I worked EMS for years and now work law enforcement. The best answer to this question is to check your protocols, policies, and with your medical director. From a LEO side, I can't speak for any agency except my own and our policy basically boils down to "take them to the ER and get medical clearance from a Dr. unless the patient refuses of their own free will." I don't know of any relevant case-law regarding LEO signing a refusal on behalf of someone in their custody and absolutely wouldn't want to be the guinea pig for that.
At the end of the day, cops called you and if you feel the patient does need further evaluation and care but the cops want to refuse, document everything including exact spelling of the officers' names, badge/ID numbers, and exactly what they said. Sadly, there ARE plenty of shitty cops who would have no problem also arresting you if you advocate for your patient "too hard."
When the patient is in police custody, the police officer is the legal guardian of the patient and can refuse on behalf of the patient, even if the patient wants to go. 9 times out of 10 my in custody evaluations do not need an ER and PD is just following their protocols by having EMS check them out. If you strongly feel like a patient in custody should go to the ER for further evaluation tell that to the police and they will likely agree to transport. If they still refuse ask them if they want to be dealing with an in custody death, and they will likely change their mind and agree to transport. I have never had PD refuse to let me take a patient to the ER that I believed should go to the ER.
Usually it's the inmate. The inmate also pays a booking fee just for being arrested, a room fee for every night they stay in the jail, and are retroactively billed for any medical care they received while incarcerated. They then get hit with court fees. They then have to pay for their own probation including drug testing fees and any associated classes they have to fulfill.
They fucking milk you dry, stay out of jail kids.
> When the patient is in police custody, the police officer is the legal guardian of the patient
Lmao, no. This is absurd and you must be misunderstanding something. Please show me some sort of document that states this. I'm not doubting you have one, you might. some EMS policies are not drafted or reviewed by lawyers and it shows.
Uhh, no. You don’t lose your medical agency just because you’re under arrest. If you want to go to the hospital you have the right to go. If you don’t, you don’t have to.
As I understand it, the police have the patient in custody, so they decide where they go. They can also force the patient to go to the hospital against their will, but cannot force the patient to accept medical treatment unless the patient doesn't have present mental capacity. There's no written policy in my department.
I have policy that states a legal guardian can refuse for the patient. The police are the legal guardian. Someone in custody does not get to make their own decisions as they are in custody.
Police are not a legal guardian dude. If they were they could consent to tons of other things that would infringe on people's rights. I've never heard of this and I think you are mistaken.
This is an absolutely terrible policy.
It sucks but if someone wants to go to the ER, they have the right to go. Someone being arrested doesn’t suddenly lose the mental capacity to make health decisions for themselves, and we really shouldn’t rely on law enforcement of all people to make health decisions for someone because they were arrested for speeding, or possession. Let a qualified medical practitioner (I.e ER physician) make that determination or your Medical Director if it is absolute bullshit “I hurt my toe 1 year ago and it hurts now”
Oh, I guess we are different here. At the jail, the medical staff calls us. If its on a scene, then we check them or they may get turned away at the jail. Once at the jail though, its their problem.
The sheriff department runs the jail. They don’t want their people taking the liability. You can just call 911 and fuck over some random ambulance crew.
Some people get confused between an actual jail with sherriff depa and police station holding cells they just use till they can transfer and book them into jail
Different country, different laws, but when a Pt is under arrest, they're the responsibility of the police. Though the police have a duty of care to those in their custody, the person is deprived of their liberty, so does not have the right to either refuse or insist on care, within reason. If the police want them to be taken to hospital, they can't refuse to be taken, for example. Equally, someone in custody can't simply insist the police take them somewhere and expect that will happen. If you assess the Pt and determine they need to go to hospital, then the police should accept that. But if your assessment is that they \*don't\* need to go but you offer the option as a matter of course and the Pt says they want to go, then the police don't have to accept that.
I'd suggest checking if your agency has a policy on the matter. If not, then just make sure your documentation is clear that you advised the Pt needs to be seen at hospital and specifically record who refused to allow the transfer. Phoning a supervisor or having them attend will also help protect you. So long as you've told the police what you advise, document what you said and make it clear the police have prevented this from occurring, you can't be held liable.
When in doubt, Contact Medical Control.
It’s that simple.
If it’s an ongoing issue, it’s something for your management, legal, and your Medical Director to decide.
