The security company under contract with Greenville Memorial Hospital says its officers do not put patients in restraints and only assist medical personnel to apply them.
On March 6, three American Security guards were involved in an altercation with Donald Keith Smith that ended with Smith face-down on a gurney while in four-point restraints, authorities have said.
Smith, 48, died of traumatic asphyxiation because of his positioning on the gurney, said Coroner Parks Evans said in ruling it a homicide.
The State Law Enforcement Division is investigating.
American Security staffers do not put restraints on patients, said Michael Gardner, president of American Security’s Healthcare Division. He said that while he wasn’t at the hospital on March 6, it’s his understanding that Smith struck one of the security guards in the face and was then subdued on the bed by other guards.
A video of the incident reveals that Smith punched a security guard in the nose after a verbal exchange and is then subdued by guards who place him face down on a bed for about 10 minutes, according to a review of the video obtained by The Greenville News through the federal Freedom of Information Act.
Gardner said security officers may assist in holding the patient down, but medical personnel apply the restraints.
Greenville Hospital System contracts with American Security to provide 117 guards to supplement a GHS police force of 34 officers who all work throughout the hospital system, said Ric Ransom, a senior administrator at Greenville Memorial with oversight of the GHS Department of Public Safety. Contract guards have been used for about 20 years, he said.
Both GHS police officers and American Security guards are assigned to the ER on a permanent basis, he said. Five security guards are typically posted in the ER at any time, he said, and at least one GHS officer is stationed at the ER entrance by a public safety substation.
In addition to operating at GHS and its member hospitals, American Security is also used by Bon Secours St. Francis Health System and Baptist Easley Hospital, Gardner said. It also provides guards for other hospitals in South Carolina and the Southeast, he said, and for private businesses and residential communities, such as The Cliffs. It employs about 3,000 guards, he said.
SLED requires all security guards to receive a minimum of four hours of training, Ransom said.
The guards at GHS have an extra 32 hours of training to work in a hospital that includes customer service, interpersonal skills, aggression management and de-escalation training as well as schooling on patient privacy laws, patient rights and patrol responsibilities, Ransom said.
Gardner said that is standard in the industry, and that American Security guards are required to be certified under the International Association for Healthcare Security and Safety. In addition to SLED classes and four days of training, American Security guards also follow a syllabus from GHS’s police force, he said. The company also assigns field training officers to new guards who are supervised for a few days to learn their assignments before working on their own, he said.
Training includes de-escalation techniques to calm patients down, but doesn’t cover the use of restraints because medical personnel do that, he said.
GHS said police officers aren’t permitted to administer four-point restraints, either, only clinicians. Generally, four-point restraints means that a patient’s hands and feet are strapped to the bed. This type of restraint is typically reserved for patients who are dangerous to themselves or others.
While the guards don’t carry weapons, handcuffs or other tools of restraint on GHS property, GHS police carry both guns and Tasers, Ransom said.
The hospital system launched its own police force in 2013 because when it was served by the Greenville County Sheriff’s Office and Greenville City Police Department on a secondary employment basis, it was sometimes left without coverage when officers’ first responsibility was to their primary employer, Ransom said.
The GHS force was authorized by an act of the state Legislature, he said, and its officers were commissioned by the state to better respond to public safety needs. The officers are empowered by the state to make arrests, and like officers at other public agencies are required to undergo rigorous training prior to certification, he said.
Ransom said GHS has a process in place to investigate all complaints or incidents occurring in the hospital as part of its efforts to improve performance and patient safety.
GHS police are considered employees of the governmental public/not-for-profit arm of GHS, Ransom said. They are paid by GHS and their structure is similar to forces at colleges and other hospitals, such the Medical University of South Carolina, he said.
MUSC Health has a Department of Public Safety made up of 63 accredited police officers and 23 administrative employees, such as dispatchers, spokeswoman Heather Woolwine said.
It also has a Hospital Safety and Security team of 63 security staffers and doesn’t use contracted security. Police and security staff each of the three ERs, she said.
All are trained to work in a health-care environment, getting training in patient privacy, MUSC’s code of ethics, customer service, interpersonal skills and de-escalation tactics, she said.
The police officers carry guns, she said, but security guards don’t.
They are certified through the International Association of Healthcare Safety and Security, the governing body for health care security professionals, she said.
All security staff are also trained, certified and recertified annually in Therapeutic Alternatives in Crisis Training, which requires that “individuals should be restrained face up to prevent asphyxiation and because individuals are less likely to resist when placed in a face up position,” Woolwine said.
They’re also trained to be attentive to an individual’s indication of distress during the restraining process, she said, adding that security only restrains patients at the direction of clinical staff.
The security team also has developed a checklist regarding the use of restraints which emphasizes that proper body alignment is maintained, that individual comfort is ensured, that skin irritation is prevented, that circulatory and/or neurological impairment is prevented, and that respiratory impairment is prevented, she said.
Some hospitals have their own police forces, like GHS and MUSC, some have their own security personnel, and still others contract for security services.
AnMed Health in Anderson employs SLED-certified security personnel, but does not have its own police force because of cost and liability, spokesman Ross Norton said. They do work in the ER, he said.
Their training is consistent with IAHSS recommendations and to other timely security-related issues as they arise, he said.
AnMed doesn’t use contracted security guards, but occasionally uses contracted city or county police officers, Norton said.
Palmetto Health uses both employed and contracted security guards, said spokeswoman Tammie Epps, contracting with AlliedUniversal Security, which supplies 199 full-time equivalents, some of whom work in the ER along with employed guards.
It would take a change in law for the hospital to have a police department because that’s reserved for governmental entities, she said.
But Palmetto Health works closely with local law enforcement agencies “to ensure that we are collaborating to protect our team members, patients and visitors,” she said.
Palmetto Health guards get the same SLED training and similar other training as GHS and MUSC security, she said, including patient rights, working in behavioral care environments, and non-violent crisis intervention. Any armed guards get additional SLED firearms training and qualification, she said.
Medical staffers order restraints, she said, but guards may assist in immobilizing a patient while staff apply the restraints.
Baptist Easley Hospital uses SLED-certified American Security guards, said spokeswoman Andrea Stegall. While it doesn’t have its own police force, it calls on Easley Police or the Pickens County Sheriff’s Office when necessary.
It has three guards per shift seven days a week who rotate through three posts: the ER, the Security Satellite Office for viewing security surveillance cameras and controlling access to other parts of the hospital, and a roving/patrolling post, she said.
Baptist Easley guards undergo the same training as GHS as well as four hours of Therapeutic Alternatives in Crisis Training, which includes four-point restraint education, although they don’t apply them.
Spartanburg Regional Healthcare System employs licensed SLED-certified security guards on all four hospital campuses, said David Church, Vice President Oncology and Support Services.
They are trained per SLED regulation and Non-Violent Crisis Intervention by the Crisis Prevention Institute, which includes the proper and safe use of seclusion, restraint applications and techniques, and alternative methods for handling behavior, symptoms and situations, he said.
Spartanburg Regional follows CMS guidelines, which requires violent situations to be handled as criminal activity with the perpetrator being turned over to local law enforcement, he said.
St. Francis could not be reached for comment.