A breakdown on replay

In the security video, a woman shuffles barefoot down an emergency department hallway at Jefferson Abington Hospital. Her arms are tightly clutched to her chest, holding the blanket covering her naked body.

Within 20 seconds, she is on her back on the floor, a security guard’s arm across her chest, pressing her head to the side and pinning her down.

The patient, brought to the hospital during a mental health crisis, was not violent before the April 2024 incident. She was not bolting from the hospital when the guard stepped directly into her path and cornered her against the wall.

The video, which The Inquirer obtained, shows the guard reach across the patient’s shoulders to grab her. She bites his forearm. The struggling pair land on the floor, where he holds her down for three minutes.

His actions amounted to excessive use of force, Pennsylvania health inspectors concluded last May after watching the video, interviewing staffers who witnessed the incident, and consulting with hospital administrators.

Jefferson officials view the same video differently, saying the guard followed protocol with a patient he believed could try to leave the hospital. The guard accused the patient of attacking him, and charges were pressed against her.

The patient, a 47-year-old mother named Julie, has no memory of the incident, she told The Inquirer in an interview. She said she was shocked when an arrest warrant charging her with criminal assault arrived in the mail weeks later. As instructed, she turned herself in.

The newly released footage offers a close-up view of how split-second decisions can lead to dangerous situations, as hospitals increasingly grapple with patients with mental health needs.

A third of all the safety citations issued by the state over the last three years against the 30-some hospitals in Philadelphia and the surrounding Pennsylvania counties involved patients being treated for mental or behavioral health issues, an Inquirer analysis found.

Security staff were faulted in only five of these citations, out of more than 600 analyzed by The Inquirer dating back to 2022.

Abington’s security stands out with the worst track record: The hospital was cited three times between April and July of last year for security guards being inappropriately aggressive with patients being treated for mental or behavioral health needs.

In one instance, a guard restrained a patient using handcuffs, which security guards were not authorized to have under Jefferson policies.

In another incident, a guard chased a patient who had run out of the hospital and apprehended the patient off Jefferson’s property, where the guard had no authority.

In Julie’s altercation, Abington received the health department’s harshest reprimand, so-called immediate jeopardy — the term for potentially life-threatening safety failures.

The Inquirer is withholding Julie’s surname because she worries about discrimination over mental illness, which she has struggled with since leaving an abusive marriage 15 years ago.

A face, smell, or sound can trigger a flashback to past trauma for Julie. Her heart rate races, her body seizes up, and her mind blacks out. On April 23, 2024, a trigger sparked a crisis that landed her in an ambulance, on her way to Abington.

Julie was unaware that the Pennsylvania Department of Health had found fault with Jefferson staff’s treatment of her until an Inquirer reporter contacted her lawyer.

“I went there for help,” Julie said. “I’d never been attacked like that before.”

Jefferson declined to say why it did not inform Julie of the health department’s safety citation, as required by state law, because of patient privacy. The health system also did not respond to questions about the pattern of safety issues at Abington.

Jefferson administrators said the security video shows that the guard’s actions were justified at every step. The hospital reviewed the video with The Inquirer, and also shared it with Abington Township Police Department. Although the officials expressed concern at the quality of the video obtained by The Inquirer, they would not furnish a copy for publication because of patient privacy.

“He’s following the steps that we should be following to de-escalate the situation,” said Joe Byham, vice president of security for Jefferson Health.

The guard said he was initially told he had done everything right — but was fired months later, after the health department investigated, without being given a reason. He confirmed his employment status to The Inquirer but did not want his name used out of concern it could hurt his future job opportunities.

Julie’s case came to light after Craig Busick, a security shift supervisor at Abington, heard that the guard had been bragging to colleagues about “body slamming” the patient. That seemed to contradict the guard’s official report of being bitten, unprovoked, so Busick decided to review the security footage.

What he saw convinced Busick the guard should be put on leave or fired. Instead, after reporting his concerns to managers, Busick was disciplined with a performance management plan and later fired.

“It’s absolutely disgusting that a person in security or medicine could look at this and say there’s no excessive use of force,” Busick said. “That’s why I kept pushing the issue.”

Jefferson health system administrators drew drastically different conclusions from the zoomed-in security footage than did former security supervisor Busick.

In Jefferson’s view, the guard followed protocol from the onset. Jefferson says the patient had made comments about leaving the hospital. Once in the hallway, the guard tried to talk to her and direct her back to her room.

He put out an arm to block her path, Jefferson said. She pushed his arm away.

He moved to grab her around her shoulders. That’s when she bit his forearm.

Jefferson says the two ended up on the ground after they both tripped on the long blanket that was wrapped around her body and pooled at her feet.

The guard guided her safely to the ground, where he held her down, they said.