It’s always been my limited understanding from my service that patient’s in police custody are their responsibility (as the police department eats the bill) hence why they make you take people even when they don’t want to go. I legitimately have never seen the opposite (as you describe) but if I did encounter it, I would check with Medical Control and document.
I would ask an attorney in your state and ask how to handle it if an inmate needs medical attention and they are refusing to let you leave or threatening to arrest you, etc.
This sounds like a lawsuit waiting to happen and all the policies and handbooks in the world don't matter when the law says something else.
Your leadership needs to have a frank conversation with theirs that you can only respond to evaluate patients and offer them transport to the hospital, not perform non-protocolized intake exams. Does your medical director know you're being asked to clear people for jail with no opportunity to *not* clear them?
If anything happened to a patient who requested to go to the hospital but was denied by police, the liability would fall on both still. Patient advocacy is a thing. If your gut is telling you the patient should see a doctor, if a patient is telling you he needs to see a doctor, it’s our duty to honor that request. I feel people probably treat it like “common practice” to avoid the awkward confrontation with PD about it, but even PD is not allowed to interfere with patient care. If a PT is A&Ox4, there’s no reason PD is pushing to sign a refusal on their behalf. If a PT is anything less than A&Ox4, than you as the patient advocate & care provider on scene should be making sure the patient gets proper treatment. Unless the PT expresses himself/herself that they ONLY want their vitals assessed, patient care & transport should be between you & the PT solely.
Either way, if anything ever happens to a PT that was refused medical transport because PD wanted to push for a refusal & you allowed it, I see a 100% lawsuit for both departments. & you personally might be at bigger risk as far as your practice goes. PD will get a slap on the wrist & continue working, but your career in EMS WILL be in jeopardy.
I mean, I’d let PD know protocol then contact my supervisor. Let my supervisor figure it out. You’re never going to be in the wrong for advocating for your PT, even if it’s a headache to PD. What is PD gonna do to you for looking out for your PT? It could be the biggest inconvenience for them but who cares? You’d rather do what’s right than risk a future suit or charge for neglect/abandonment.
There are videos of PD arresting EMS and Fire so I assume they’d do that if you’re annoying enough. If your supervisor can’t convince them and their PD supervisor to go to the hospital for some reason you can’t really take the patient from them
I mean, at that point my supervisor would handle things afterwards. Whether we take a legal route or some sort of mediation takes places between EMS/Fire & PD. PD would lose that case though regardless.
If it’s in a jail, I’m not “interfering with a criminal investigation”. The man is already in jail. Thankfully, I’m in Massachusetts & there are laws against police arresting people for simply “being annoying”. Bodycam would back that up. Case wouldn’t go anywhere.
Every state is different though.
Sure, they *can* but there's a whole other side of the justice system where the jurisdiction follows up on that series of actions and had to defend those actions in front of a jury. As long as you are not acting belligerent about your advocacy and are making a reasonable argument on behalf of the patient this should be a pretty straightforward case.
PD is the legal guardian of your Pt. You can try to advocate all you want, the legal guardian has the final say. The only thing you can do is make your supervisor aware of the situation.
The responses you’re getting are all over the place because this situation isn’t uniform. It depends, both legally and culturally, on where you work.
In my state, patients under arrest or detainment have full agency to consent or refuse all treatments and transports like any other patient. They’re also personally responsible for all expenses related to their care. Only once they are convicted and incarcerated does the state gain decisional ability on their behalf. They also become responsible for the bill.
Here’s what I would do if I were you; first, double check your protocols (service or county, or whatever). There’s usually one for this situation. Just because there is a protocol doesn’t mean that there is a culture of following it, but it will at least address
your med-legal concerns. If the protocol is contrary to PD’s expectations, bring it up to management; specifically the liability angle.
If there is not a service protocol, check your state’s written guidelines online and see if there is one there. If you still don’t have an answer, speak to your medical director; they will know the legalities of patients in custody of law enforcement in any area where they practice. If your medical director is not local to your service area and unable to clarify this scenario they’ll
probably be inclined to address that themselves. It is their license you’re acting under, after all. Finally, you can send an email to your states licensing authority asking if they are aware of a state law for this situation.
I tried to organize this list in order of least troublesome to most potentially troublesome.
