Hospital security guards increasingly using force against Vancouver patients, raising questions of care

This project was produced in partnership with Cited Podcast with the assistance of Cited's Sam Fenn and Gordon Katic. Listen to a related audio documentary.

Early last October, Nicholas Ellan was admitted to Vancouver General Hospital as a psychiatric patient. A family member had expressed concern for him and contacted authorities.

“A VPD officer and a psych nurse came to my residence, knocked on my door, and told me that they had a warrant to bring me in under the [B.C.] Mental Health Act,” Ellan said in an interview at the Georgia Straight. “And I cooperated.”

Ellan, a community organizer in the Downtown Eastside, ended up spending 17 days under psychiatric care at VGH. “It got strange,” he said. There was a case of mistaken identity, Ellan said he later learned, where VGH staff believed he was a problematic patient who in the past had acted violently toward staff. He recounted several interactions with private security guards employed by VGH. One of those interactions ended with him forcibly taken to the floor, restrained, and administered a sedative that rendered him unconscious.

Ellan does not fault the private security guards employed by Vancouver hospitals (who are provided by Paladin Security Group Ltd., one of the largest security firms in the province). “I can be a loud person,” he said. “I’m tall, over six feet. I’m male, and I’m in my thirties….It’s understandable that they would go to security immediately once I get agitated, visibly agitated. It didn’t make sense to me at the time but, reflecting upon it, I kind of understand.”

Ellan’s complaints concern how the care he received changed after that encounter.

“A nurse would start shift, order me to get into pajamas because it was eight o’clock, and then threaten to call security if I didn’t change immediately,” he explained. “There were a lot of situations where the immediate response was to call security.

“They would rely on the constant presence or the threat of the constant presence of security, and physical force, to maintain order in the ward,” Ellan continued. “It was always understood, or very quickly understood, that if a nurse told you to do something and you didn’t comply, then the end of the road was always sedation and solitary confinement.

“It was a claustrophobic experience,” he concluded. “It was a situation where you are coerced into disciplining yourself.”

A steady rise in incidents

On November 11, the Straight reported that health-care professionals working in Vancouver hospitals are facing violence more often in recent years. That’s only half the story.

Now we report on statistics obtained via freedom-of-information requests that reveal patients are, similarly, experiencing force used against them by hospital security guards with increasing frequency.

In B.C., when a security guard is called in response to a patient like Ellan exhibiting aggression, they’re instructed to create a report in what’s called the Integrated Protection Services (IPS) system under the category of “Code White”.

At Vancouver General Hospital, the number of those reports created each year increased from 306 in 2011 to 482 in 2016 and a projected 570 in 2017.

At St. Paul’s Hospital, the same statistic rose from 349 in 2011 to 907 in 2016 and a projected 980 in 2017.

Behind every number in the data is an incident report filed by a private security guard assigned to VGH or St. Paul’s Hospital.

Through additional freedom-of-information requests (more than two dozen for this two-part series), the Straight obtained a sample of the incident reports, comprising those statistics covering a six-month period in 2016. In more than 140 pages, they detail hundreds of incidents. Some are false alarms, others are resolved without significant drama, and many make for disturbing reading.

The documents include situations where no one can dispute that a call for security was warranted.

At VGH during the first quarter of the fiscal year 2016/17, for example: “Upon arrival security found staff hands on with patient [redacted] beside the nursing station, [redacted] was actively resistant attempting to break out of staffs grasp by flailing his arms and kicking his feet. Security immediately went hands on and secured the patients arms, with staff assistance Security Officer [redacted] escorted the patient back to his room, at this point Security Officers [redacted] and [redacted] joined the call. Security then placed the patient in bed and applied four soft restraints to all limbs. [Redacted] was actively resistant throughout trying to free his arms from securitys grasp and uttering threats such as "you are all going to die". All limbs were secured and a 5^th point was applied to [redacted] chest, once done security and staff exited the room.”

Other reports recount incidents where force may have been necessary but where it was possible that verbal de-escalation could have resolved a situation.

At St. Paul’s Hospital in March 2016, for example: “The Patient was speaking on the phone when she began to escalate verbally. While on the phone the Patient began to yell angrily. S/A[redacted] began to approach the Patient, but the Patient knocked over her chair, began yelling at S/A [redacted] and struck S/A [redacted] on the left arm with a hospital phone. At this point S/A[redacted] took physical control of the Patient's right arm, with S/O [redacted] controlling the right, and assisted the Patient to prone with S/O [redacted] controlling the legs. At the direction of STAFF-OTHER, Security stood the Patient up and physically escorted the Patient to her QR to then assist her to prone position again.”

