DHMC Makes Adjustments to Security Following Fatal Shooting

  • Dan Dahmen, director of security for Dartmouth-Hitchcock, center, looks for the correct place to install a security enhancement to allow lockdown of the Medical Specialties Unit from within the area at Dartmouth-Hitchcock Medical Center in Lebanon, N.H., on Jan. 11, 2018. With him is Andy Houghton, D-H Engineering's project manager. Marissa Rainville, a registered nurse, left, and secretary Hayley Hudson give their input. (Valley News - Jennifer Hauck) Copyright Valley News. May not be reprinted or used online without permission. Send requests to permission@vnews.com.

  • Tom Carlson, manager of security operations at Dartmouth-Hitchcock, speaks with Mary Berry, a security officer, at a station installed at the entrance to the Critical Care Unit following a Sept. 2017 active shooter incident at Dartmouth-Hitchcock Medical Center in Lebanon, N.H., on Jan. 11, 2018. (Valley News - Jennifer Hauck) Copyright Valley News. May not be reprinted or used online without permission. Send requests to permission@vnews.com.

  • First responders, doctors, staff, patients, their family members and others wait near the main entrance of Dartmouth Hitchock Medical Center during an active shooter situation on Tuesday, Sept. 12, 2017, at the medical center, in Lebanon, N.H. (Valley News - Charles Hatcher) Copyright Valley News. May not be reprinted or used online without permission. Send requests to permission@vnews.com.

Valley News Staff Writer
Sunday, January 14, 2018

Lebanon — Officials at Dartmouth-Hitchcock Medical Center are making changes to security, communication during emergencies, and education and training of employees following the fatal shooting of a patient last September.

But New Hampshire’s lone academic medical center has opted not to install metal detectors or have armed guards at its Lebanon campus.

D-H officials, who outlined the changes to the Valley News last week, said they believe the measures will make a difference without changing the atmosphere for the thousands of workers and patients who come and go each day.

Aside from making the presence of security officers more visible, “I hope they’re things that (visitors) don’t notice,” D-H Vice President of Facilities Tom Goins said. “I think our objective is from the customers’ perspective to maintain safe, business-as-usual operations as much as possible.”

The changes follow the Sept. 12 fatal shooting of 70-year-old Pamela Ferriere, a Groton, N.H., resident who was a patient in the intensive care unit.

Police allege she was shot by her son, Travis Frink, 49, of Warwick, R.I., who was arrested in his car near DHMC at the intersection of Lahaye Drive and Mount Support Road about 2½ hours after the shooting. No one else was injured in the incident.

Frink was indicted last month on both first- and second-degree murder, and is being held without bail. He pleaded not guilty at an earlier court appearance.

The shooting interrupted some services at DHMC as hundreds of patients and workers evacuated the building. The hospital’s emergency department stopped accepting patients for several hours, transfers to and from other facilities and meals were delayed, and many appointments had to be rescheduled.

The incident, which in hospital lingo is known as a “code silver,” also created some confusion for people who either didn’t receive an alert from the hospital letting them know what was happening, or did get the alert and didn’t know what to do.

In a group interview last week, Goins, D-H Director of Security Dan Dahmen and Emergency Management Coordinator Jim Alexander all said that they were generally “pleased” with the hospital’s response to the shooting.

But they have targeted the three areas of security, communication and training for improvement after consulting with Lebanon Police and with employees, and gathering input from a peer review conducted by officials from Boston-based Massachusetts General Hospital and Brigham and Women’s Hospital, which both have experienced shootings.

Security Upgrades

Visible changes in security since the shooting include a security guard who is responsible for monitoring the waiting room outside of the ICU, until someone from the reception department can be hired and trained to perform this role. The monitor answers visitors’ questions, makes sure they have passes and are allowed into patients’ rooms at appropriate times, Goins said.

And the hospital contracted with the Lebanon Police Department to provide coverage in the emergency department until early December, when DHMC hired more security staff to act as monitors in the ICU’s waiting room, Dahmen said.

