Hospitals Reexamine Security for Newborns

The risk is low.

Very, very low.

That is how physicians, nurses, security experts and hospital administrators describe the chances of a newborn being switched at birth or kidnapped from the hospital. More common, but still very unlikely, is a temporary switch: A baby is removed from the nursery, for instance, and given to the wrong mother but the mix-up is corrected quickly.

Even a negligible risk, however, can become reality, as the well-publicized incident at the University of Virginia Medical Center has demonstrated so tragically. The families of the two babies born in the summer of 1995 are still discussing how best to raise little Rebecca Chittum and Callie Marie Johnson since it was discovered in July that the newborns were sent home with the wrong families. (The first clue came from results of DNA tests, reportedly conducted after one mother requested a raise in child support payments.)

“We still think it’s highly unlikely it was accidental,” says Marguerite Beck, a University of Virginia spokeswoman, of the switch. Identification bracelets were put on both babies right after birth, she says. (The medical center is now testing an umbilical clamp etched with numbers matching those on mother’s and baby’s ID bracelets.

A police investigation launched to determine whether the switch was criminal is continuing.

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Other incidents are lower profile. In August, a woman who had given birth to a son at Lowell General Hospital in Massachusetts breast-fed the baby handed over to her by a hospital employee and then discovered the infant was a girl.

Even as hospital officials acknowledge that such cases are the exception, they say the University of Virginia incident and similar events have served as a wake-up call, inspiring a widespread reevaluation of security protocols and equipment. More hospitals are turning to high-tech security systems to supplement old-fashioned security techniques. But even the most effective system can’t cancel out the need for nurses and new parents to become more security conscious, experts say.

Earlier this month, Rep. Sheila Jackson Lee (D-Texas) introduced a bill that would require hospitals reimbursed under the Medicare system to establish and implement security procedures to reduce the likelihood of infant patient abduction. Anyone who purposely destroys newborn identification records or misidentifies a newborn can face up to 10 years imprisonment and unspecified fines under the bill’s provisions.

About 4 million babies are born each year in the United States. Since 1995, four newborn switches and seven abductions have been reported to the Joint Commission on Accreditation of Healthcare Organizations, which accredits 18,000 hospitals and other health facilities nationwide. Three of those switches have occurred just since April, according to Janet McIntyre, a commission spokeswoman who has no information on the outcomes. “That by no means represents the total number,” she says. “It’s just the ones that were reported to them.” In April, the accreditation commission began to encourage hospitals to report switches and abductions, but there is no requirement to do so.

Since 1983, 101 infants have been abducted from U.S. hospitals (and an additional 79 infants 6 months and younger were kidnapped from homes and elsewhere), according to John Rabun, vice president of the National Center for Missing & Exploited Children, an Arlington, Va., private nonprofit organization funded by the Justice Department that tracks abductions. Fourteen of those infants were abducted from California hospitals.

The key to improving security for newborns is to pay careful attention to documenting identification from the moment of birth, according to Penny Hammer, the nurse manager of the Women’s and Children’s Center at Valley Presbyterian Hospital, Van Nuys. That can be easier said than done in a busy maternity unit. At Valley Presbyterian, Hammer says, she has seen days when 14 women were in labor at the same time.

Her staff relies on both high-tech and low-tech security measures, similar to those now followed at many other hospitals. A birth kit is taken into the delivery room. After delivery, the appropriate ID bracelet bands--pink or blue--are pulled and attached to the infant, mother and father (or other support person). Each band has the same number printed on it.

Identification sheets are put into each band, listing the mother’s full name, medical record number, date and time of birth, delivery doctor and gender of the newborn.

Someone in the delivery room, usually the father, then signs the identification verification form, stating that the baby’s sex and ID band have been checked.

After the baby is cleaned up, a band with a sensor is attached to a limb. The sensor is a critical part of a security system, in which specific zones, or perimeters, are created, typically at exit points, elevators and hallways leading to exits, to alert staff if the baby is moved beyond the established perimeters. The systems work on the same concept as the antitheft systems used by department stores, in which a tag attached to clothing sounds an alarm if it reaches an exit.

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Antennas are installed within the zones or perimeters, explains Terry White, president of Innovative Control Systems, which makes the Accutech security system, creating a radio frequency field. When the sensor attached to the infant is detected by the antenna, depending on the system programming, a silent alarm might be triggered, a pager could be notified, an audible alarm might sound or doors could lock. The systems have override functions, she adds, so if an infant needs to be rushed to surgery, for instance, staff can enter a code into a security keypad and disable the system. The systems cost about $15,000 to $300,000, depending on hospital size and the sophistication of the programming.

But no security procedure is foolproof, as Rabun of the National Center for Missing & Exploited Children knows firsthand. To date, he has offered assessments of the security procedures and systems in 687 maternal-child units, taking up to five hours to walk through the units, observe and suggest ways to improve security. Among the most common problem he sees is a wrist ID band that has fallen off as the infant’s birth weight drops in the first few days. If there’s a backup band or sensor attached to another body part, he says, there is less to worry about.

Developers of the security systems are working diligently on the next generation. A system being tested by Pinpoint Corp., for instance, features continuous tracking of the infant wearing a tag device. It can build in what company President Armando Viteri calls a “yellow alert” notification--letting staff know, for instance, when the baby is being moved out of the nursery but is still within the established perimeter.

White hopes the next generation of systems will be able to detect when the sensor is not making contact with the baby’s skin.

As security-system developers fine tune the technology, hospital officials are focusing on helping staff to be more vigilant. Many hospitals now conduct drills, often known as a Code Pink, to guard against abductions. At Valley Presbyterian, for instance, such drills are conducted about every other month. A hospital volunteer brings in a friend who is unknown to the hospital staff to serve as a decoy. The decoy is given a doll, which is wrapped in a blanket or put in a backpack, and then provided an escape route from the hospital.

As soon as the decoy sets out, a Code Pink is announced over the public address system, the signal to hospital staff to man doorways and exits to apprehend the decoy.

Parents--even mothers exhausted from labor--must also be security conscious, experts say. “They should always check the identification badge of the person bringing the baby back into the room,” says Dana Refano, director of Women’s and Children’s Services at Santa Monica-UCLA Medical Center. “Hospital employees are told to identify themselves when they come in to a room. Our ID badges for maternity unit employees are purple with a teddy bear.” And when a baby is returned from the nursery or from medical tests or exams to the mother’s room, the ID bands of both should be checked.

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Peg Eby-Jager of The Times editorial library contributed research to this story.