Is Enough Being Done to Ensure Hospitals are Safe From Terrorist or Criminal Attacks?

by DR. JAMES “JIM” BLAIR, COL RET, ARMY AMEDD December 18, 2010
As federal and metropolitan governments build more robust structures and mitigate safety and security vulnerabilities in their building environments, non-federal hospitals become more susceptible to a growing number of known threats.
It may be useful to ponder Winston Churchill's observation about the cultural impact of the way we build our buildings “We shape our buildings; thereafter, they shape us”.
The tragic deaths at Johns Hopkins Medical Center constitute a recent example of an Institution known for its excellence in the delivery of clinical care that has turned a blind eye to the physical safety and security of its stakeholders. In a post 9/11 environment with increasing successful and aborted terrorist attacks (some by luck) on the nation how could one expect to defend 80 entry points into its operation? Refusal to use known technology to enhance security (metal detectors) base on the assumption “patients will not come” defies reality. Has the traveling public stopped flying because security has tightened at airports? Fielding a security force without firearms, or at least a few, is living in denial.
The evolving fusion of terrorist elements with organized criminal elements should be a “heads-up” for areas with existing high crime rates.
The changing nature of terrorist threats include a number of innovative strategies and tactical approaches pose increased danger to the unprepared. Some of these approaches are not novel and have been used with growing success around the world.
The perceived movement away from 9/11 type attacks does not mean they could not happen. Serial attempts to use airborne platforms as weapons delivery systems persist, the last, cargo bombs surfacing this month. A twist on the tactic of timing, coordinated CBRNE attacks during natural disasters could see the combination of ground “Mumbai-like” attack coordinated with planned aviation bomb event.
Earlier this year, a Department of Health and Human Services (DHHS) funded study, The Next Challenge in Healthcare Preparedness: Catastrophic Health Events (Preparedness Report), (pdf document), revealed that the Nation's Public Health and Healthcare sector was not prepared to deal with “Catastrophic Health Events.”
We will leave it to the reader to define ‘catastrophic.’ Could it be a cargo plane with a bomb or a passenger plane with a bomb timed to explode over a population center coordinated with a terrorist ground attack?
Is there any doubt that within any of our urban centers organized radicalized Islamic groups could field a score or more of young adults armed with conventional weapons guided by seasoned handlers with cell phones? (Mumbai Model)
Pre 9/11 the federal healthcare community, spurred by Oklahoma City, Murrah building attack, took serious steps to protect their facilities from future attacks. The dual benefits of designing and constructing more robust treatment facilities has resulted in greater protection of all stakeholder from both natural and man-made events.
Unfortunately, the non-federal hospital and healthcare sector has not followed the federal sector's lead. The industry continues to design and construct their facilities with limited regard for known threats.
The American Institute of Architects (AIA), on a four year cycle, updates its Guidance for Design and Construction of Healthcare Facilities. Prior to 1987 the guidelines were published by the Department of Health and Human Services (DHHS) and its predecessor organizations back to the Hill Burton era.
Somewhere in the text of the last three editions of the guidance we noted the statement “Having the Courage and Wisdom to adopt requirements that are forward looking and address the needs of the future, looking backwards only to discover what not to do”.
It appears that hospital and healthcare building industry was and is existing on some parallel universe not unlike the old Superman Comic's BizarroWorld. Unfortunately they had a host of enablers. Members of the healthcare media who found these patient care sites with great glass domes and access to gardens and windows bringing nature to the bedside worthy of grand prize winners on the healthcare landscape. One article heaped praise on the patient designed free-standing cancer center which failed to protect from what the Defense Science Board identified in 2007 as the “low hanging fruit” one-half of the dreaded “Dirty Bomb”.
The opportunity lost during this last decade to mitigate known vulnerabilities through design and construction is unfathomable. It takes more than a non-federal healthcare building industry and their media admirers to place a trusting public at risk. The Health Guidance Revision Committee (HGRC) purports to have the best and brightest in the health facility design and construction community.
I must admit I have known dedicated architects who were at the top of their craft who were sensitive to the need to construct robust structure intended to provide safe and secure workplaces, but the reality is that purchasers have the last say.
Many of us in the all-hazards readiness business gave the 2002 HGRC group a provisional pass based on the proximity of the 9/11 attacks. The lapses in the 2006 AIA guidance caught us by surprise, we had been assured by the leadership that that edition would reflect “real world” concern for known looming threats. We were stunned by the lack of response for recent evidence-based threats-9/11 and Katrina.
We spent two weeks reviewing the document and talking with key contributors to the report. These conversations brought more heat than light. Dozens of calls were made to Federal Agency authorities in an attempt to see who had signed off on the document. Seeking information on who reviewed the document in The Department of Homeland Security convinced us that “no one had seen the document” let alone reviewed it.
Assurances that our concerns would be addressed in the 2010 guidance gave us little comfort; it was 2006 and a lot could happen before 2010. Fast forward to 2010. To say we were disappointed is the understatement of the decade. The document still contained wording to the effect, I paraphrase, “controlling access to treatment facilities is difficult to impossible and undesirable”.
We failed to process the 2006 official answer and should have known little would change. That correspondence, in part, read “... would like to state that all 125 committee members are dedicated to making the Guidelines for Design and Construction of Healthcare Facilities a top-notch set of recommended standards... There is not a person on the committee that has intentionally tried to keep any effort to add language for hardening our healthcare buildings out of our guidelines.”
 We posit that a lot of committee members representing federal agencies had failed to do their duty. We again tried, without success, to find any evidence the Department of Homeland Security had been involved in the process.
We are left with the questions: Has the practice of passing such responsibilities from Federal Agencies to Trade Organizations served the public good? Where are risk insurers and credit rating organizations?
A pdf version of this article can be downloaded here. Contributor Dr. James Blair, DPA, MHA, FACHE, FABCHS, CAS, is president and CEO of the Center for HealthCare Emergency Readiness. He is the author of the book, Unready: To Err is Human: The Other Neglected Side of Hospital Safety and Security, which was published in June. He is also a career-retired army colonel with 28 years of active service. Among his private sector experiences, he served as VP of Hospital Corporation of America, Middle East Limited and as an independent consultant to Joint Commission International.

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