In total, over the past year, DHMC has added about five full-time positions to its security force, bringing the force up to 28 total positions, Dahmen said.

Reasons for this increase are not directly related to the shooting and include being able to respond, if necessary, to the new Jack Byrne Center for Palliative & Hospice Care on the DHMC campus; creating the new position of operations manager; and providing adequate coverage in the hospital’s emergency department.

Beyond adding positions, Dahmen said the hospital after the shooting has re-evaluated where and how it uses its security force. A parking officer has become a security officer and the force’s patrol routes have changed to improve its visibility in “high-profile areas,” he said.

Dahmen also has ordered bullet-proof vests, so that should the hospital’s security guards be in a similar situation where they are helping law enforcement officers navigate the maze-like facility in the future, they will be protected.

Other recent and ongoing equipment upgrades, not related to the shooting, include moving from analog to digital security cameras, adding remote door-locking capabilities for security staff and giving providers the ability to lock down their own units from the inside at the push of a button.

Goins noted that Frink was identified through video footage.

All told, Goins said the hospital is investing more than $400,000 in security upgrades in the fiscal year that ends on June 30. That includes giving the security officers remote access control, buying bulletproof vests, upgrading the cameras, adding people and the cost of an Alertus communication system, which were all included in this year’s budget, he said.

“There’s always competing demands for capital,” Goins said. “Security takes a high priority.”

Changing ‘Run’ to ‘Avoid’

Other relevant changes, many of which were already in the works prior to the shooting, likely have been less noticeable for patients and visitors and include updating a guidebook for how to respond to emergencies, and changing the term the hospital will use to alert people should a similar situation occur in the future from “code silver” to “active shooter.”

The security staff are also updating online trainings and videos used to prepare people for emergencies, such as an active shooter.

One of the most significant changes hospital officials have made to their emergency preparedness guidelines and training sessions is that rather than advising people to run when they learn an active shooter is present, DHMC officials are now directing people to avoid the situation, which might mean sheltering in place rather than evacuating the building, depending on whether they are close enough to hear the incident taking place, said Goins.

The recommendation offered to hospitals nationally “is run, hide, fight for that kind of situation,” Goins said. But, “having 10,000 people respond (by evacuating) is problematic unto itself.”

Having health care providers evacuate the building, especially when they are in the midst of caring for non-ambulatory patients, is a risk in itself, Goins said. Should an active shooting incident occur again, DHMC is directing people who are not in the affected area to stay where they are.

“We have to be very careful not to separate caregivers from patients who need care,” he said.

Inpatient areas, operating rooms and procedure areas were not evacuated at the time the active shooter alert went out, D-H spokesman Rick Adams wrote in an email on Wednesday.

“Cases that were in progress during the event continued,” he wrote.

But some caregivers, who were not in the middle of providing care and were in other areas of the hospital such as the cafeteria, left the building during the evacuation, Adams wrote.

By evacuating the building, these caregivers may have been prevented “from returning, or reporting to, designated patient areas and seeing other patients.”

Overall, patient care was not compromised, hospital officials said in interviews shortly after the shooting.

D-H’s Chief Clinical Officer Ed Merrens, in a news conference the day after the shooting, described the effect of the incident as “a stutter step for us from a clinical standpoint, but everyone got great care.”

Though he said providers maintained a high quality of care, Merrens noted at the time that one area of frustration from a clinical standpoint was the time it took for law enforcement officers to search the building, clearing the way for staff to re-enter following Frink’s arrest.

Lebanon Police Chief Richard Mello, in a phone interview last week, said his department has been working with the hospital to develop a plan to prioritize sweeping certain parts of the building before others should another incident occur.

In addition, Mello said his department is working with the hospital to develop maps more suited to the department’s purpose than the mechanical/engineering maps officers had available to them in September.

The difference is that mechanical maps emphasize water, sewer, heating and cooling systems, whereas the police are more interested in knowing where doors and closets are located, Mello said.

