Author: Alan A. Ayers, MBA, MAcc, Experity
Content Advisor, Urgent Care Association of America
Associate Editor, Journal of Urgent Care Medicine

Your urgent care center, although focused on providing medical treatment, is still essentially a retail business. Your patients are your customers, and they come and go; financial transactions (cash, credit card, insurance) take place; and employees deliver clinical care and customer service simultaneously. Hence, urgent care centers, like other retail establishments, face the very real and continuing threat of crime. In fact, instances of both brazen theft and violent robbery at medical facilities and pharmacies nationwide have begun making news headlines, and the trend appears to be growing at an alarming rate.1 It seems the promise of ready cash coupled with the perception of an “easy” stock of prescription narcotics onsite has made urgent care centers a target for desperate addicts and bold drug dealers.

Also, urgent care centers, unlike most other doctor’s offices, are designed to deliver a retail-like patient experience, which can inadvertently increase their vulnerability. For instance, the high-visibility, high-traffic location that attracts urgent care patients can also draw criminals to your practice and facilitate their easy getaway. By offering conveniences like extended hours and weekend service, your urgent care may be open during the predawn and late-evening hours – both favored time slots for criminals planning a robbery.2 Add to that the possibility of your patients or staff members heading to a poorly lit parking lot only to encounter their vandalized vehicle—or worse, a mugger with bad intentions—and it’s clear that crime prevention is a serious issue that every urgent care operator must address. If your customers and employees don’t feel safe at your urgent care center, you can be sure neither will stay with you for long.

Being Proactive Against the Threat of Crime
The good news is there are indeed tried and true strategies, tactics, and deterrents that urgent care owners have at their disposal to help discourage criminal activity at their centers and keep their employees and patients safe. Local law enforcement agencies offer a multitude of informational resources for preventing retail crime, and they are free and readily available to owner/operators serious about protecting their establishments. These resources include tip sheets, checklists, brochures, and reports detailing the many different ways to effectively reduce and deter crime, which can be easily adapted to your urgent care center.

Guarding Against Theft/Robbery of Cash
The headline, situated directly above a full-sized photo of glaring squad car lights, literally jumped off the screen: Two daring criminals, wearing masks and packing pistols, burst into a south Sacramento urgent care center shortly before 9:00 p.m. on a Wednesday. The assailants hurdled the main counter, pistol-whipped one employee and made off with an undisclosed amount of cash. The assaulted employee escaped serious harm, suffering only minor injuries, while the other five employees present during the crime were unhurt. The suspects then fled the scene on foot.3

Although this was one of the more dramatic examples to make the headlines, it effectively underscores the risk any retail establishment accepts when it tenders cash from its patrons. Simply put, when cash is on the premises, robbery is a possibility. And the perception—right or wrong—that there may be narcotics present, as an urgent care has, only serves to heighten that risk.

Admittedly, your urgent care center does have the option to forego cash payments altogether (accepting only credit cards, insurance payments, and personal checks) and to prominently display signage that reflects that stance. But because customer service is deeply rooted in the ethos of the entire urgent care concept, such a policy can be off-putting and a great inconvenience to customers seeking care at your center who can only pay in cash. Thus, urgent care operators who prefer to maintain a cash payment option should definitely implement and follow standardized “cash control’ procedures such as those in Table 1. While by no means an exhaustive list, it does comprise many of the key “cash safety” elements commonly prescribed by law enforcement agencies for retail businesses. Urgent care operators should implement as many of these safeguards as possible whenever possible to make their centers less appealing to prospective robbers.