Jefferson says that medical staff in the hallway at the time were monitoring the situation. At least a dozen medical staff pass in and out of the video during a shift change, some engaging, others observing.

Ultimately, Julie was lifted onto a stretcher, tied down at her wrists and ankles, and returned to her room.

Busick, the shift supervisor that night, got to the scene after she was on the stretcher, and didn’t see the conflict until he reviewed the video.

The guard said the patient had bitten him, and Busick recalls seeing redness on the guard’s arm. The guard reported the incident to Abington police.

Busick had no reason to question the guard’s explanation, he said.

Healthcare workers experience among the highest rates of workplace violence, accounting for nearly three-quarters of on-the-job injuries, according to the Bureau of Labor Statistics.

But after reviewing video footage of the incident, Busick felt the victim was the patient, not the guard.

Busick was shocked by the guard’s aggressive response to a patient walking slowly down a corridor, with nurses following closely.

He didn’t understand why the guard would corner the patient against the wall, if his goal was to direct her back to her room.

And Busick was taken aback to see the guard put his hands on a patient clothed only in a blanket, who did not appear to be acting violently.

In his view, the guard had violated Jefferson policy, which says security should physically engage with a patient only when the person is immediately at risk of suicide or trying to harm another person. State inspectors drew the same conclusion in their investigation.

“It is stunning how bad that was,” said Busick, who has worked in law enforcement for 45 years and came to Abington in 2020.

Busick recommended that the guard be put on leave while administrators reviewed the incident, emails and text messages shared with The Inquirer show.

Busick was reprimanded for going outside the chain of command to report the incident and was put on a performance management plan, according to documents reviewed by The Inquirer.

No action was taken internally until the health department arrived, unannounced, to investigate a complaint filed by Busick’s wife, a retired patient advocate at Abington, he said. In response to the state’s citation, Abington updated its policies related to use of force. It retrained staff to make clear that medical staff — not security officers — are responsible for patients.

Busick took his copy of the video to Abington police, Julie’s lawyer, and The Inquirer.

He was fired in January for unspecified reasons and is suing for wrongful termination.

Jefferson declined to respond to questions about Busick’s claim that his complaint was ignored and that administrators retaliated against him for raising the issue.

The security video shows a woman in crisis and a security guard who overreacted when she didn’t follow his commands, said three experts in hospital security or mental health advocacy who viewed the footage.

“This woman was walking down the hall, covering her naked body, and this man’s first response was to body check her? Why?” said Carla Sofronski, executive director of Pennsylvania Harm Reduction Network and a mental health patient advocate.

The Crisis Prevention Institute, which trains hospital staff on handling conflicts, urges avoiding direct contact whenever possible. The physical tactics the guard used were not in line with its teachings, said CPI’s AlGene Caraulia, vice president of integration and sustainability, who reviewed the seven-minute security video.

Staff should avoid cornering someone against a wall, floor, bed, or other hard surface, said Jeff Schill, CPI’s vice president of training, speaking generally about CPI’s approach to crisis de-escalation and not specifically the Abington incident.

If two people end up on the floor, staff should try to return the patient to a sitting, kneeling, or standing position as soon as possible, according to CPI’s best practices.

Holding patients on the ground could make it hard for them to breathe.

“We don’t try to do takedowns,” Schill said.

CPI and mental health advocates also recommend educating hospital staff on how mental health conditions affect patients’ behavior.

For instance, pacing across a room — or down a hallway, in Julie’s case — is an example of a repetitive movement that can be calming during a manic episode, said Sofronski, the mental health advocate.

She recommends redirecting patients by asking open-ended questions about how they’re feeling, listening without judgment, and validating their concerns.

“If we meet aggression with aggression, the outcomes are generally not good,” she said.

Julie felt sick to her stomach when her lawyer showed her the hospital security video in December, months after pleading guilty to an infraction for harassment with physical contact.

Until then, Julie had been left to her imagination to recreate the incident.

“It took my breath away,” she said, describing how she was handled as “being tossed around like a bag of sand.”

She has avoided hospitals and doctors’ offices for the last year, missing routine screenings such as mammograms and colonoscopies.

“I’m so worried that if I mess up and ask for help, I’ll be penalized again,” she said.

On May 1, a Montgomery County judge heard an appeal by Julie’s lawyer, Tom Pfender, to reconsider her guilty plea because they had become aware of the surveillance video and state citation.

The Montgomery County District Attorney’s Office withdrew the charges after reviewing the video for the first time the same day. The district attorney had not been involved previously, as is routine with cases involving minor offenses.

Julie plans to file a civil complaint against Jefferson alleging battery, neglect, and unlawful restraint.

In the meantime, she hopes speaking out will help others with mental health issues to advocate for themselves.

“This is too big for me to process,” she said, “especially when it’s trauma that got me up there in the first place.”