BY THE NUMBERS
Police responses to hospitals in the Chattanooga region in 2011:
Erlanger hospital -- 370 reports
Memorial hospital -- 330 reports
Memorial Northpark hospital -- 157 reports
Parkridge hospital -- 213 reports
*Chattanooga numbers show every time police were called to the hospital, not just incidents at the hospital
Erlanger at Hutcheson -- 11 reports
Hamilton Medical Center -- 61 reports
Source: Police departments
Hospitals -- long considered places of healing -- have experienced an increase in violent crimes in the last decade.
In the last five years, nearly three times as many assaults, rapes and homicides at hospitals were reported to the national hospital accreditation organization than in the previous five years.
"There was that day when hospitals were safe havens but what we've seen in the past eight or 10 years is that has shifted," said George Mills, director of engineering at the Joint Commission, which accredits more than 19,000 hospitals nationally. "People will now go to hospitals to finish whatever [crimes] may have started somewhere else. Hospitals have more lock-down situations."
Police responded hundreds of times to local medical centers in 2011, records show. That included responses to incidents at the hospitals as well as calls related to crime victims or suspects brought in for treatment.
Local hospitals said they are reviewing their security and response to violent crimes after a shooting in a local intensive care waiting room left two people dead on Jan. 6.
James Benson, 59, has been charged with two counts of felony murder after authorities say he walked into Erlanger at Hutcheson, a Fort Oglethorpe hospital, and killed his estranged wife, 56-year-old Mary Sue, and his mother-in-law, Charlotte Johnson, 77.
Hutcheson had relied on in-house unarmed security guards, but since the shooting, officials have contracted with Walden Security to provide armed guards.
Out of security departments for the five area hospitals -- Erlanger Health System, Memorial Health System, Parkridge Health System, Erlanger at Hutcheson and Hamilton Medical Center in Dalton, Ga. -- four declined to be interviewed for this story and provided a statement instead.
"Every hospital across the country is probably reviewing their security this morning," Gregg Gentry, head of Erlanger Health System's human resources department, said Monday after the shooting. "As these situations happen, it makes us pause and think through everything. It is our goal to provide the safest environment for our staff, patients and visitors."
Hospitals provide a unique set of safety challenges to security personnel -- gang shooting victims arrive at trauma units, domestic spats end up in emergency rooms and estranged family members meet in visits to hospitalized family members.
"Hospitals are literally a powder keg," said Bryan Warren, director of the International Association for Healthcare Security and Safety. "They are open 24 hours a day, seven days a week, 365 days a year. It can be a very emotional place."
Police respond to area hospitals for disturbances that range from shootings and assaults to disorderly conduct and drunkenness, incident reports show.
Nationally, the Bureau of Labor reported 91 homicides and 145 violent acts at health care facilities from 2007 to 2010. The previous four years were lower with 80 homicides and 126 violent acts.
The Joint Commission reported an even more dramatic increase with 177 assaults, rapes and homicides at hospitals in the last five years, compared with 61 cases in the previous five years.
Experts said numbers are probably much higher because many crimes go unreported.
Warren, whose agency works with hospitals to assess risks and implement security measures, said hospitals have to play a balancing act of providing access to patients and visitors while maintaining a safe environment.
Security risks also vary widely from hospital to hospital, depending if the hospital is a small rural hospital or a large urban facility that routinely cares for patients involved in gang incidents, he said.
Since 9/11, many public places have had tightened security and increased use of metal detectors.
Hospitals also have made changes, but most rely primarily on security guards and cameras to monitor their premises.
Other high-traffic facilities such as the Hamilton County Courthouse took a more drastic approach by closing off the main entrance and placing metal detectors at the two other public entrances, said Sheriff's Deputy Chief Ron Parson.
SECURITY IN LOCAL HOSPITALS
Local hospitals have more than 10,000 employees and thousands more patients and visitors on their campuses throughout the year, making them some of the most heavily trafficked places in Chattanooga.
"It's just like a little city. A little bit of anything can come in the door at any time," said Glen Johnson, who has headed Memorial's security since 1994. Out of the five area hospitals, Johnson was the only security director to agree to an interview.
Area hospitals use a mix of security measures to police their premises -- Memorial uses unarmed in-house security guards, while both Erlanger and Parkridge have contracts with Walden Security, which provides armed guards.
"We are constantly shifting staff to areas where we feel the need is greatest," Erlanger's Debbie Shepherd wrote in an email. "We do have to balance the need for public safety and an overly restrictive security system."
Hamilton Medical Center employs 14 armed security officers, who are trained for defensive weapons twice a year, said hospital spokesman Daryl Cole in an email.
But hospital officials declined to say if their security had changed since a shooting in the parking lot in December.
A 24-year-old patient, Andrew Desimone, sneaked from his hospital room to the parking lot on Dec. 18 and shot Kevin Bradford, who was visiting a relative, Dalton police reported. Desimone escaped, and police later found him at his home and arrested him on aggravated assault charges.
After last week's shooting at Hutcheson, officials said they will spend time to assess the incident.
"We will continue to debrief from last week's tragic events and review our security program and protocols," Hutcheson's administrator, Debbie Reeves, said in an emailed statement.
Memorial depends on guards, security cameras and a close relationship with the police department to provide security, Johnson said.
"You have to be really proactive; we monitor for any trends," Johnson said.
Experts said there are no national standards for hospital security or federal laws that dictate uniform security measures.
However, the Joint Commission assesses security as part of its credentialing process, which begins with a review of the hospital's security policies and procedures, Mills said.
After looking at the security management plan, the organization checks to see whether the hospital is implementing those policies.
"We go out and survey the building," Mills said. "If the hospital says they challenge people who come into the emergency room, we walk into the emergency room to see if that is actually happening."
The Joint Commission released a study of violence in the health care setting in June 2010 that noted several factors contributing to the problem.
Leadership issues, particularly in areas of policy and procedure, were noted in 62 percent of the events. An increased need for staff education and other human resources-related factors were found in 60 percent of the events, the study noted.
The International Association for Healthcare Security and Safety emphasizes security is everyone's responsibility, Warren said. It provides security education for all employees, from volunteers working the gift shop to doctors, he said.
"You have to get everyone involved to increase that collaborative environment," he said.
The Joint Commission continues to look at security but has not made major changes in how it assesses security in recent years, Mills said.
Compared to hospital security in 1994 when he first took over, Johnson said hospital security has seen drastic changes and improvements.
"There is no comparison with what we have in place now," Johnson said.
Technology has helped hospitals to provide much better security, with the ability quickly to lock down sections of the hospital or monitor visitors, he said.
The primary defense is public and employee awareness, Warren said.
"Anything can happen anywhere. We need to get out of the mindset that if it hasn't happened yet, it won't," he said.