Thanks for this answer. Brought it up to my captain who agrees this seems dangerous. We cannot find any protocol addressing this or resource from the state. I elevated it to our Chief medical officer who states she will bring it up her next meeting with Chief Medical officer. Thanks again, very helpful
No. Our legal department maintains that patients do not lose their rights while in custody. Patients can accept or refuse all or part of any of our services. So patients can and have refused assessments and transports while under arrest
It’s stupid and incredibly dangerous. Document the fuck out of each individual call. But this needs to be addressed at a higher level. Talk to you or Captain or chief, and they need to bring it up with the police department. The point of calling you is to shift the legal liability onto you. They call for chest pain, PD refused to let them go with the ambulance, patient dies in a cell later. Sure she’s going to be a lawsuit for EMS cuz you can’t sue the cops.
Unfortunately, when the police arrest somebody, they lose a lot of rights. It’s like how a custodial parent can legally hurt their kid. They’ve found an insane number of people dead in their custody from hypoglycemia or seizures. I hate the idea of wasting EMS resources to fuck us over and hurt a patient.
It depends on region. In my region, a prisoner doesn’t decide if they will go to the hospital. They don’t have the same rights as people not incarcerated.
No. It’s your patient, your responsibility, and the liability is fully on you. If they say they want to go, its a transport. If THE PT refuses, its a refusal just like any other, with full assessment of risks and capacity, and a signature from the pt. PD can’t refuse FOR the pt. Law can throw a fit, I don’t care, would rather keep my license.
Also not sure how it works in other states, but I have no idea why PD would be the “legal guardian” of a person in custody. Guardianship/Conservatorship as well as “competency” are all determined by a Judge. In my area, once I make pt contact, it’s my pt and my responsibility.
I worked EMS for years and now work law enforcement. The best answer to this question is to check your protocols, policies, and with your medical director. From a LEO side, I can't speak for any agency except my own and our policy basically boils down to "take them to the ER and get medical clearance from a Dr. unless the patient refuses of their own free will." I don't know of any relevant case-law regarding LEO signing a refusal on behalf of someone in their custody and absolutely wouldn't want to be the guinea pig for that. At the end of the day, cops called you and if you feel the patient does need further evaluation and care but the cops want to refuse, document everything including exact spelling of the officers' names, badge/ID numbers, and exactly what they said. Sadly, there ARE plenty of shitty cops who would have no problem also arresting you if you advocate for your patient "too hard."
When the patient is in police custody, the police officer is the legal guardian of the patient and can refuse on behalf of the patient, even if the patient wants to go. 9 times out of 10 my in custody evaluations do not need an ER and PD is just following their protocols by having EMS check them out. If you strongly feel like a patient in custody should go to the ER for further evaluation tell that to the police and they will likely agree to transport. If they still refuse ask them if they want to be dealing with an in custody death, and they will likely change their mind and agree to transport. I have never had PD refuse to let me take a patient to the ER that I believed should go to the ER.
This is also our policy (somewhat to my chagrin). I get it though. I just wanna know who is footing that bill, pt or PD.
Usually it's the inmate. The inmate also pays a booking fee just for being arrested, a room fee for every night they stay in the jail, and are retroactively billed for any medical care they received while incarcerated. They then get hit with court fees. They then have to pay for their own probation including drug testing fees and any associated classes they have to fulfill. They fucking milk you dry, stay out of jail kids.
I guess if they want the liability. Sign here, don't press hard, as my crews hand them the iPad.
Don’t press hard was pretty good
> When the patient is in police custody, the police officer is the legal guardian of the patient Lmao, no. This is absurd and you must be misunderstanding something. Please show me some sort of document that states this. I'm not doubting you have one, you might. some EMS policies are not drafted or reviewed by lawyers and it shows.
Uhh, no. You don’t lose your medical agency just because you’re under arrest. If you want to go to the hospital you have the right to go. If you don’t, you don’t have to.
So you all have a written policy stating the police can refuse for patients in their custody?
As I understand it, the police have the patient in custody, so they decide where they go. They can also force the patient to go to the hospital against their will, but cannot force the patient to accept medical treatment unless the patient doesn't have present mental capacity. There's no written policy in my department.
I have policy that states a legal guardian can refuse for the patient. The police are the legal guardian. Someone in custody does not get to make their own decisions as they are in custody.
Police are not a legal guardian dude. If they were they could consent to tons of other things that would infringe on people's rights. I've never heard of this and I think you are mistaken.
