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Alur R, Hall E, Khatri U, Jacoby S, South E, Kaufman EJ. Law Enforcement in the Emergency Department. JAMA Surg. 2022;157(9):852–854. doi:10.1001/jamasurg.2022.2595
Law enforcement officers (LEOs) may interact with patients and clinicians in the emergency department (ED) when seeking medical care for individuals under arrest, investigating crimes, and providing security. These objectives may not align with clinician and patient priorities.1 Patients and clinicians have reported that LEO presence in the ED can disrupt clinical care, interfere with privacy, compound stress and trauma, and decrease patient trust in clinicians.2,3 Furthermore, unequal exposure to law enforcement may exacerbate racial bias and disparities in health care.3 Little is known about the frequency, circumstances, and context of LEO presence in US EDs. In this qualitative study, we quantifed LEO interactions with patients and clinicians in an urban ED.
The University of Pennsylvania Institutional Review Board approved this study and waived the informed consent requirement because no patient contact occurred. We followed the SRQR reporting guideline.
Systematic social observations of patient-clinician interactions with LEOs were conducted from July 6 to August 6, 2021, daily from 7 am to 7 pm plus 12 evenings from 8 pm to 12 am, at Penn Presbyterian Medical Center in Philadelphia, Pennsylvania. Trained observers recorded time, place, and duration of encounters as well as numbers and types of LEOs present and duration of their presence. Patient chief concern, demographic characteristics, ED length of stay, and disposition were collected from the electronic medical record. These data were compared with those of the total census of ED patients during observation periods. Patient race and ethnicity were collected from the electronic medical record to explore known racial inequity in exposure to policing.
Proportions were compared using χ2 tests, and continuous variables were compared using the Kruskal-Wallis test. Two-sided P < .05 was considered significant. All calculations were performed with Stata, version 16 (StataCorp LLC).
During 348 total observed hours, at least 1 LEO was present in the ED for 108.4 hours (31%). LEOs interacted with 77 patients (2% of total ED patients [n = 3414]) directly (in conversation and/or with physical contact) and indirectly (waiting outside patient rooms) (Table 1). Evening observations accounted for 13% of observed time but 31% of LEO encounters. Among patients with LEO interactions, the most common chief concerns were gunshot wounds (37%) and motor vehicle crash injuries (21%) (Table 2). A total of 140 encounters were observed for 77 patients. Direct interactions lasted a median (IQR) of 5 (3-6) minutes for patients (n = 51) and 2.5 (2-3) minutes for clinicians (n = 46). A median (IQR) of 2 (1-3) LEOs were present per patient. In 4 cases (5%), the patient was a LEO accompanied by additional LEOs. Patients stayed in the ED for a median (IQR) of 4.1 (2.6-5.2) hours.
In recent interviews, ED physicians’ perspectives on LEO presence in the ED ranged from extremely supportive (felt safer) to extremely unsupportive (felt it harmed patient trust).4 Little legal, professional, or institutional policy exists to guide these interactions, and clinicians and LEOs lack training in this area,5 leaving the potential for ad hoc decision-making based on variable clinician reactions and LEO priorities that could compromise patient care.1 To our knowledge, this study was the first structured social observation of LEO presence in the ED. Limitations include findings that reflect local conditions and may not be generalizable.
Although LEOs interacted directly with few patients, their presence was common and had unknown implications for other patients, clinicians, and the care space. The courts have typically interpreted hospitals as extensions of public spaces, but patients with illness and injury are made more vulnerable by pain, adverse effects of medications, hospital staff intervention, lack of control over their protected health information, and inability to walk away from an interaction.6 Therefore, it is incumbent on health care institutions to prioritize patient-centered care over competing concerns by creating policy that consistently and systematically emphasizes patients’ need for care, privacy, and autonomy as the guiding principles for law enforcement activity within the clinical space.
Accepted for Publication: April 16, 2022.
Published Online: July 20, 2022. doi:10.1001/jamasurg.2022.2595
Corresponding Author: Elinore J. Kaufman, MD, MSHP, Penn Presbyterian Medical Center, 51 N 39th St, Medical Office Building, Ste 120, Philadelphia, PA 19104 (firstname.lastname@example.org).
Author Contributions: Dr Kaufman and Ms Alur had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Concept and design: All authors.
Acquisition, analysis, or interpretation of data: Alur, Hall, Jacoby, South, Kaufman.
Drafting of the manuscript: Alur, Kaufman.
Critical revision of the manuscript for important intellectual content: All authors.
Statistical analysis: Alur, Kaufman.
Obtained funding: Alur.
Administrative, technical, or material support: Alur, Hall, Kaufman.
Supervision: Hall, Khatri, Kaufman.
Conflict of Interest Disclosures: Dr Kaufman reported receiving a grant from Agency for Healthcare Research and Quality during the conduct of the study. No other disclosures were reported.
Funding/Support: This study was supported by the University of Pennsylvania Medical Student Health Services and Policy Research Summer Fellowship (Ms Alur).
Role of the Funder/Sponsor: The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.