(Editor’s note: This story by Nora Doyle-Burr was published by the Valley News on Jan. 14, 2018.)
[L]EBANON, N.H. — Following up on the fatal shooting of a patient last September, officials at Dartmouth-Hitchcock Medical Center are taking steps to improve security, communication during emergencies, and education and training of employees.
But New Hampshire’s sprawling academic medical center stopped short of installing metal detectors or posting armed guards at its Lebanon campus.
Hospital officials, who outlined the changes in an interview with the Valley News last week, said they believe the measures will make a difference without altering the atmosphere for the thousands of workers and patients who come and go each day.
Aside from making the presence of security officers more visible, “I hope they’re things that (visitors) don’t notice,” Dartmouth-Hitchcock Vice President of Facilities Tom Goins said. “I think our objective is from the customers’ perspective to maintain safe, business-as-usual operations as much as possible.”
The changes follow the Sept. 12 fatal shooting of 70-year-old Pamela Ferriere, a Groton, N.H., resident who was a patient in the intensive care unit.
Police arrested Ferriere’s son, Travis Frink, 49, of Warwick, R.I., about two hours after the shooting. Frink was in his car near the hospital campus at the intersection of Lahaye Drive and Mount Support Road. Frink has pleaded not guilty to charges of both first- and second-degree murder, and is being held without bail.
The shooting interrupted some services at the medical center. Hundreds of patients and workers were evacuated; the hospital’s emergency department stopped accepting patients for several hours; transfers to and from other facilities and meals were delayed; and many appointments had to be rescheduled.
The shooting, which in hospital lingo is known as a “code silver,” created confusion for people who either didn’t receive an alert from the hospital, or did get the alert and didn’t know what to do.
In a group interview last week, Goins, hospital Director of Security Dan Dahmen and Emergency Management Coordinator Jim Alexander all said that while they were generally “pleased” with the hospital’s response to the shooting, there was room for improvement in three areas–security, communication and training.
The areas were identified in consultation with Lebanon Police, with hospital employees, and in a peer review conducted by officials from Boston-based Massachusetts General Hospital and Brigham and Women’s Hospital, which both have experienced shootings.
Security upgrades
One of the more visible changes since the shooting is that a security guard is now posted in the waiting room outside the ICU. The guard answers visitors’ questions, makes sure they have passes and that they are allowed into patients’ rooms at appropriate times, Goins said.
The hospital also contracted with the Lebanon Police Department to provide coverage in the emergency department until early December, when DHMC hired more security staff.
In total, over the past year, DHMC has added about five full-time positions to its security force, bringing the force up to 28 total positions, Dahmen said. But the additions were not directly related to the shooting and were more about accommodating the needs of the new Jack Byrne Center for Palliative & Hospice Care, as well as providing adequate coverage in the hospital’s emergency department.
Dahmen said the shooting prompted the hospital to re-evaluate where and how it uses its security force. One parking officer has been redesignated a security officer, and the force’s patrol routes have changed to improve its visibility in “high-profile areas,” he said.
Dahmen said he also has ordered bullet-proof vests for the protection of the hospital’s security guards, should they find themselves in a similar situation in the future, where they are helping law enforcement officers navigate the maze-like facility.
Other recent and ongoing equipment upgrades, not related to the shooting, include moving from analog to digital security cameras, adding remote door-locking capabilities for security staff and giving providers the means to lock down their own units from the inside at the push of a button.
Goins noted that Frink was identified through video footage.
Goins said the hospital is investing a total of more than $400,000 in security upgrades in the fiscal year ending June 30. “There’s always competing demands for capital,” he said. “Security takes a high priority.”
Changing ‘Run’ to ‘Avoid’
Other changes, many of which were in the works prior to the shooting, likely have been less noticeable to patients and visitors. They include updating instructions and training for responding to emergencies, and changing the term “code silver” to “active shooter.”
One of the most significant changes to the hospital’s emergency preparedness guidelines and training sessions is that rather than advise people to run when they learn an active shooter is present, hospital officials are now directing people to avoid the situation, which might mean sheltering in place rather than evacuating the building, Goins said.
The recommendation for hospitals nationally “is run, hide, fight for that kind of situation,” Goins said. But, “having 10,000 people respond (by evacuating) is problematic unto itself.”
Should an active shooting incident occur again, the hospital will direct those who are not in the affected area to stay where they are.
