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Health Care Access & Coverage
Law Enforcement in the Emergency Department
Police are Commonly Found in EDs – But Hospital Policy is Lacking Regarding Their Interactions With Patients
Patients seeking care for acute illness or injury in the Emergency Department expect to see doctors and nurses. The presence of law enforcement may be a surprise and one that can affect patients’ experiences of health care. Police officers may be present in the ED for a variety of reasons—but their appropriate role in health care settings is not well defined.
The presence of law enforcement in EDs has not been measured or well described. Our team tackled this question by observing the flow of law enforcement through a major urban Level I trauma center for one month to understand the role of law enforcement – how often they were present, for which patients, and why they were there.
As we reported recently in JAMA Surgery, we found that at least one law enforcement officer was present in the ED almost a third of the time (31%). Over the course of the month, they directly interacted with 77 patients, the equivalent of 2% of all patients. Most of these patients were injured by gunshot wounds (39%) and motor vehicle crash injuries (21%). Interactions were brief—generally under 5 minutes in length. While law enforcement officers interacted directly with only a tiny proportion of patients, they were a visible presence for many more.
Law enforcement presence could significantly affect the trust and safety that patients feel throughout their hospital stay especially while vulnerable in the ED. Some patients view police in a protective role – providing security, investigating crimes, and establishing order. Others may feel just the opposite – viewing the police as a threat to their physical, social, and psychological safety due to pervasive structural racism in both law enforcement and health care and their own negative experiences. In some cases, patients may view police in health care space as a threat to the privacy of their health information, which, in turn, can compromise their trust in the hospital as a safe and confidential place for care.
Minimal legal, professional, or institutional policy guides police presence and interactions within health care settings. This lack of policy leaves room for ad-hoc bedside decision-making guided less by data and principle than by variable provider reactions and law enforcement priorities or requests.
Courts generally have interpreted hospitals as extensions of public spaces, where the same rights should apply. But ill and injured patients are less able to advocate for their rights, particularly if they have mental health or addiction issues. The dynamics between civilians and the police in the ED may be affected by pain, medications, hospital staff intervention, lack of control over protected health information, and the inability to walk away from an interaction.
In Philadelphia, interactions may be more frequent than in other areas, due to a unique policy that creates a specific connection between law enforcement and the ED. Police—rather than ambulances—transport more than 3 in 4 patients injured by stabbing or gunshot. In other parts of the country, and in county hospitals in particular, local law enforcement may provide hospital security directly, additionally increasing police presence.
Guidance is Needed in Health Care Settings
Patients seek care in the ED at their most vulnerable moments. It is incumbent upon health care institutions to prioritize patient-centered care over competing concerns by law enforcement. There is an enormous gap in hospital policy when it comes to law enforcement—clinicians should not be left to determine these issues on a case-by-case basis, nor should they be expected to understand patient rights. There is a need for hospital policies that consistently and systematically emphasize patients’ needs for care, privacy, and autonomy and create a clear separation with the roles and duties of law enforcement.
Student, Perelman School of Medicine
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