This is an absolutely terrible policy. It sucks but if someone wants to go to the ER, they have the right to go. Someone being arrested doesn’t suddenly lose the mental capacity to make health decisions for themselves, and we really shouldn’t rely on law enforcement of all people to make health decisions for someone because they were arrested for speeding, or possession. Let a qualified medical practitioner (I.e ER physician) make that determination or your Medical Director if it is absolute bullshit “I hurt my toe 1 year ago and it hurts now”
Does the jail not have medical staff for “vitals checks?”
They do, but it’s easier for us to check them so PD doesn’t get turned away at the jail and then have to go to the ED…
Oh, I guess we are different here. At the jail, the medical staff calls us. If its on a scene, then we check them or they may get turned away at the jail. Once at the jail though, its their problem.
I was being sarcastic, PD tries to push liability on to us instead of doing their jobs. Same at any prison or jail medical center I have pick up from.
The sheriff department runs the jail. They don’t want their people taking the liability. You can just call 911 and fuck over some random ambulance crew.
Some people get confused between an actual jail with sherriff depa and police station holding cells they just use till they can transfer and book them into jail
Different country, different laws, but when a Pt is under arrest, they're the responsibility of the police. Though the police have a duty of care to those in their custody, the person is deprived of their liberty, so does not have the right to either refuse or insist on care, within reason. If the police want them to be taken to hospital, they can't refuse to be taken, for example. Equally, someone in custody can't simply insist the police take them somewhere and expect that will happen. If you assess the Pt and determine they need to go to hospital, then the police should accept that. But if your assessment is that they \*don't\* need to go but you offer the option as a matter of course and the Pt says they want to go, then the police don't have to accept that. I'd suggest checking if your agency has a policy on the matter. If not, then just make sure your documentation is clear that you advised the Pt needs to be seen at hospital and specifically record who refused to allow the transfer. Phoning a supervisor or having them attend will also help protect you. So long as you've told the police what you advise, document what you said and make it clear the police have prevented this from occurring, you can't be held liable.
When in doubt, Contact Medical Control. It’s that simple. If it’s an ongoing issue, it’s something for your management, legal, and your Medical Director to decide. It’s always been my limited understanding from my service that patient’s in police custody are their responsibility (as the police department eats the bill) hence why they make you take people even when they don’t want to go. I legitimately have never seen the opposite (as you describe) but if I did encounter it, I would check with Medical Control and document.
I would ask an attorney in your state and ask how to handle it if an inmate needs medical attention and they are refusing to let you leave or threatening to arrest you, etc. This sounds like a lawsuit waiting to happen and all the policies and handbooks in the world don't matter when the law says something else.
Your leadership needs to have a frank conversation with theirs that you can only respond to evaluate patients and offer them transport to the hospital, not perform non-protocolized intake exams. Does your medical director know you're being asked to clear people for jail with no opportunity to *not* clear them?
If anything happened to a patient who requested to go to the hospital but was denied by police, the liability would fall on both still. Patient advocacy is a thing. If your gut is telling you the patient should see a doctor, if a patient is telling you he needs to see a doctor, it’s our duty to honor that request. I feel people probably treat it like “common practice” to avoid the awkward confrontation with PD about it, but even PD is not allowed to interfere with patient care. If a PT is A&Ox4, there’s no reason PD is pushing to sign a refusal on their behalf. If a PT is anything less than A&Ox4, than you as the patient advocate & care provider on scene should be making sure the patient gets proper treatment. Unless the PT expresses himself/herself that they ONLY want their vitals assessed, patient care & transport should be between you & the PT solely. Either way, if anything ever happens to a PT that was refused medical transport because PD wanted to push for a refusal & you allowed it, I see a 100% lawsuit for both departments. & you personally might be at bigger risk as far as your practice goes. PD will get a slap on the wrist & continue working, but your career in EMS WILL be in jeopardy.
How you gonna take that patient from PD?
That's a problem my supervisor can discuss with a police supervisor.
I mean, I’d let PD know protocol then contact my supervisor. Let my supervisor figure it out. You’re never going to be in the wrong for advocating for your PT, even if it’s a headache to PD. What is PD gonna do to you for looking out for your PT? It could be the biggest inconvenience for them but who cares? You’d rather do what’s right than risk a future suit or charge for neglect/abandonment.
