He stated there was no verbal response from the patient. He stated, "[Contracted Security Officer #1] told him I don't know how many times to put the knife down." He stated 2 Local Patrol Police Department Officers arrived at the scene and Security Officer #1 and #2 then stepped into the waiting room. He stated the 2 Local Patrol Police Department officers then entered the doorway to Triage. He stated, "I was telling [Psych tech #1] to hang on help was on the way...[Psych tech #1] was saying 'Help me I can't breathe I am 19 weeks pregnant'...'I can't breathe'..." He stated the Local Patrol Police Department Officers and Contracted Security Officer #1 were telling Patient #1 to put down his knife. He stated Patient #1 then began to back away slightly, moving closer to a desk in the Triage area. He stated Patient #1 verbalized "...F you what are you gonna do?" He stated the Local Patrol Police Officers continued to ask Patient #1 to put his weapon down. He stated Contracted Security Officer #1 then said, "Use the yellow one [referring to a Taser]" to the Local Patrol Police Department Officer at the front doorway. He stated Local Patrol Police Department Officer #2 told the patient 3 times to put the knife down, then Contracted Security Officer #1 said "tase him." Security Officer #3 stated the Taser barbs connected on Patient #1's mid sternum area. He stated he heard the wires connect and a buzz sound. He stated Patient #1 turned to go after Local Patrol Police Department Officer #2 with the knife and he heard a pop. He stated he saw the cartridge go over Psych tech #1's head and hit the wall. He verified Contracted Security Officer #1 shot Patient #1. He stated, "[Patient #1] stood straight as a board and fell , he never let go of the knife as he was going down the knife was steadily going straight up." Security Officer #3 stated he was not trained on pepper spray and did not carry pepper spray. When asked about procedures and how the Contracted Security Officers are involved in security, he stated that if there is a security stat call over the hospital dispatch, Contracted Security Officers will also respond, if the situation is extremely hostile, they would assume leadership. He stated, "That is protocol...Our security team tries to handle everything, [Contracted Security Officers] is here for everyone's safety, if situation bad enough, [Contracted Security Officers] will be leader, hands down." When asked if these scenarios were covered in CIT, he stated there was a scenario for a patient brandishing a weapon but not where a patient or staff member have been attacked or actually harmed. He stated, "This is my thing, I don't care how much CIT...this situation, from front cover to back [of training manual]...I don't think it would have worked...he [Patient #1] looked hollow inside...that look on his face...it was scary."

8. Via email on 1/18/17 at 1:50 PM,the management personnel from Hospital #2, also providing management for Hospital #1, failed to assume responsibility for Contracted Security Officer #1 who was providing security services for Hospital #2 and Hospital #1 (located on the campus of Hospital #2) on 11/24/15. The management declined to allow surveyors to conduct an interview with Contracted Security Officer #1, due to an open investigation into the shooting by the Tennessee Bureau of Investigation (TBI).

9. On 1/20/17 at 7:30 AM, surveyors met with TBI Special Agent #1 at the TBI office. She presented two separate redacted Incident/Investigation reports from the Local Police Department dated 11/24/16. The surveyors were allowed to read and make notes from the reports. One report documented the crime incident: Aggravated Assault. One report documented the crime incident: Justifiable Homicide. The summary of both the incidents were the same and revealed the following:
On 11/24/16 officers responded to Hospital #1 in reference to a 911 call to dispatch where a man stated his son had stabbed a woman at Hospital #1. Officers (name redacted), encountered a Hospital #1 patient stabbing a Hospital #1 employee (name redacted) with a knife. Officer (name redacted) engaged with his firearm and Officer (name redacted) engaged the suspect with his taser. After being shot (name redacted) collapsed. Officer (name redacted) removed the knife from (name redacted) hand. Officer (name redacted) began to handcuff (name redacted) as Officer (name redacted) checked (name redacted) vitals. Officers realized (name redacted) did not show signs of life and began cardiopulmonary resuscitation. Officer (name redacted) applied pressure to (name redacted) stab wounds. Emergency Medical Services (EMS) arrived on scene and took over life saving procedures. Both (name redacted) and (name redacted) were transported to the ED of the Hospital #2 by EMS. Officers immediately secured the scene for investigation. The reports did not indicate a time the officers arrived at the scene at Hospital #1. TBI Agent #1 verified she was unable to determine what time the officers arrived on the scene from the reports.

10. During an interview on 1/5/17 at 12:00 PM, the Director of Safety and Security for Hospital #2 (Hospital #1 is on the campus of Hospital #2 and Security responds to any need on the campus therefore Security is the same for both hospitals) stated the Contracted Security Officers assigned to the hospital assumed responsibility when a situation became criminal. He stated, "They [the Contracted Security Officers] assigned to the hospital] are under a separate authority...if they are our [hospital] employee...they can't act as a Police Officer." He stated, "They do assist in non- police matters." He stated if someone broke the law, at that point it became criminal and the Police assigned to the hospital assumed authority. He stated, "Our Security don't have arrest authority... " He stated the Contracted Security Officers assigned to the hospital were unable to serve as a Police Officers and be employed by the hospital because they would lose their Peace Officer Standards in Training certification as a Police Officer. He stated the contract was with the Local Police Department and not the individual Police Officers. When asked about the Security Department policies (a red policy manual was provided to surveyors that contained Security Policies), he stated, "The department manual is for our employees." When asked how the Contracted Security Officers complied with hospital policies, he stated, "We do an orientation with them." When asked if the policies in the red manual were covered in the orientation, he stated,"Some of them are..." He then stated the Local Police Department followed their own policies. He stated, "We do general orientation with [Contracted Security Officers]...more in depth with our [hospital Security] officers." He stated the Contracted Security Officers are only required to follow the checklist for general orientation to the hospital. He stated Crisis Intervention Training (CIT) was not required for the Contracted Security Officers, it was optional.

During an interview on 1/4/17 at 2:03 PM, the Director of Inpatient Services stated the Contracted