At 1:30 p.m. July 24, 49-year-old Richard Plotts is accused of walking into a Delaware County health center, griping about its gun ban.

Burdened with mental health issues and a criminal history involving drugs and guns, police say Plotts pulled a .32-caliber revolver from his waistband and opened fire, killing his caseworker before his psychiatrist shot back with his own .32-caliber semi-automatic, injuring Plotts.Plotts pleaded not guilty earlier this month in Delaware County Court.Plotts is charged with murder, reckless endangerment and weapons offenses in the July shooting death of 53-year-old Theresa Hunt inside a psychiatrist's office at Mercy Fitzgerald Hospital in Darby, just outside Philadelphia.Hospitals have traditionally been places where patients, staff and visitors come and go freely. But the numbers of violent incidents in recent years have forced them to rethink their security policies."Health care facilities are required to have security protocols in place, but there are not specific guidelines, and (the policies) vary by facility," state Department of Health spokeswoman Holli Senior said."It's up to each facility to have protocols and plans in place to ensure the security of patients, visitors and staff. When an incident like a shooting occurs, facilities are required to report them to the department within 24 hours," she said. "The department expects the facility to conduct a thorough review of the incident and determine if corrective action is necessary."If a plan needs to be done, the department will monitor the facility to ensure it's implemented," Senior said.The Joint Commission, which oversees hospitals in the state, also requires updated safety and security plans and drills.Local hospitalsplan for safetyBlue Mountain Health System, with hospitals in Lehighton and Palmerton, regularly reviews its policies and emergency preparedness response protocols, spokeswoman Lisa Johnson said.While BMHS would not reveal specifics of its security polices, officials have learned from a 2010 shooting incident at Johns Hopkins Hospital in Baltimore, when a distraught man shot his elderly mother and her surgeon before turning the gun on himself, and the 2012 mass shooting at Sandy Hook Elementary School in Newtown, Connecticut.BMHS studied the tragedies to develop and refine its "Code Black" emergency response plan to alert hospital staff of any assailants with a weapon who appear to be potentially or actively engaged in assaultive behavior on its campuses, Johnson says."We also do department-by-department education and inspections so staff know where to shelter in place, how to protect patients, lockdown procedures and potential escape routes from each department in the event of a Code Black. We have had Homeland Security evaluate our facilities from a safety standpoint," she said."From our emergency preparedness drills, we have limited access through certain entrance doors, are currently upgrading our security cameras and adding additional cameras and extra security guards in certain areas," Johnson said.Like a cityLehigh Valley Hospital Network, housed in complexes on Cedar Crest Boulevard and in center city Allentown, as well as Bethlehem and Hazleton, strikes a delicate balance between security and the calm, open atmosphere necessary for the comfort and confidence of patients, staff and visitors, says Mike Wargo, who is administrator of its public safety department."Lehigh Valley Hospital Network moved three years ago from a security department model to a public safety department model," he says.Security services, emergency communications (including an in-house 911 system), fire and life safety, emergency management, and medical evacuations divisions all work together.The public safety department has a staff of about 300 people. Of those, about 80 report to security services."We look at our organization as very similar to a city," Wargo says. "Police, fire and emergency services all work under a single leadership.""Any one of us can respond because our staff is cross-trained to be able to respond to any emergency on campus. Security services is really focused on community policing: access control and patrol, follow-up investigations, and patrolling campuses for theft, vandalism and other problems," he says.The cross-training enables those working for one division to help in another division. All staff are also trained in spotting odd or potentially dangerous behaviors, and in calming aggression."They're also trained in good communications skills," Wargo says. "Most people who require a security response can usually be calmed down. If they are physically acting out, we call local police."They also take no chances."Our security officers have bulletproof vests and are trained in self-defense," Wargo says."We do drills with staff for exactly the scenario that took place (in Delaware County). They were conducted by the emergency management division, which engages the emergency communications center, local police and security services to immediately respond," Wargo says.Pocono Medical Center, Stroudsburg, has trained security officers stationed at the emergency department door and patrolling each floor of the hospital as well as the parking area. All staff are trained to spot and de-escalate potentially volatile situations, and training is refreshed each year, spokesman Geoffrey Roche said.In addition, volunteers greet every person who enters the hospital, asking in a friendly manner if they are there to visit and if they need help finding anything. Every person must wear a visitor's pass.If something would happen on a nursing floor, staff is trained to call immediately. Each security officer carries a wireless phone, and the hospital has its own 911 line.The security team also does a program called Handle With Care that teaches employees how to appropriately handle anyone who may need to be calmed down or who is otherwise acting inappropriately."Our entire team takes (security) very, very seriously," Roche said.The team has taught sessions on how to defuse potential violence to area churches, and helped train school resource officers on signs, symptoms and resources for handling violence and behavioral health issues. The team is credited with saving the life of a patient who was driven to the emergency entrance with no pulse and who was not breathing. They performed CPR until the patient was taken into the emergency department. Minutes later, he was awake, alert and asking to go home.PreventionWargo says prevention is key."An incident like what happened in Delaware County is extremely hard to prevent unless you have a complete lockdown, such as airports do," he says. "But do you want a hospital where everybody goes through metal detectors and has their bags checked? It's just not the culture of health care. The culture of health care is a comfortable environment with the balance of security by other means, such as detection and observation."Wargo says care is given after an incident to help staff cope with the emotional fallout."After an incident, everybody goes back to everyday operations. But there is still an impact. It's important to have programs help them mentally and physically recover. We have behavioral health specialists to talk with them and allow them to express their (concerns) and adjust to life after the incident," Wargo says. "It takes just as much if not more effort to get back to taking care of patients."Wargo says everyone needs to be alert to changes or differences in their workplace to prevent violent incidents. Be aware of changes in co-workers' behavior or strangers in places restricted to staff."Report things that are out of place or that make you feel uncomfortable," he says.St. Luke's University Hospital Network, based in Bethlehem, also would not share details of its security measures.Spokeswoman Denise Rader says the network's security program is "accredited by the International Association for Healthcare Security & Safety. This network of safety professionals shares best practices and security information, as well as provides training for a variety of safety issues, including violence."