A third incident, which was logged at VGH as occurring in “Q1 2016/17”, describes an interaction closer to the sort of borderline-coercion that Ellan alleged.

“Security arrived on scene and were informed by Registered Nurse [redacted] that [redacted] needed to take medication and that no aggression had occured as of yet. Security asked Staff what had prompted them to call a Code White and Staff informed them that the patient "looked like he might get upset". Staff had not yet entered PT [redacted] room or attempted to interact with him. Staff and Security then entered PT [redacted] room where he was sitting in a chair by the window and spoke with him, asking him if he would consent to taking medication. PT [redacted] was non‐compliant and began to swear at staff, telling them to "fuck off". Staff and Security both attempted to de‐escalate him and he then threatened to sue staff members. At this point, Staff informed him that while he was [redacted] he was obliged to take medication and informed him that he could choose between taking oral medication and IM medication. PT [redacted] chose to take oral medication and after he had finished, Staff and Security exited his room.”

Presented with these statistics, Vancouver General Hospital’s operator, Vancouver Coastal Health, declined to grant an interview. It referred questions to Providence Health Care, a partner that operates St. Paul’s Hospital.

Elaine Yong, a spokesperson for Providence Health Care, maintained that the increase is largely the result of changes in reporting practices and better staff compliance to incident-reporting standards. Yong also called attention to hospital programs designed to create friendly interactions between patients and security. For example, she compared security guards' “Client Service Ambassador” program to Wal-Mart’s “Greeter” program, where employees stand at the front of a store to welcome customers.

Unintended and counterproductive results

In part one in this series, the B.C. Nurses’ Union and other stakeholders highlighted violent actions against hospital staff as a growing concern. Interviewed for part two, Michael Anhorn, executive director of the Vancouver-Fraser branch of the Canadian Mental Health Association (CMHA), emphasized that a person with a mental-health issue is statistically more likely to be the victim of a violent incident than they are to commit one.

However, after reviewing the statistics obtained by the Straight, Anhorn said the sharp increases evident there are part of a complicated picture wherein good things are happening too.

“Previously, these events probably occurred in jails or in police stations,” he explained. “Now we are increasingly making sure that a mental-health crisis is attached to the health-care system and not the criminal-justice system.”

There’s data to support that suggestion. In recent years, Vancouver police officers brought increasing numbers of mental-health patients to the city’s hospitals. In 2010, there were 2,276 VPD apprehensions under Section 28 of the B.C. Mental Health Act, which allows an officer to take an individual into police custody if they are deemed a threat to themselves or others. The number grew each year until 2015, when it hit 3,050. (Since then, it’s been on a downward trend, projected to hit 2,754 in 2017.)

Anhorn said that as this transition continues, one challenge for government is to avoid transposing the harsh security conditions of a prison system while still ensuring hospital staff work in the safest conditions possible.

“One of my concerns is that in moving these kinds of crises into the health-care system that we not just re-create a criminal-justice-type system within the health-care system,” he emphasized.

If patients are separated from care professionals via security guards and physical barriers, the less effective that care is likely to be, Anhorn said.

“One of the main drivers of mental health is social connection. If we isolate people, their mental health is going to suffer.”

Thomas Kerr is associate director of the B.C. Centre on Substance Use and has published papers examining the roles of security in social services. In a telephone interview, he warned that added safety measures can have unintended consequences that are counterproductive.

“The presence of security guards can create hostile conditions which actually prompt escalations,” Kerr told the Straight. “I don’t want to take anything away from security guards, but these are not mental-health professionals. And it can be very, very challenging de-escalating somebody who is unwell and in a hospital environment.

“It raises questions about who should really be dealing with these people,” Kerr added, “and if there’s anything that security guards themselves are doing to potentially contribute to this problem.”

This article is part two in a series. It has explored an increase in physical force used by hospital security guards against patients. Part one examined similar trends in patients’ aggressive behavior directed toward health-care staff.

This project was produced in partnership with Cited Podcast with the assistance of Cited's Sam Fenn and Gordon Katic. Listen to a related audio documentary.