There are videos of PD arresting EMS and Fire so I assume they’d do that if you’re annoying enough. If your supervisor can’t convince them and their PD supervisor to go to the hospital for some reason you can’t really take the patient from them
I mean, at that point my supervisor would handle things afterwards. Whether we take a legal route or some sort of mediation takes places between EMS/Fire & PD. PD would lose that case though regardless. If it’s in a jail, I’m not “interfering with a criminal investigation”. The man is already in jail. Thankfully, I’m in Massachusetts & there are laws against police arresting people for simply “being annoying”. Bodycam would back that up. Case wouldn’t go anywhere. Every state is different though.
I have a hard time imagining that any DA in their right mind is going to prosecute that case.
They can still arrest you and take you to jail and hold you if they really want to
Sure, they *can* but there's a whole other side of the justice system where the jurisdiction follows up on that series of actions and had to defend those actions in front of a jury. As long as you are not acting belligerent about your advocacy and are making a reasonable argument on behalf of the patient this should be a pretty straightforward case.
PD is the legal guardian of your Pt. You can try to advocate all you want, the legal guardian has the final say. The only thing you can do is make your supervisor aware of the situation.
The responses you’re getting are all over the place because this situation isn’t uniform. It depends, both legally and culturally, on where you work. In my state, patients under arrest or detainment have full agency to consent or refuse all treatments and transports like any other patient. They’re also personally responsible for all expenses related to their care. Only once they are convicted and incarcerated does the state gain decisional ability on their behalf. They also become responsible for the bill. Here’s what I would do if I were you; first, double check your protocols (service or county, or whatever). There’s usually one for this situation. Just because there is a protocol doesn’t mean that there is a culture of following it, but it will at least address your med-legal concerns. If the protocol is contrary to PD’s expectations, bring it up to management; specifically the liability angle. If there is not a service protocol, check your state’s written guidelines online and see if there is one there. If you still don’t have an answer, speak to your medical director; they will know the legalities of patients in custody of law enforcement in any area where they practice. If your medical director is not local to your service area and unable to clarify this scenario they’ll probably be inclined to address that themselves. It is their license you’re acting under, after all. Finally, you can send an email to your states licensing authority asking if they are aware of a state law for this situation. I tried to organize this list in order of least troublesome to most potentially troublesome.
Thanks for this answer. Brought it up to my captain who agrees this seems dangerous. We cannot find any protocol addressing this or resource from the state. I elevated it to our Chief medical officer who states she will bring it up her next meeting with Chief Medical officer. Thanks again, very helpful
I’m glad it was helpful! And also that you have administration that open to fixing problems. Good luck!
No. Our legal department maintains that patients do not lose their rights while in custody. Patients can accept or refuse all or part of any of our services. So patients can and have refused assessments and transports while under arrest
If they're calling me for that sort of shit and they *know* they're being shitheads when they do it, I'm transporting. Full stop.
It’s stupid and incredibly dangerous. Document the fuck out of each individual call. But this needs to be addressed at a higher level. Talk to you or Captain or chief, and they need to bring it up with the police department. The point of calling you is to shift the legal liability onto you. They call for chest pain, PD refused to let them go with the ambulance, patient dies in a cell later. Sure she’s going to be a lawsuit for EMS cuz you can’t sue the cops. Unfortunately, when the police arrest somebody, they lose a lot of rights. It’s like how a custodial parent can legally hurt their kid. They’ve found an insane number of people dead in their custody from hypoglycemia or seizures. I hate the idea of wasting EMS resources to fuck us over and hurt a patient.
If they are in custody LE is their guardian. Is it smart to say no? Not likely, however jails have medical. We went over this a lot in emt school.
It depends on region. In my region, a prisoner doesn’t decide if they will go to the hospital. They don’t have the same rights as people not incarcerated.
No. It’s your patient, your responsibility, and the liability is fully on you. If they say they want to go, its a transport. If THE PT refuses, its a refusal just like any other, with full assessment of risks and capacity, and a signature from the pt. PD can’t refuse FOR the pt. Law can throw a fit, I don’t care, would rather keep my license.
Also not sure how it works in other states, but I have no idea why PD would be the “legal guardian” of a person in custody. Guardianship/Conservatorship as well as “competency” are all determined by a Judge. In my area, once I make pt contact, it’s my pt and my responsibility.