Table 1: Cash Control Procedures to Reduce Crime Risk:

Designate a central location for the cash drawer. Have the cash register or drawer located so that most employees and customers have a clear view of it. The location of the cash drawer should also be viewable from the outside to discourage a criminal worried that a passerby will witness a robbery attempt.
Maintain minimal cash reserves. Only keep on hand the minimum amount of cash required to conduct normal business, and “drop” the rest either in an anchored safe onsite or at the local bank. Display appropriate signage stating that your center does not accept large denominations and employees do not have access to the safe.
Immediately drop the largest denominations. Drop $20s immediately in the safe. Do not store them under a tray in the cash drawer. Robbers are familiar with this tactic.
Make frequent deposit trips to your local bank. Vary your routes and departure times and never travel alone. Avoid making night deposits whenever possible. Transport the money in an inconspicuous container. If you ever feel threatened in transit, head directly to the nearest open business, fire station, or police precinct. For high-crime areas and/or high-risk situations, consider hiring an armored car company or bank courier service.
Prepare “decoy” money in advance. Record serial numbers from a stack of low-denomination bills and store them in a cash drawer. Keep these bills out of normal circulation so that they can be given to a robber during a robbery. This tactic aids the authorities in their apprehension efforts, and a robber behind bars is one that your establishment and others no longer have to worry about.
Adapted from “A Guide to Robbery Prevention and Response to Robbery,” Portland (Oregon) Police Bureau, http://www.portlandoregon.gov/police/article/31555 Accessed 5 March 2013.

Masked Robbers Hit the Urgent Care
Another day, another disturbing headline: Around 2:00 p.m. on a Tuesday, two men dressed as medical personnel—wearing blue-green scrubs, white surgical masks, and sunglasses—descended upon the pharmacy attached to an urgent care center along Texas’ Gulf Coast. Wielding guns, the robbers handcuffed one employee while ordering another to lock the front door. They then demanded that the unshackled employee fill a bag with enough Hydrocodone, Xanax, and Soma to treat 500 patients before fleeing in a stolen truck.4

Part of a Larger Trend?
While there are no official national statistics that chart the frequency of drug-related robberies of medical facilities and pharmacies, incidents of individuals carrying “pharmacy-type” bags being assailed outside of pharmacies, hospitals, and doctors’ offices are on the rise.5 This dangerous trend can be attributed mostly to the widespread prescription-drug abuse currently running rampant throughout the United States. Potent cocktails of Xanax, Lortab, and Soma are rapidly growing in popularity among drug abusers, and quickly displacing conventional street “dope” as the addict’s drug of choice.

According to the National Institutes of Health (NIH), nearly 16 million Americans used prescription pain relievers for non-medical purposes in last year alone, and of those, 6 million can be classified as habitual abusers.6 As of 2009, prescription drugs were the second most-abused category of drugs, trailing only marijuana.7 So not only is America facing a growing legion of prescription-drug addicts desperate to feed their habit, street gangs and enterprising drug pushers—known to command a street value of upwards of $5,000 for 60 80-mg OxyContin pills—are discovering pharmaceutical theft, robbery, and “pill peddling” to be a very lucrative business.8

Faced with these very real threats and searching for solutions, it might just seem easier for urgent care operators to simply turn their centers into veritable fortresses – bars, bullet-proof glass, armed sentries, and all. But again, urgent care centers are by design customer-service oriented, and surrounding patients with “excessive” security measures can work to erode the comfort, solace, and welcoming vibe that any successful center strives for in the first place. Caught in a bind, some urgent care operators opt to maintain a warm and hospitable environment—albeit lax in security—and remain a favorable target for addicts and calculating drug traffickers.

To Carry or Not to Carry
Not surprisingly, policies regarding storing and dispensing narcotics onsite vary widely among different urgent care centers. On one end of the spectrum are those who refuse to carry or dispense any narcotic that carries the potential for abuse/addiction, the logic being that if a medical condition is serious enough to require narcotics for pain management, then the patient is a better candidate for a hospital emergency room in the short term (and a primary care physician later). At the other end are urgent care centers that offer fully-certified pain management services ancillary to their ambulatory practice. And somewhere in the middle—actually, the majority of urgent care centers—are those that stock a minimum quantity of narcotics, sufficient to temporarily alleviate patients’ acute pain until they can either get a prescription filled or see their primary care physician for follow-up.

