Police and the ED

[wareagle726]

First of all, I have to start by saying I have immense respect for all the LEO's out there and want to help in any way possible.

I had an interesting case the other day of a clearly intoxicated guy who was stabbed in the chest but refused treatment. I deemed him to not have capacity and did the usual. For the first time, the officer was very upset and continuously questioned everything I did and said that I was "possibly impeding the law" by keeping him and sedating him. I have never had this push back before. I think I was acting in the best way for the patient but it got me questioning what legal justification we actually have. In the end he was fine and sobered up and went with the cops. I would think and hope that our job to take care of the patient supersedes any immediate civil issues although it did make me wonder.

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[skougess]

First of all, I have to start by saying I have immense respect for all the LEO's out there and want to help in any way possible.

I had an interesting case the other day of a clearly intoxicated guy who was stabbed in the chest but refused treatment. I deemed him to not have capacity and did the usual. For the first time, the officer was very upset and continuously questioned everything I did and said that I was "possibly impeding the law" by keeping him and sedating him. I have never had this push back before. I think I was acting in the best way for the patient but it got me questioning what legal justification we actually have. In the end he was fine and sobered up and went with the cops. I would think and hope that our job to take care of the patient supersedes any immediate civil issues although it did make me wonder.

I always tell police “I’m not going to stop you from arresting someone in my ED. That’s your business. But in the meantime I’m going to do my job.”

 

[WilcoWorld]

I would think and hope that our job to take care of the patient supersedes any immediate civil issues

You're right, it does - at least for potential life threats

 

[bravotwozero]

You're right, it does - at least for potential life threats

You'd think the cops would have a vested interest in keeping their suspect alive so they can actually prosecute him/her...not sure how justice is served by letting a suspect die in custody

 

[cyanide12345678]

If you have a decent ethanol number in your results, you are completely right in arguing this person was intoxicated and did not have capacity.

You would have been in a lot more trouble if this person would have left, died, and family would have come out after you. Lawyers would have ripped you apart for letting an intoxicated person make a complex medical decision.

 

[Mushdoc]

On a similiar but different note. I was asked by the RN recently if an intoxicated patient had capacity to sign a consent for to have blood drawn for the police.

On the one hand they were drunk enough that I wouldn’t have said they have medical capacity to leave the ER

On the other hand I feel like legal not really my problem. I am only responsible for/ can only assess the medical risk of venipuncture which is low, not the legal risk. And anyways police let drunk people consent to breathalyzers and searches of their vehicles all the time. That would be a fun defense. Your honor, I couldn’t legally give consent to test me for being drunk...because I was drunk.

I do feel like we sometimes have a double standard for consent. You are too drunk to leave the ER but I will let you consent to this laceration repair or ankle reduction

 

[DeadCactus]

I have never had a bad interaction with a LEO. Still, there are plenty of anecdotal reports of individual officers trying to overstep their bounds. Our duty is to the patient, we are not an arm of the law enforcement apparatus. The goal is not to be antagonistic but I think it's important to keep that boundary firm and very clear.

Capacity is a situationally dynamic concept but I don't think many of us would allow an agitated, intoxicated patient forego medical evaluation for a potentially life threatening injury. That doesn't change just because a LEO wants to take them away.

"I would think and hope that our job to take care of the patient supersedes any immediate civil issues although it did make me wonder."

I wouldn't say our job supersedes it. I would say our job is to do our job as we would for any other patient. Law enforcement can elope with the patient or never bring them in if they think what they need to do is more important. Evaluate them how you normally would, collect consent as your normally would, sedate/hold them when you normally would, and discharge (or let them leave AMA) when you normally would.

 

[Siggy]

I do feel like we sometimes have a double standard for consent. You are too drunk to leave the ER but I will let you consent to this laceration repair or ankle reduction

Confirmation bias.

The patient agrees with what we want to do, therefore we can do it.

The patient disagrees with what we want to do... therefore they must not be of sound mind (age, psych, etc).

 

[AlmostAnMD]

I had a guy who shot a hostage and a cop. The cops beat the **** out of the guy (I assume) and brought him to the ED.

They brought him for "medical clearance," assumably to take him to jail to continue to beat the **** out of him.

In the ED he had a STEMI. They were pissssseedddddddddd I was admitting him. I had a whole SWAT team glaring at me

I mean, what do you want me to do, clear the STEMI?

 

[Matthew9Thirtyfive]

I had a guy who shot a hostage and a cop. The cops beat the **** out of the guy (I assume) and brought him to the ED.

They brought him for "medical clearance," assumably to take him to jail to continue to beat the **** out of him.

In the ED he had a STEMI. They were pissssseedddddddddd I was admitting him. I had a whole SWAT team glaring at me

I mean, what do you want me to do, clear the STEMI?

They were probably hoping you’d let the STEMI kill him.

 

[PianoMedic]

On a similiar but different note. I was asked by the RN recently if an intoxicated patient had capacity to sign a consent for to have blood drawn for the police.

On the one hand they were drunk enough that I wouldn’t have said they have medical capacity to leave the ER

On the other hand I feel like legal not really my problem. I am only responsible for/ can only assess the medical risk of venipuncture which is low, not the legal risk. And anyways police let drunk people consent to breathalyzers and searches of their vehicles all the time. That would be a fun defense. Your honor, I couldn’t legally give consent to test me for being drunk...because I was drunk.

I do feel like we sometimes have a double standard for consent. You are too drunk to leave the ER but I will let you consent to this laceration repair or ankle reduction

My knowledge of medicolegal issues is very limited, but I feel the double standard mentioned might fall under the “reasonable person standard”: what would a reasonable person consent to in this situation.

My face is half hanging off, but I’m drunk: suture my face back together.

My ankle is at a 90 deg angle to my lower leg: safer sedate me and put it back so that it can heal.

Sign out AMA after a 70-90 mph rollover with death of another occupant in the same vehicle: this is where it could get murky. A reasonable person wouldn’t sign out ama unless some extenuating circumstances, so I think in the patients best interest, doing the work up against their stated intent at that time and facilitating that in whatever way is necessary should be defensible.

But I’m definitely no lawyer and have very limited experience in such matters.

 

[Vandalia]

The consent for a blood draw in suspicion of impaired driving is a really simple one: Do you think an attorney is going to argue, "Judge, the blood draw on my client needs to be suppressed because he was too intoxicated to give consent ... oh wait, can I retract that?"

The good/bad thing (depending on your prospective) is that the only way to challenge it is to tie the noose around your own neck.

 

[GeneralVeers]

I don't worry about any police procedures. It's up to them whether they do the things by the book, or break their own rules. I follow the rules and ethics that govern our practice. Every patient is treated the same regardless of whether or not they are in custody. If police want to take someone away before medical screening exam is done, I don't try to stop it, but document the situation.

 

[southerndoc]

The one time I got pushback from a LEO for working up a patient they brought for medical clearance, I asked them if they didn't want my opinion why did they even bring him. Then I told them that he's under arrest, he surrendered his freedom to them when they arrested him, and if they don't want him treated they can choose to take them against my advice. They never said another word after that.

 

[hebel]

Confirmation bias.

The patient agrees with what we want to do, therefore we can do it.

The patient disagrees with what we want to do... therefore they must not be of sound mind (age, psych, etc).

This is known as the patient's ability to assent. Ability to assent to certain treatments generally has a different standard than general consent or capacity (which often is assessing someone's ability to dissent to a usual treatment or standard of care).