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Fake doc roams Boston hospital

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March 9, 2017

Incident at hospital where surgeon was killed renews security debate

When a man upset over the death of his mother walked into a Boston hospital in January 2015 and killed the doctor who had treated her, it sent shockwaves through the healthcare safety community as an important lesson was learned about how susceptible hospitals are to security breaches.

Or so we thought, until a woman was discovered in September 2015 wandering through a Boston hospital posing as a doctor.

In the earlier particular case, Stephen Pasceri, 55, of Millbury, Massachusetts, walked into the Carl J. and Ruth Shapiro Cardiovascular Center at Brigham and Women’s Hospital on January 20, 2015, and specifically asked for the doctor, Michael J. Davidson. When the two stepped into an exam room to speak, colleagues reported hearing loud voices and then two shots fired as Pasceri shot and killed Davidson and them himself.

The shooting spurred Brigham and Women’s Hospital, as well as other Boston hospitals, to conduct their own security assessments and increase drills, and it inspired others across the U.S. to consider increasing security measures such as visitor pat-downs, security patrols, and metal detectors.

It’s one thing to be able to detect and stop an intruder before they walk into the doors of a hospital and cause trouble, but what happens when the intruder not only gains access, but blends in and spends some time there—potentially even treating patients?

That scary scenario is exactly what happened to Brigham and Women’s nine months later, when it was discovered in September 2015 that a “fake doc” had for several days roamed the halls of the hospital unchallenged, dressed in scrubs, asking questions at a lecture, attending patient rounds, and observing operation—even helping transport a patient to the recovery unit, according to a February report in the Boston Globe.

So what happened? According to the Globe, Cheryl Wang, 42, and a former surgical resident who had been dismissed from a program in Mount Sinai St. Luke’s Hospital in New York City, and had been reported to New York’s state disciplinary board, somehow blended in with the circulating mass of medical personnel, slipping into restricted areas and suggesting she had connections to an attending doctor.

At some point, physicians caught on and she was escorted off the property. Meanwhile, hospital officials posted her photograph near operating rooms and alerted other hospitals in Boston. The next day, she showed up for rounds in a conference room at Massachusetts General Hospital and was told to leave. Astonishingly, when she left, she was followed by Brigham officials to Children’s Hospital Boston, where she tried to do the same thing—she was intercepted and turned away, the Globe reported.

“Ms. Wang was an observer. She did not touch, treat, or provide care to a single patient,’’ Brigham and Women’s spokesman Erin McDonough told the Globe, though security video reportedly shows that Wang gained access to five operating rooms over two days.

The fact that Wang was able to not only gain access to the hospital, but do it several times without anyone noticing and become a part of the medical treatment community raises some serious questions about hospital security. At the very least, many hospitals—city hospitals can be busy places where hundreds or thousands of people come and go—control access to patient treatment areas, operating rooms, and other sensitive areas using security features such as electronic ID badges. But these systems are not without their faults—and they are susceptible to human factors.

In this case, Wang took advantage of this busy environment, hedging her bets that she wouldn’t be noticed as an outsider among the many other doctors, nurses, and residents at the hospital every day. It’s called “tailgating,” a problem that security experts have warned against for years. In this practice, hospital staff hold ID badges against the electronic card reader to gain access to surgery suites, and then groups of people hold the door for one another, not questioning that someone dressed in the same medical garb might not belong there.

According to the Globe article, Wang regularly was seen following fellow employees during shift changes, and was able to sneak into sensitive areas.

“This individual looked and acted like she belonged in our institution. She was wearing our scrubs, knew her way around, understood the hospital culture and terminology, and was familiar with people’s names,’’ McDonough told the Globe in a written statement. “Because of this, we let our guard down. We know that in addition to best practice security measures, the safety and security of our hospital requires the vigilance of everyone who works here. All involved are fully committed to providing a secure [operating room] for our patients and staff.”

For its part, Brigham and Women’s Hospital seems intent on not allowing a repeat incident, and officials have reassessed the facility’s security protocols, according to the Globe. The hospital has changed protocols for allowing observers into operating rooms, and physicians sponsoring a visitor are now required to verify with a student’s educational institution that the student “is in good standing,’’ which is apparently something they never did with Wang. In fact, the report said that Wang was able to forge recommendation letters that helped her win permission to shadow a Brigham surgeon for two days in September. She was apparently able to return several months later in scrubs with the hospital’s logo that she reportedly obtained during her September visit.

What are hospitals doing?

Obviously, the problem of intruders (even those that seem to be legally there) getting into hospitals is a perennial problem, and healthcare safety officials are constantly grappling with the debate of just how secure hospitals should be. On the one hand, hospitals are supposed to be healing places where sick and injured people come to get better, so security officials (and administrators) are hesitant to install too many deterrents that will make the facility seem unfriendly.

At the same time, an increasing number of violent incidents and intruders in hospitals have left facilities scratching their heads trying to come up with the perfect mix of security measures that could help keep the same problem from happening as did at Brigham and Women’s.

As an example, let’s look at some of the measures that Parrish Medical Center in Titusville, Florida, took after an armed man entered the hospital on July 17, 2016 and shot and killed patient Cynthia Zingsheim, 92, and healthcare aide Carrie Rouzer, 36, for no apparent reason. The facility now maintains a law enforcement presence and enhanced security at public entrances, restricts public access to the main entrance and emergency department by requesting identification, and conducts random bag checks.

Security officers are now armed with additional protective equipment and gear and are receiving more training. The health system also is considering installing metal detectors and other equipment to identify prohibited items.

In addition, law enforcement officials say the hospital’s active shooter plan, and brave security guards who confronted and held the assailant until police arrived, were two of the major factors that helped keep the incident from escalating to a worse mass shooting.

The ID badge that helped Wang get into Brigham and Women’s has grown from being just a piece of identification, and is increasingly being used as a security tool in hospitals. With encrypted electronic chips, GPS, and proximity sensor technology becoming increasingly reliable and affordable, hospitals are looking for ways to cut down on the number of badges that staff need to carry. An all-in-one solution allows staff members not only to identify themselves, but also to swipe in for their shifts, pay for meals through a debit card system, gain access to restricted areas, and provide security personnel with an electronic “footprint” to track where in the hospital they have been, if needed—a feature that may have been helpful to track Wang in her comings and goings at the hospital.




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