While urgent care centers that do opt to keep narcotics onsite are required to observe minimal precautions—staff background checks, dual key controls, access logs, twice-daily inventories, and medicine storage in vaulted cabinets—these safeguards, although a good starting point, are generally in place to reduce the occurrence of an inside job. To ward off threats from armed assailants looking to score cash, narcotics, and pain relievers, however, more drastic measures have to be implemented. Regardless of whether narcotics are actually available at a facility, the greater concern is a robber’s perception that drugs are located inside. And it is that perception, true or false, that compounds the danger to the urgent care center’s patients and staff.

Preventing Robbery Through Great Customer Service
Often, a potential robber or his accomplice will visit an urgent care center first as a patient who may or may not actually need medical attention. While awaiting “treatment,” he may then “case” the center to discover where the cash and pharmaceuticals are stored, and to observe the handling procedures. Therefore, even if prominently displayed signage states that there are no narcotics on the premises, urgent care staff should be trained to look for “suspicious” behavior and respond accordingly. Even if a robber realizes that a center has no narcotics, he or she may decide to stick around for a chance at making off with some cash. So in general, urgent care staff should greet each patient with a warm, “May I help you?” or “Can I offer you assistance?” Actual patients will appreciate that approach and it can serve to unnerve a thief plotting a robbery attempt. Robbers who are, indeed, harboring plans to rob the center will want as little interpersonal interaction with other customers and staff as possible in order to remain anonymous.

What to Do If a Robbery Occurs
Because every robbery is different, urgent care staff members will need to assess themselves, the robber, and the situation to determine the best course of action. However, there some basic guidelines that should always be followed during a robbery attempt and it’s imperative that a center’s employees are trained in what to do and, more importantly, what not to do. Table 2 provides some training tips.
Table 2: Training Tips in Dealing with a Robbery

While the robbery is taking place:
Act calmly. Do exactly what the robber says, no more and no less. Keep your movements short and smooth to avoid startling the robber. Keep away from the robber and limit eye contact. Give the robber exactly what he or she asks for. Don’t offer any more.
Don’t stall. The quicker the robber leaves the less chance of violence.
Do not resist or try to be a hero. Cooperate for your own safety and the safety of others. Robbers usually are excited and easily provoked. Tell the robber about any movements you plan to make.
Activate the silent alarm if it can be done safely without alerting the robber.
Observe carefully. Study the robber’s face and clothing and note any distinguishing features including height, weight, race, hair, eyes, nose, scars, tattoos, etc. Be aware that the robber may be using physical disguises, e.g., a wig, mustache, etc. Also try to remember as much as possible about the robber’s voice, language, accent, mannerisms, etc. If there is more than one robber, get a good description of one before going to the others. You can get confused if you try to remember too much.
Get a good description of any weapon used.
Remember what was taken, where it was put, and how it was carried.
Watch carefully for any things the robber may touch. Don’t disturb or touch them. They may contain fingerprints that can help identify the robber.
Don’t block the robber’s escape route from the center.
After a robbery occurs:
Call 911 immediately after the robber leaves and follow all instructions from the dispatcher, e.g., to keep the phone lines open until officers arrive. The dispatcher will probably ask for a description of the robber, his or her vehicle, and direction of escape. Be prepared to provide this information. It will be broadcast to the responding officers, who may see and be able to stop the robber.
Observe the direction of escape and the characteristics of any vehicle involved, i.e., its license, make, model, color, etc.
Close the facility. Lock all doors and cease operations until officers arrive and conduct a preliminary investigation of the scene.
Preserve the crime scene. Tell your employees not to touch anything the robber may have touched or otherwise contacted, and to keep away from areas where the robber had been.
Ask all witnesses to remain until officers can interview them. Get their names and contact information if they are unable to remain. Ask to see their driver’s licenses or other ID to verify this information. Write down everything you can remember about the robbery so you can provide the police with a good description of what happened as well as descriptions of the robber(s), vehicle(s) involved, and weapon(s) used. Have each employee involved do the same. It is important that they do this independently, i.e., without discussing the robbery with other employees.
Make a list of all drugs that were taken.
Report the loss of drugs to your local U. S. Drug Enforcement Agency office.
Answer all questions of the responding officer and the robbery investigators. Have each employee involved remain in the store and do the same.
Provide camera imagery to the police investigators. Any camera system that is installed should be designed to provide high-quality, digital imagery of any robbery.
Offer a reward for the arrest and conviction of the robber and request that other medical facilities in your area post the notice.
Analyze the robbery and take appropriate measure to prevent a recurrence.
Adapted from “Preventing and Dealing With Pharmacy Robberies.” SDPD Neighborhood Policing Resource Team. San Diego Police Department. 19 May 2012. Web. Accessed 27 Feb 2013. <> https://sandiego.gov/police/pdf/crimeprevention/PreventingPharmacyRobberies.pdf

