In settings where employees are entirely focused on providing care, ensuring that patients, visitors and employees alike are safe is of paramount importance. Unfortunately, incidents of violence can occur, and health care providers need to consider how to mitigate and manage these risks.
Let’s consider a potential scenario. A couple has been arguing loudly all afternoon about the purchase of a new sports car when the husband doubles over in pain. The wife calls 911 and the police and an ambulance arrive on the scene. Police take brief statements from the couple about the day’s events and after a quick evaluation, the paramedics take the man to the ED. His wife and a close friend meet him at the emergency room and another argument ensues. In the exam room, the wife takes a scalpel from a nearby treatment table and threatens her husband if he says another word. The friend and a nurse immediately leap to intervene and in the process of taking away the scalpel, they receive cuts to their hands and wrists.
From the relatively minor to the very severe, violent incidents within health care settings are unfortunately not so rare.
In insurance terms, by definition, the scenario above is a deadly weapons incident and while identification of the victim(s) may seem easy, it often is not. Victims may include everyone from the hospital itself to the actual injured as well as witnesses. For those in charge of a health care facility, understanding where insurance can indemnify the cost and which factors might cause claim expenses to be denied or excluded should be carefully considered.
In the recent past, general liability and terrorism coverage would be the closest policy types for this incident. With that coverage, the risk manager may have met with their broker and carrier and discovered that policy exclusions prevent payment and support for this type of incident. General liability coverage often includes “foreseeable events” as grounds for exclusion. In the scenario above, the carrier could argue that based on police records and statements from the scene, the action taken by the wife was a “foreseeable event” and the hospital ED should have been better prepared and taken precautions.
Unfortunately, the scenario above is relatively minor compared to many of the actual incidents on record that affect both employees and patients in health care. According to Gunviolencearchive.org there were 55,254 incidents of gun violence in the United States in 2018, meaning that on an average day, a gun related incident occurred every nine minutes. But gun violence is not the only threat, so insurance carriers have begun to expand the definition of deadly weapons and design coverages to cover a wide variety of risks, as well as risk management and crisis response services to provide support before, during and following an incident.
Considering the above scenario once again, should the friend acting as a ‘good Samaritan’ decide to sue the hospital for failing to provide a safe environment for visitors, these newer forms of specialist liability insurance would prove effective.
Some carrier policies in the market have done an excellent job covering the needs of the individuals involved in an incident. Health care organizations should ensure any active shooter (deadly weapons) policy under review has broad risk definitions and broad coverage. As an example, consider the following when speaking to your broker:
- A broad definition of a weapon. This should include guns, knives, vehicles, grenades, scalpels, needles and syringes, medical equipment, acids, chemicals and more.
- A clear understanding of what triggers the policy. Is it triggered by the “brandishing of a weapon,” whether it is used in the incident or not? Eliminate requirements regarding motivation or “intent” — this should not be a consideration in the policy.
- A focus on prevention. The policy should include a security vulnerability assessment, an analysis of security protocols and a risk report. Your teams should be trained on active shooter awareness, scenario-based exercises, creating an incident response plan and training for people on what to expect and how to react.
- A crisis response plan. These are often traumatic events for the people involved. Personal safety comes into question and these situations need to be managed quickly and professionally. You might need immediate crisis response services to help everyone involved. For example, in the “fog” during and after the crisis, leaders need to know what steps to take, witnesses and victims may need counseling, public relations may need to manage the media, provision of legal coaching and support to help you engage families and victims, an employee may need the assistance of a family member with travel costs required, you might need temporary security services to provide site support and you will want a post-event investigation.
- A section on limitations. Your policy might cover specific limits for medical injuries, disability and funeral costs, business interruption and property damage.
The trouble with reasonably foreseeable events is that they often aren’t. We believe there has been significant improvement in coverage design and overall policy costs to warrant a review of this coverage for any health system. A worthy line of coverage to consider is a policy that covers prevention, high quality crisis management and intervention for all involved and the right mix of cost indemnification for your organization.
About the author. Mark Stenmark serves as the national property and casualty (P&C) leader for Vizient Insurance Services. He is responsible for strategy, product development, sales, marketing, P&L, contract negotiation and the maintenance of multi-year B2B relationships with national insurance carriers and P&C broker partners. In his nearly 20 years with the company, Stenmark also held regional and national positions in market management, business development, sales operations and purchased services.