“We have to be very careful not to separate caregivers from patients who need care,” Goins said.
Inpatient areas, operating rooms and procedure areas were not evacuated in response to the September shooting, hospital spokesman Rick Adams wrote in an email on Wednesday.
“Cases that were in progress during the event continued,” he wrote.
But some caregivers, who were not in the middle of providing care and were in other areas of the hospital such as the cafeteria, left the building during the evacuation, Adams wrote.
By evacuating the building, these caregivers may have been prevented “from returning, or reporting to, designated patient areas and seeing other patients.”
Overall, patient care was not compromised, hospital officials said in interviews shortly after the shooting. Chief Clinical Officer Ed Merrens, in a news conference the day after the shooting, described the effect of the shooting as “a stutter step for us from a clinical standpoint, but everyone got great care.”
Though he said providers maintained a high quality of care, Merrens noted at the time that one area of frustration from a clinical standpoint was the time it took for law enforcement officers to search the building, clearing the way for staff to re-enter following Frink’s arrest.
Lebanon Police Chief Richard Mello, in a phone interview last week, said his department has been working with the hospital to develop a plan to prioritize sweeping certain parts of the building before others should another incident occur.
Mello said his department is working with the hospital to develop maps more suited to the department’s needs than the mechanical/engineering maps officers had available to them in September.
The difference is that mechanical maps emphasize water, sewer, heating and cooling systems, whereas the police are more interested in knowing where doors and closets are located, Mello said.
Maps are examples of issues “you don’t necessarily think of unless you have to live through (an emergency),” Mello said.
Another area of focus since the shooting has been improving communication in emergency situations, said Adams, who served on the emergency response team. Since the shooting, the hospital has been encouraging employees to sign up for the alert system, which includes texts and messages sent to various devices through the Alertus app.
One major change has been to give Dartmouth College employees access to notifications from DHMC via the Alertus app, Adams said. Several Dartmouth College employees who were working on the hospital campus at the time of the shooting said afterward that they were confused about what they should do and they did not receive the same alerts that hospital employees did.
Opting out of firearms
The hospital has opted out of other, more drastic measures, such as arming security guards or installing metal detectors at entrances.
Officials said they feel no need to arm their security force because the Lebanon Police Department and officers from other neighboring communities respond to the hospital grounds so quickly. And, they said, metal detectors, though sometimes useful in the emergency departments of hospitals in cities such as Chicago and Detroit, where gang violence is a problem, can delay patients from getting care and are not always effective.
Dahmen said he reviews annually the question of whether to arm the security force.
Instead of firearms, the security force is equipped with non-lethal methods of force, and trained in de-escalation techniques and take-downs, Goins said.
Armed law enforcement officers arrived on the scene within minutes of the 911 call, Alexander said. Within five minutes, he said there were three to five police officers in the building and within 20 there were as many as 25 officers on the scene.
No hospital in New Hampshire has a commissioned force, Alexander said, noting that the state police provide coverage at the state-operated New Hampshire Hospital. The federally funded White River Junction VA Medical Center, in Vermont, does have its own police force.
Alexander, a former Lebanon police chief, said that in rejecting the idea of installing metal detectors, hospital officials considered “what type of community do we want to be.”
Adding metal detectors is expensive and not always effective, he said.
“What do you really get for the money spent?” he said. Instead, he said, “Good training goes a long way.”
Should DHMC security guards encounter a need to use a metal detector for a specific purpose, the hospital has handheld detectors available, Dahmen said.
Healing
Hospital officials are currently taking a break from live active shooter trainings out of sensitivity to those who are still recovering from the trauma of the event, Goins said.
The shooting itself was witnessed by at least one member of the hospital’s staff, a nurse, who had been caring for Ferriere during her stay.
“Before the event, we would literally walk around and say we’re having an active shooter drill,” Goins said. “I’m a little more sensitive to that now. I don’t want to go around and say, ‘bang, bang.’ ”
Emotionally, people who were close to the incident are still healing, Adams said.
“It takes a long time for an institution to fully recover,” he said.
DHMC officials plan to share what they’ve learned with others in the D-H system, which in the Upper Valley includes New London Hospital, Mt. Ascutney Hospital and Health Center in Windsor and Alice Peck Day Memorial Hospital in Lebanon, and beyond.
“Most institutions haven’t gone through what we’ve gone through,” Goins said.
