Transfer of Guantanamo Detainees Should Prompt Review of Prisoner Patient Policies

Scott Wallask, for HealthLeaders Media , June 16, 2009

Announced plans to move military detainees from Guantanamo Bay to the United States to face trial could have lingering effects on hospital security departments.

And in the broader picture, the concern is not just about Guantanamo detainees—it's about all high-value prisoners who might show up in your emergency room.

"I think it would serve [hospital executives] well to take a real look at what they've committed to" in terms of treating prisoner patients, says James Blair, FACHE, president and CEO of the Center for HealthCare Emergency Readiness based in Nashville.

First detainee arrives on U.S. soil

On June 9, Ahmed Khalfan Ghailani, a detainee from the U.S. military prison in Guantanamo, appeared in a federal courtroom in New York City to face conspiracy charges related to the 1998 bombings of U.S. embassies in Kenya and Tanzania.

When not in court, Ghailani—an alleged member of Al Qaeda—is being held at the Metropolitan Correctional Center, according to The New York Times.

The correctional center, which is overseen by the Federal Bureau of Prisons, is in Lower Manhattan, across the street from the courthouse. Hauling Ghailiani between the prison and the courtroom, even under tight security, "opens windows of opportunity for anyone who would try to spring him," Blair says.

In the case of terrorism suspects, the threat rises because sympathizers within a parent organization have the patience and expertise to plot intricate escape plans, adds Blair, who is a former chief of education and training for the U.S. Office of the Army Surgeon General.

A common arrangement for hospitals

Many U.S. hospitals have contracts in place to help prisons and jails handle medical treatment for prisoners. Prisoner patients typically arrive at a medical center under the control of one or two prison officers.

Over the years, there have been dozens of incidents where prisoners attempt to escape custody while at a medical facility. Some turn deadly, such as a prisoner patient escape from Montgomery Regional Hospital in Blacksburg, VA, in August 2006, during which the suspect shot and killed a security officer in the facility as he fled.

"I don't care if you are a 30-bed hospital or a 1,000-bed hospital—you are getting [prisoner] patients one way, shape, or form," says James Kendig, MS, CSE, CHSP, vice president of safety, security, and clinical transport services at Health First, Inc., in Melbourne, FL. Kendig spoke recently to HealthLeaders' sister publication, Healthcare Security Alert.

It is important for hospitals with federal prisons in their community to think ahead of time about security issues surrounding prisoner patients, Blair said.

CEOs and hospital security directors should take the following two actions, as outlined by Blair:

  • Verify whether the hospital has a contract for prisoner care in regular times or will provide mutual aid for prisons during a community disaster
  • Determine what steps the Federal Bureau of Prisons will take to guard prisoner patients coming to your hospital

Kendig helped create a PowerPoint presentation that trains law enforcement officers about the nuances of taking prisoners to healthcare facilities for treatment. The Florida Hospital Association has posted the video on its Web site (scroll down to the Law Enforcement and Corrections Training for Hospitals" link).

Blair says he worries about high-value prisoners, such as terrorism suspects, if they are transported to a hospital for a feigned illness. He imagines a plot in which sympathizers bomb the hospital's emergency department as a diversion for local law enforcement and then forcibly free the prisoner en route while police presence is elsewhere.

This scenario might be a good test of the hospital's emergency operations plan as required by The Joint Commission, he adds.

Scott Wallask is senior managing editor for the Hospital Safety Center. He can be reached at

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