Area hospitals and law enforcement work together to combat the unknown

For those who work in health care and law enforcement, preparing for worst-case scenarios-no matter how unlikely-is a part of the job. How to address potentially volatile situations with combative patients or active threats to hospital safety are two areas where collaboration among those groups occurs.

Three weeks have passed since tragedy struck the small, close-knit town of Aitkin, where Sheriff's Investigator Steven Martin Sandberg lived and worked.

Sandberg, 60, was shot and killed Oct. 18 by a suspect receiving treatment at St. Cloud Hospital, according to the Minnesota Bureau of Criminal Apprehension.

Sandberg was guarding the suspect, Danny Leroy Hammond, 50, of rural Aitkin, in a hospital room.

About 5:15 a.m., Hammond got out of his bed and started an altercation with Sandberg, the BCA reported, during which he took Sandberg's gun and shot him.

A hospital guard then entered the room and used a Taser to subdue Hammond, who shortly after suffered a "medical emergency" and died, according to the BCA, which did not provide further information on Hammond's death.

Before the deaths of Sandberg and Hammond last month, area hospitals were already in the process of establishing and refining policies for emergency response to acts of violence. The 2015 Legislature passed a law requiring hospitals design plans as part of their licensing requirements. The law also provided funding to the Minnesota Department of Health to offer training and resources to healthcare providers in violence prevention.

Law enforcement in the Brainerd lakes area agreed they have a great partnership with area hospitals on hospital security. They conduct trainings and work closely together to address workplace violence and active threats.

Sheriffs and police chiefs said every scenario is different and they cannot predict what a soon-to-be-arrested suspect or inmate might do while receiving treatment in the hospital.

Crosby Police Chief Kim Coughlin said oftentimes officers arrest a suspect before they are hospitalized, so the suspect is monitored by law enforcement while they are being treated.

"There are just so many situations out there, and the biggest thing is a lot of times we just don't know how they're going to react," Coughlin said. "It all depends on what kind of drugs or alcohol are on board, which is often the case, or what kind of mental health issues there are or what kind of medical needs there are. It could be anything from a traffic accident where we have to take them to take blood or an assault. ... There are such a wide variety of things and the situation with Deputy Sandberg is a rare occurrence."

At Cuyuna Regional Medical Center in Crosby, staff has gone back and reviewed policies in light of the incident in St. Cloud. Tom Bausman, hospital emergency manager, said they are engaging "all the front line staff and law enforcement in the process of looking at it."

"Things are just changing and I'm not sure why," Bausman said. "I think everybody is looking hard and doing all the training they can to try and make sure we keep our patients and our visitors safe here in the hospital."

Bausman said they work closely with Crosby police on potentially dangerous patients and those in police custody. He said they had a situation recently that called for police protection and it worked well.

"Two of the Crosby police officers were here the entire time," Bausman said. "One officer was in the room with the patient, and one was in the hallway."

Coughlin said if a suspect is being hospitalized on a misdemeanor charge of disorderly conduct and is combative, officers would guard the suspect. However, if this same person has calmed down and will be cited for disorderly conduct, officers may not guard them.

Coughlin said the hospital has soft restraints for inmates and those recently arrested, and police have handcuffs, but it all depends on how serious the medical issue is on what type of restraint is used if any.

"It is all situation-dependent on the restraints," Coughlin said. "The biggest thing is no matter where we are at, whether it be at a hospital or the Holiday station or a restaurant, things can happen at any time and we have to be vigilant of that."

Active threat training is already in place at CRMC, Bausman said. Staff recently went through 3-Echo training, which is a program addressing how people should respond in the event of an active shooter.

"In that situation, whoever first identifies or sees the danger, we make sure they stay safe and ensure the safety of the patients and bystanders in the area or visitors," Bausman said. "The next step is to notify the rest of the hospital."

Bausman said this initiates lockdown procedures, including doors locking between areas of the hospital and the securing of entrances and exits.

Crow Wing Sheriff Todd Dahl said his office is in charge of all the inmates in custody who go to Essentia Health-St. Joseph's Medical Center in Brainerd, as well as any suspects they arrest or will arrest in the county's jurisdiction.

"It all depends on the severity of the issue," Dahl said of how they guard inmates at the hospital. "It all depends on whether or not they are a flight risk, depends on whether they have violent tendencies, things along that line. We'd go over this in our office and stay with them for the time they are being seen by a doctor or whether they will be guarded on a 24-hour basis."

Miranda Anderson, marketing director for Essentia Health- St. Joseph's Medical Center, said the hospital and clinics have an emergency preparedness committee that meets quarterly to review policies, implement drills and prepare disaster plans.

"Representatives throughout the hospital, clinics and outside agencies including law enforcement are a part of this group," Anderson wrote in an email. "Also, Essentia Health representatives participate on the Crow Wing County Emergency Management and Public Health Advisory Committee.

