A Penn LDI Panel Looks at Health Equity and Other Issues in a Post-Dobbs World
When Health Care and Law Enforcement Overlap
Ideas From a Symposium of Stakeholders
On September 24, 2021, the virtual symposium “When Health Care and Law Enforcement Overlap” convened six expert panels to discuss how emergency treatment, law enforcement, legal rights, scientific evidence, and ethics intersect in the context of professional and institutional purview. The discussion illuminated areas of concern and generated suggestions for policies and processes that balance medical, public safety, and privacy concerns at this critical intersection.
“One thing that law enforcement and emergency care have in common is that in our society where we have disinvested in so many systems and structures of care… the challenges, particularly that vulnerable people face, often end up in the hands of law enforcement or in the emergency room, or both.”—LDI Fellow Elinore Kaufman, MD, MSHP
Clinicians’ Perspectives on Providing Health Care in the Presence of Law Enforcement
Physician panelists representing pediatric and emergency medicine, trauma surgery, and internal medicine emphasized the importance of providing health care in ways that support dignity, compassion, respect, and patient privacy. Law enforcement can be a partner in protecting patients, staff, and the public. However, the combination of armed law enforcement and questioning patients in the treatment setting has the potential to exacerbate existing trauma and erode the patient-provider therapeutic alliance. This dynamic has the potential for greater impact on patients of color. Additionally, particularly in the pediatric setting, the involvement of law enforcement can impede communication between providers and a patient’s family members and guardians. Panelists reflected on the many ways that emergency care can potentially undermine people’s rights, despite its best intentions to help. There is little understanding of what comprises best practices for law enforcement in emergency care spaces, and current policies and efforts to educate hospital staff regarding their rights and responsibilities when interacting with law enforcement in the emergency department are inadequate.
Reconciling the Goals of Public Health and Public Safety
Individuals with expertise and experience in policing and law enforcement discussed how to align the goals of clinical care and public safety. The perception of whether a patient is a suspect, a victim, or a witness often dictates how the patient is approached and treated, both by law enforcement personnel and hospital staff. Panelists commented that these discussions center on “safety,” but urged listeners to consider: “Whose safety are we considering? And how are we coming to the conclusion that safety has been achieved?”
Panelists noted the knowledge, role, and responsibilities of a law enforcement officer depends on their rank. The officers most likely to accompany an individual under arrest to the emergency department are junior ranking patrol officers who are being supervised remotely. Panelists noted that there is no standard training for officers on optimal conduct in hospitals. Furthermore, the number of jurisdictions (18,000 agencies in the country), makes it very difficult to standardize a training program.
Supporting Patients Through Advocacy, Organizing, and Social Services: How Communities are Responding to Law Enforcement in Hospitals
The panel of community organizers and legal experts discussed proposed strategies for navigating policing in health care. They suggested health care providers could intervene when observing a potentially harmful interaction between a patient and a police officer and discussed institutional changes that could reduce harms associated with law enforcement in hospitals. They mentioned current efforts spearheaded by health care providers, including removing sheriffs’ offices from health care settings, organizing to address the harms associated with mandatory reporting of specific events that are not associated with increased safety or better patient outcomes, and mobilizing and advocating to overhaul child welfare and family regulation systems to eliminate their inherent racial and economic biases. The panelists suggested that health care providers receive training on trauma-informed approaches to deescalating conflict and that clinicians should know how to guide patients to mental health and other social services if they have been harmed in police encounters.
Evidence, Impact, and Context: What We Do and Don’t Know from Multidisciplinary Perspectives on Law Enforcement and Health Care
The symposium concluded with a panel of academic researchers in the fields of nursing, sociology, law, criminology, and anthropology. They reviewed the state of evidence on the relationships between law enforcement procedures and policies and clinical care, and described the many challenges and opportunities that exist when conducting research on this multidisciplinary topic. The current climate in support of social justice and equity encourages evaluative inquiry into topics that may have previously seemed too broad in scope. The panelists recommended that researchers invest in cross-sector collaborations, develop multidisciplinary research teams, and evaluate areas where law enforcement increasingly overlaps with public health and medicine, such as naloxone distribution programs.
Reflections and Recommendations
- Currently, there is no statutory right to patient privacy in health care settings when there is an overlap with law enforcement procedures. The Health Insurance Portability and Accountability Act (HIPAA) was designed for portable and discrete pieces of health information, not for the dynamic situations that occur when law enforcement activity is present in clinical care areas. Laws that consider the unique vulnerabilities of patients in health care settings and training of medical providers on how to best use their discretion, are needed to protect patients, law enforcement officers, health care providers, and institutions.
- Members of law enforcement lack clear guidance for their actions in hospital settings. A potential remedy might be local hospital/law enforcement partnerships tasked with creating policies to guide hospital law enforcement in collaboration with members of the community. Once developed, patrol officers could be provided with a “pocket guide” or “reference card” summary of the agreed-upon rules of conduct. If possible, hospitals could designate a liaison and a space for law enforcement activity within hospitals to minimize unnecessary contact with other patients and staff.
- Health care providers also require guidance for interacting with law enforcement while caring for patients in the hospital setting. Hospitals must develop clear policies for interaction with law enforcement that are centered on patient privacy. Clinicians, often unaware of ethical and legal boundaries, may defer to the authority of law enforcement officers, which highlights the need for additional education and training among health care providers about their obligations to uphold and advocate for their patients’ rights. The toolkit developed by the Working Group on Policing and Patient Rights might be a starting point.
The goal of this event was to start the conversation and to spark further discussion, collaboration, research, and practice or policy changes. Thank you to the symposium panelists.
This symposium was co-hosted by Penn LDI and the Penn Medicine Department of Emergency Medicine, and was co-sponsored by the Campaign for Community, Penn Injury Science Center, and Penn Medicine Trauma Center.
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