Do No Harm: When Police enter the Hospital
By: Hattie Huston-Paterson, Md, Amanda Labora
Tags: Doctors, Police Brutality, Surgery, Trauma, Racism

Do No Harm: When Police enter the Hospital

When Jacob Blake was shot seven times in the back in Kenosha, he arrived at the hospital handcuffed to the bed, accompanied by police.

On any given night at Los Angeles trauma centers, we see the murky entanglement of healthcare and law enforcement play out. Trauma centers are hospitals accredited to take care of the most critically ill people after injury. If you are shot, stabbed, assaulted or in a bad car accident, you will arrive at a trauma center, where a team of trauma surgeons and emergency providers will evaluate and treat your injuries.

In this city, police are often the first responders to scenes of injury, sent to “secure the scene” before the arrival of medics. It is common for people who are shot to see a police officer before a medic. Trauma Centers in some cities have collaborated with the police to take advantage of this head start. In Philadelphia, police officers “scoop and run” people who have been shot, taking them directly in the police cruiser to the hospital. This has been demonstrated to improve survival. Here in Los Angeles, however, the police accompany the medics to the hospital and continue in their role of investigators and law enforcement around the care of the injured patient. Sometimes these people are in police custody when they arrive to us and may have handcuffs or other restraints applied by the police prior to arrival.

Police take their role of securing the scene seriously, which can create blind spots about the urgency of the patient’s injuries as well as the legal boundaries of patient privacy. Trauma bays — the space in the Emergency Room where we resuscitate critically ill patients — are small, and a police officer can take up limited essential space. It is not uncommon for us to ask people — learners, extra nurses, junior doctors — to leave to have more space to work. A police officer is unaware of this workflow and sometimes does not leave when asked. Physical restraints, like handcuffs, can be a dangerous barrier to examining and treating a patient with serious injuries. We must move fast, and the inability to examine or treat due to handcuffs can critically delay life-saving interventions. When a patient needs to go to the operating room, police will often follow and wait outside, asking for detailed status updates. They seem to not have training in federal restrictions on protected patient information.

In the most extreme cases, the presence of police in the Trauma Bay has turned deadly. In 2016 at Harbor-UCLA, Ruben Jose Herrera, a patient with bipolar disorder was brought in for a trauma evaluation. When he used a metal stool to create physical distance between himself and the police who were accompanying him, the police responded by shooting him in the chest, killing him. Redirecting agitated and unruly patients who are too confused, scared or sick to keep themselves safe while under our care is commonplace. We have the tools and training to prevent patients from harming themselves or others.

As surgeons, when a patient experiences a surgical complication on our watch — let alone a death — we conduct a detailed root-cause analysis and search unflinchingly for our mistakes. We publicly present complications to our peers so that they might never happen again. Patient harm caused by police presence is an unacceptable, preventable outcome that deserves equally close examination.

Hospitals and professional organizations must step up and create clear guidelines that support the right of patients to access healthcare free of interference and intimidation by the police. Additionally, police officers who routinely enter hospitals need training on healthcare privacy laws.

Though much has been written about the use of hospital-employed armed guards, the access of police to patient care areas has gone on in the name of workplace safety. In San Francisco, a coalition of healthcare workers is calling for the removal of the sheriff’s department from the city’s Level I Trauma Center, where they act as hospital security, citing disproportionate use of force on Black patients seeking emergency care. Workplace violence, disproportionately experienced by our nursing colleagues, is a serious issue. But as a collective, we must re-imagine what a culture of safety looks like. We need to examine our own biases for why certain types of patients — namely our Black and brown patients — conjure feelings of being unsafe.

The lack of institutional guidelines and support make it difficult for individual providers, especially when they are also people of color, to enforce boundaries with the police. Hospitals and professional bodies need to stand up to the potential for police brutality in the hospital by delineating clear expectations, guidelines, and accountability structures. We must develop clear limitations for police involvement in the care we provide. First of all, police should not be allowed in patient care areas without the explicit permission of the physician in charge. Physicians are well-poised to determine a patient’s medical stability and mental competency to interact with the police. Hospitals should post clear guidelines in patient care areas that describe patient and provider rights regarding police presence. Large public and private healthcare organizations should engage with the LAPD to provide training on HIPAA-compliant questions pertaining to patients. Lastly, there should be a clear mechanism for providers and patients to raise concerns and complaints about police behavior in hospitals.

Police presence in the hospitals can visit trauma upon our patients and our colleagues, many of whom carry a reasonable distrust of the police. It also interferes with medical care, especially in the current environment where police do not have formal training on patient privacy.

Above all, the presence of police in the hospital threatens our core duty: to comfort and heal the afflicted. Police presence centers the legal and criminal justice narratives of physical injury and may introduce bias into the care that we provide. We are called to care for people from every walk of life, free of judgment and regardless of circumstance. Better protections for patients around police involvement in the hospital is essential to continuing in this aim.

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Dr. Hattie Huston-Paterson and Dr. Amanda Labora are resident surgeons in Los Angeles who run Equal Treatment, a non-profit organization focused on racial justice in surgery.