Patient/Employee Safety in the Building
Although several effective robbery prevention strategies have been outlined here so far, an urgent care operator’s vigilance in implementing security methods should not stop there. Consider:

  • Parking lots—places of easy getaway where people and their valuables are together—are favored targets of thieves and criminals.9 If a potential criminal can’t muster the courage to actually commit a robbery inside the urgent care or pharmacy, then as the headlines increasingly suggest, they are more than willing to visit their mayhem on patients entering/leaving the parking lot.
  • In 2009, OSHA, supported by statistics that clearly illustrate how vulnerable late-night retail businesses are to the risk of robbery, released a widely-circulated publication that both covers the problem in-depth and outlines practical solutions to mitigate a shop owner’s risk.10

A typical urgent care center falls under both categories, as many centers are open and/or have staff inside during late-evening hours, with patients heading to darkened parking lots where there may be thieves waiting to pounce.

Therefore, the key is avoiding a narrow focus on only deterring the “sensational” cash/pharmaceutical robberies that have dominated the headlines. Instead, an urgent care center is best served by a thorough and comprehensive safety initiative that covers the entire facility around-the-clock, including the parking areas and after-hours operations. Keep in mind that the object is not necessarily to foil crime at the center, but to prevent it in the first place. To that end, highly visible deterrents signal a commitment to security and work well to discourage most robbery attempts. The following list of deterrents is well-established in the law enforcement, retail, and pharmaceutical industries, and is derived from a variety of reputable sources (but is not exhaustive):

  • Center Design. Adequate lighting should be installed in both the interior and exterior of the facility. Mounted, curved mirrors should be placed in concealed areas and at hallway intersections. Height markers should be placed next to egress doors, so that witnesses can better describe assailants. Closed-circuit TV should be employed with a split-screen monitor displaying the recorded images from the waiting area and parking lot. Security cameras should be installed at all egress doors and narcotics storage areas, with the recording equipment locked in a private storage area, or recorded off-site. Do not use fake cameras, as robbers can tell the difference. Signage should be displayed on windows and doors but not in a way that obstructs the view of the customer service area from outside of the center. A monitored security system, including motion and door sensors, silent alarms, panic buttons, and a back-up battery, should be utilized. Security personnel should be employed to monitor the premises. Decals with the name of the security company should be affixed to the main egress doors.
  • Parking Lot/Exterior. Parking Lot/Exterior. Lot attendants/security personnel may be a consideration in certain circumstances. Lighting for the exterior of the building and parking areas should be installed. Bushes, shrubbery, and trees should be trimmed around the building, so as to not obstruct views or offer a hiding place. Security cameras should be visible and operating in the parking lot areas and facility exterior. Adjacent businesses can partner to warn each other of suspicious activity in shared parking lots. Good-quality locks should be used on all doors, particularly side and back doors used primarily for deliveries.
  • Staff Safety Policies. Perform extensive background checks on all new hires. Change keys/pass codes whenever an employee leaves. Have security personnel escort staff and patients to their parked vehicles after hours. Employees should never work alone in an urgent care center, particularly during early morning or late-night shifts. Alarm systems should be activated once the center closes for business, regardless of whether employees are still on the premises.

