When medicine and law enforcement intersect (and sometimes collide)
Key Takeaways
Calls to the overburdened 911 system may lead to interactions in the emergency department (ED) between police and physicians that could potentially harm patients.
Police presence in the ED can interfere with patient care and compromise patient rights; patients of color are at highest risk.
Physicians should familiarize themselves with the law and advocate for patients, who shouldn’t be interviewed by the police until they are stable—both physically and mentally. Initiatives such as the 988 Suicide & Crisis Lifeline may help limit unwarranted police involvement.
Emergencies and crises typically start with a call to 911—an estimated 240 million calls are made to the nation's emergency system every year. And those calls can bring law enforcement into the emergency department (ED), putting police and clinicians on a collision course that can potentially harm patients.
The ED can become a gateway for law enforcement in matters of public safety such as assault, gunshot wounds, stabbings, mental health crises, and more. But police and healthcare professionals (HCPs) have conflicting duties and responsibilities, and there are no universal standards in place to guide interactions between police, patients, and physicians.
What can clinicians do to protect patients and ensure the best medical care when there is police presence in the ED?
Police in the ED
Not only is the ED a destination for those needing urgent care; it is also a safety net for individuals with mental health challenges or chronic illnesses that are not treated within the primary care system. But that safety net can be challenged when police enter the picture.
“The problems of policing extend beyond the street and into areas of our lives that are often hidden from view,” according to the authors of an article in the Harvard Law Review (HLR), which focuses on “how policing affects people in a place they are particularly vulnerable: the emergency room.”[]
Compared to recent news about policing on the streets and in public schools, ED security has received minimal attention—in part, because HCPs generally view police presence as desirable and protective.
The role of police is to respond, protect, and investigate, but as reported in the HLR article, police are also using the ED to conduct surveillance and have been observed doing the following in EDs:
Monitoring incoming patients via license plate readers at entrances
Recording names and birthdates—and taking cell phones—of patients who aren’t in custody
Watching patient procedures, and probing staff about patient diagnoses and injuries
Executing search warrants and arresting patients in the hospital
Police presence may directly interfere with patient care.
The article showed that some nurses allocate care based on their perceptions of a patient’s criminality.
Police may involve hospital staff in their procedures. Physicians and nurses can provide police with information, becoming part of the investigation. They also may advise police on whether a patient is well enough to be interrogated.
Targets for police abuse
Although it is common for crisis responses to start with calls to 911, the Bureau of Justice Assistance sees this as inefficient; the calls overburden the 911 system and may bring police into situations where they’re not needed.[]
For Black individuals and other patients of color, receiving trauma care in the presence of police can be particularly stressful.
They may be injured and experience emotionally disturbing practices such as “stop and frisk,” according to University of Pennsylvania authors publishing in Social Science & Medicine.[]
Injured participants valued police officers’ involvement when they perceived that the officers provided safety at the scene, speed of transport to the hospital, or support and information after injury. But they also found police questioning to be “stressful and, at times, disrespectful or conflicting with clinical care,” the authors added.
Protecting patients
With traumatic injury often bridging the realms of healthcare and law enforcement, divergent responsibilities can compromise patient care. Although the police and the healthcare team must protect injured people and public safety, the police’s need to investigate and solve crimes could interfere with medical care and protocols for rapid diagnosis, stabilization, and triage. Moreover, trauma patients are rarely in a position to advocate for themselves.
Publishing in Health Affairs Forefront, the same University of Pennsylvania investigators noted that traumatic injury can lead to psychological and physical injuries that impair a patient’s ability to fully consent to medical procedures and legal interrogation.[]
"Once a person is transported from the scene of an injury and into a health system, health care ethics and laws obligate clinicians to offer help and guardianship."
— Jacoby, et al.
“This includes protection of privacy over health information and patients’ autonomy in decisions that affect health and well-being,” the investigators added.
No standard procedures
Currently, there is no standardized, universal policy that guides interactions between trauma patients, physicians, and police.
"The danger of the current policy landscape is that any interpretive ambiguities can result in ad hoc negotiations for when, where, and how law enforcement activities take place in health care institutions. "
— Jacoby, et al
“This may lead to unintended, informal, and even illegal access to patients and disclosures of their health information to police. It can also promote interprofessional conflict and negative clinical outcomes,” the authors wrote.
Although ED physicians have supported policies that protect the dignity, rights, and interests of patients when law enforcement is involved, these initiatives would require substantial buy-in from healthcare systems to enact, actuate, and monitor them.
Physicians can help protect trauma patients by making patient health a top priority. Law enforcement officials should wait to interview patients until they are stabilized—unless there is a situation of a mass shooting or other extreme public safety risk.
Law enforcement should also wait to interview patients until after they are psychologically able to understand and participate in interrogation. Patients should not be sedated or on narcotics at the time of police interview.
Physicians should familiarize themselves with patient rights, including access to legal counsel, and feel empowered to protect their patients as necessary.
988 Lifeline could help
The 988 Suicide & Crisis Lifeline (formerly the National Suicide Prevention Lifeline) was rolled out in July 2022 to offer individuals experiencing mental health crises access to trained counselors.
Stakeholders see the service eventually expanding into a robust web of community-based providers who can deliver a comprehensive slate of services. Currently, only a small minority of Lifeline calls require police intervention.[]
According to the Bureau of Justice Assistance, “Nationwide, communities are starting to build comprehensive and coordinated crisis systems to improve responses to people experiencing a behavioral health crisis and reduce overreliance on law enforcement officers in these situations.”
In the meantime, wrote the authors of the HLR article, “As we question the harm or necessity of police presence in communities, we should conceptualize ERs as patient sanctuaries to achieve a better balance between the rights of vulnerable patients and public safety.”
It’s hoped that by linking callers with social services, the 988 Lifeline could help relieve the overburdened 911 system and reduce negative interactions between patients and police.
What this means for you
Traumatic injury often brings police and physicians together in ED settings. These interactions can negatively impact patient rights, treatment, and privacy, as well as provision of healthcare. Physicians can familiarize themselves with the law and ensure that police interviews occur after a patient is stabilized and psychologically capable.
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