Maps are examples of issues “you don’t necessarily think of unless you have to live through (an emergency),” Mello said.

Another area of focus since the shooting has been improving communication in emergency situations, said Adams, who served on the emergency response team.

Since the shooting, the hospital has been encouraging employees to sign up for the alert system, which includes texts and messages sent to various devices through the Alertus app.

They’ve also made efforts to have employees check to be sure such messages are being sent to a cellphone and not to a home phone number, Adams said.

DHMC officials hope to deter people from relying on social media for information in future emergencies because the information shared there can be of varying quality and accuracy, Dahmen said.

One big change has been to give Dartmouth College employees access to notifications from DHMC via the Alertus app, Adams said. Several Dartmouth College employees who were working on DHMC’s campus at the time of the shooting said afterward that they were confused about what they should do and they did not receive the same alerts that DHMC employees did.

Opting Out of Firearms

The hospital has opted out of other, more drastic moves it could have taken, such as arming security guards or installing metal detectors at entrances.

The DHMC officials said they don’t need to arm their security force because the Lebanon Police Department and officers from other neighboring communities respond to the hospital grounds so quickly, during the shooting and on a regular basis when necessary. And, they said, metal detectors, though sometimes useful in the emergency departments of hospitals in cities such as Chicago and Detroit, where gang violence is a problem, can delay patients from getting care and are not always effective.

Dahmen said he reviews the question of whether to arm the security force annually.

“We haven’t felt that we need that level of response currently in the organization,” he said. “It’s something that we will continue to periodically review.”

Instead of firearms, the security force is equipped with non-lethal methods of force, and trained in de-escalation techniques and take-downs, Goins said.

Armed law enforcement officers arrived on the scene within minutes of the 911 call, Alexander said. Within five minutes, he said there were three to five police officers in the building and within 20 there were as many as 25 officers on the scene.

Such rapid response times are not a fact in other parts of the country. During his time at a hospital in Cleveland, Goins said he oversaw a transition from an armed police force to a fully commissioned force because of slow response times from the municipal force.

“The average response time from the local police force was over an hour and that was unsatisfactory,” said Goins, who according to his LinkedIn profile worked at the MetroHealth System in Cleveland from 2010 to 2014.

No hospital in New Hampshire has a commissioned force, Alexander said, noting that the state police provide coverage at the state-operated New Hampshire Hospital. The federally funded White River Junction VA Medical Center, in Vermont, does have its own police force.

Alexander, a former Lebanon police chief, said that in rejecting the idea of installing metal detectors, hospital officials considered “what type of community do we want to be.”

Adding metal detectors is expensive and not always effective, he said.

“What do you really get for the money spent?” he said.

In addition, adding metal detectors could delay patients in need of care from reaching their providers, he said.

Instead, he said, “Good training goes a long way.”

Should DHMC security guards encounter a need to use a metal detector for a specific purpose, the hospital has handheld detectors available, Dahmen said.


DHMC officials are currently taking a break from live active shooter trainings out of sensitivity to those who are still recovering from the trauma of the event, Goins said.

The shooting itself was witnessed by at least one member of the hospital’s staff, a nurse, who had been caring for Ferriere during her stay.

“Before the event, we would literally walk around and say we’re having an active shooter drill,” Goins said. “I’m a little more sensitive to that now. I don’t want to go around and say, ‘bang, bang.’ ”

Emotionally, people who were close to the incident are still healing, Adams said.

“It takes a long time for an institution to fully recover,” he said.

Moving forward, DHMC officials plan to share what they’ve learned with others in the D-H system, which in the Upper Valley includes New London Hospital, Mt. Ascutney Hospital and Health Center in Windsor and Alice Peck Day Memorial Hospital in Lebanon, and beyond.

“Most institutions haven’t gone through what we’ve gone through,” Goins said.

Valley News Staff Writer Nora Doyle-Burr can be reached at ndoyleburr@vnews.com or 603-727-3213.