Conclusion
Although the headlines suggest that urgent care centers and pharmacies are vulnerable criminal targets, it doesn’t mean your center can’t be a safe, welcoming, and profitable establishment. In fact, by taking the time to conduct a thorough analysis of your security measures, then discovering and tightening any weak areas, your urgent care can actually thrive as it establishes a community-wide reputation for being both safe for customers and tough on crime. OSHA recommends periodic visits from your security firm or an independent consultant to inspect the worksite and conduct surveys aimed at providing solutions toward keeping your security measures up to date.11 Further, you can request a complimentary security walk-through from your local police department because they are usually happy to help identify security vulnerabilities in your center and to establish a friendly rapport with the businesses in their community. In short, by simply utilizing the plentiful resources that are readily available, you can take a positive stand against crime. Rest assured that your customers, staff—and potential criminals—will definitely take notice.
References

  1. Hawley, Chris. “Pharmacy robberies sweeping US.” NBCNEWS.com. 25 June 2011.Web. Accessed 24 Feb. 2013. <> http://www.nbcnews.com/id/43536286/ns/us_news-crime_and_courts/t/epidemic-pharmacy-robberies-sweeping-us/#.US6aqDfuhts
  2. Potter, Tom, and Sizer, Rozanne M. “A Guide to Robbery Prevention and Response to Robbery.” The City of Portland, Oregon. Web. Accessed 23 Feb. 2013. <> http://www.portlandoregon.gov/police/article/31555
  3. Iqbal, Maneeza. “South Sacramento urgent care robbed at gunpoint.” News10ABC. 31 Jan 2013. Web. Accessed 22 Feb 2013. <> http://www.news10.net/news/article/227774/2/South-Sacramento-urgent-care-robbed-at-gunpoint-#_blank
  4. Lee, Jane. “Masked robbers hit clinic pharmacy.” The Baytown Sun. 16 October 2012. Web. Accessed 22 Feb 2013. <> http://www.baytownsun.com
  5. Hawley, “Pharmacy robberies sweeping US.”
  6. Results from the 2011 National Survey on Drug Use and Health: Summary of National Findings. U.S. Department of Health and Human Services. Substance Abuse and Mental Health Services Administration (SAMHSA). Web. Accessed 23 Feb 2013. <> http://www.samhsa.gov/data/NSDUH/2k11Results/NSDUHresults2011.pdf
  7. Epidemic: Responding to America’s Prescription Drug Abuse Crisis. Executive Office of the President of the United States. Web. Accessed 24 Feb 2013. <> http://www.whitehouse.gov/sites/default/files/ondcp/issues-content/prescription-drugs/rx_abuse_plan_0.pdf
  8. Oppmann, Patrick. “Addicts putting pharmacies under siege.” CNN.com. 3 June 2011. Web. Accessed 24 Feb 2013. <> http://www.cnn.com/2011/HEALTH/06/03/drugstore.robberies/index.html
  9. Witherspoon, Ralph. “Parking Lot and Garage Security.” Witherspoon Security Consulting. Web. Accessed 25 Feb 2013. <> http://www.security-expert.org/parkinglots.htm
  10. “Recommendations for Workplace Violence Prevention Programs in Late-Night Retail Establishments.” Occupational Safety & Health Administration. United States Department of Labor. Web. Accessed 26 Feb 2013. <> http://www.osha.gov/Publications/osha3153.pdf
  11. “Recommendations for Workplace Violence Prevention Programs in Late-Night Retail Establishments.” OSHA.
Protecting Your Urgent Care Center Against Robbery

Alan A. Ayers, MBA, MAcc

President of Experity Consulting and is Practice Management Editor of The Journal of Urgent Care Medicine
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