"In addition to these formal, proactive settings, Essentia Health has a strong relationship with local law enforcement who are responsive to our needs when their presence is requested to support our security staff to protect the safety of patients, their families and our staff."

Dahl said the sheriff's office works well with other law enforcement in the area and the state. He said there have been a few instances when the sheriff's office has asked for help from area police departments with guarding at the hospital. Crow Wing County also works with sheriff's offices around the state on guarding patients.

For instance, Dahl said, if a person has a Crow Wing County warrant, is apprehended in Stearns County and has to go to the hospital, the agencies work together to decide which agency guards the person.

"We work together trying to get things done," Dahl said. "We err on the side of caution. We certainly don't want to drop an inmate off in our custody without a guard and then for that inmate to pose some problems at the hospital. That is not what hospital staff is there for. Their job is to provide treatment and we are there to provide containment and we certainly don't want anyone else hurt."

Baxter Police Chief Jim Exsted said if the suspect has been arrested, but not booked into the jail, it would be the police department's responsibility to guard them should they need medical care.

"Every time we make an arrest we have the ability to decide if they go to jail or not, so there is discretion on the front end," Exsted said. "There are so many factors that come into play on when an individual needs medical care. We simply need to look at each individual case and the seriousness of it and determine the best protocol in the best interest of public safety."

Exsted said there's been only a handful of times over the last 20 years where officers have had to accompany somebody to the hospital for a period of time.

Cass County Sheriff Tom Burch said the sheriff's office works with several hospitals, including hospitals in Bemidji, Grand Rapids, Cass Lake and in Duluth. Burch said, like Crow Wing, they are responsible for their own inmates. Burch said they will guard all their inmates at the hospital when they are receiving medical care. Burch said the sheriff's office may contract with security staff at the hospital or other agencies to guard an inmate when they can't.

If a suspect is going to be arrested and put in jail but needs medical attention, the hospitals generally want the sheriff's office to guard them, Burch added.

For more serious crimes or for the ones who may be a flight risk, Burch said the sheriff's office will guard the individual, regardless. If a person is wanted for a simple misdemeanor warrant, hospital staff typically takes care of them and will call the sheriff's office when the person would be released.

When asked if the sheriff's office will do anything different after the incident with Deputy Sandberg, Burch said, it wouldn't. "In this type of business we are in, people could be harmed or lose their lives, it's extremely important that we stay very conscience of our surroundings, keep our training up and to never be complacent.

"Unfortunately, it takes a terrible thing like what has happened to remind us of that and that is why we train year after year and learn the defensive tactics that keep us sharp to avoid these things. I'm not saying anything went wrong with the instance with Deputy Sandberg, it's just no matter how well prepared you are, it can happen and it's a bad thing."

Training is constant for hospitals and law enforcement to stay on top of things, as well as keeping up with Minnesota state laws.

Jane Smalley, the risk, safety and quality manager at St. Gabriel's Hospital in Little Falls, said the hospital is bolstering policies it currently has in place to comply with the new law, which corresponds with an initiative by the Minnesota Hospital Association. This includes completing a gap analysis, which examines current security procedures and seeks to identify potential weaknesses that must be addressed.

"We already have a violence management policy that says we don't tolerate things and what staff can do once things like that happen," Smalley said. "We're going to require basic education on workplace violence every year for all staff who work here. We're going to try to do extra education in person ... for the ones that this group (workplace violence committee) will identify as 'high risk.'"

Smalley said this would likely include those who work in the emergency department and those with first access to patients and visitors, such as registration and switchboard workers.

Prior to the incident in St. Cloud, Smalley said the hospital already had an active shooter drill planned with law enforcement that was conducted in late October. In the case of such an occurrence, Smalley said staff are able to control access to the building and most patient care areas are badge controlled.

"We've tried to do that kind of security as much as we can," Smalley said. "There's been an increase in violence everywhere, and in our own facility, we've seen things escalating over the last couple of years. I used to think 'if,' and the last few years I've been thinking 'when' a shooting happens or when a nurse or someone is injured by a patient. It's just a matter of when."

Jayne Anderson, director of quality at Riverwood Healthcare Center in Aitkin, said the hospital has a very good relationship with both the Aitkin County Sheriff's Department and the Aitkin Police Department.

"We do not have in-house security," Anderson said. "Our policy is that you dial 911. The response time to Riverwood is incredibly fast."

Anderson said the hospital works with both departments on training staff on how to de-escalate combative patients. Restraints are an option, Anderson said, although the hospital's preference is to deal with the situation in other ways.

"That's a hard one to say 'yes' to every time," Anderson said. "It just depends on the person, the situation, what our physician is feeling and with consultation with law enforcement."

JENNIFER STOCKINGER may be reached at jennifer.stockinger@brainerddispatch.com or 218-855-5851. Follow me at www.twitter.com/jennewsgirl on Twitter.

CHELSEY PERKINS may be reached at 218-855-5874 or chelsey.perkins@brainerddispatch.com . Follow on Twitter at www.twitter.com/DispatchChelsey .