By Stacey Kusterbeck
If a child is brought to an ED in police custody, providers face multiple patient safety and liability risks. “It’s the extreme cases that challenge us. There are gray-area cases, where sometimes the importance of the investigation contradicts what is medically necessary and important for care,” says Michael Levas, MD, MS, medical director of Project Ujima, a violence intervention program at Children’s Wisconsin.
Emergency clinicians struggle if patient rights, parental rights, or ethical obligations conflict with state or federal laws. For example, law enforcement limits family visitation if a child is in police custody. Emergency clinicians might believe this violates ethical obligations if the child wants a parent present. “Often, there isn’t much guidance from hospitals or academic institutions,” Levas says.
Levas reports there are some recommendations for adult ED patients and law enforcement interactions in the literature, but nothing that addresses minors. Hospital policies on children in custody often are vague, inconsistent, or do not exist. “Some policies are very deferential to law enforcement, and EDs might inadvertently trample on patient rights in the process,” Levas observes.
For example, the law says emergency clinicians cannot just hand over evidence (e.g., a child’s clothing) to law enforcement without a warrant. “But our practices weren’t always taking that into account,” Levas notes.
Law enforcement often ended up taking possession of a minor patient’s items because clinicians misunderstood their legal obligation. On the other hand, police might have probable cause to search the minor patient.
“That’s outside the purview of me as a medical provider. That’s different from me taking something off a patient and handing it to law enforcement, especially if a guardian isn’t present,” Levas clarifies.
Emergency clinicians also should be familiar with local laws pertaining to visitation and parental presence during interviews with law enforcement. Some providers mistakenly assume if a child is in custody, the parents’ medical decision rights are terminated. “There is a lack of awareness. Sometimes, that can lead to policies in hospitals that are not patient-friendly,” Levas laments.
Policies on minor patients and law enforcement require expertise in civil law and patients’ rights. Hospitals and health systems do not always employ someone with that knowledge. “In hospital systems, they have expertise in corporate law and medicolegal compliance, but may not have similar expertise in civil law that may impact some of the more sensitive cases that involve law enforcement,” Levas explains.
This can result in hospital policies leaning heavily on compliance. “But the policies don’t speak to what to do if there are differing opinions between parents and law enforcement,” Levas says.
To provide clear guidance, Levas and colleagues developed recommendations for EDs on how to create policies for law enforcement interactions with pediatric patients and how to advocate for minors in police custody.1 The guidance emphasizes the importance of clear communication. For example, a child brought to the ED for medical clearance might be handcuffed to the bed by law enforcement. Law enforcement might say their policy is to remain in the room during a sensitive physical exam. Levas says physicians and nurses should consider voicing their concerns.
The medical provider might say: “As a provider, I would appreciate it if you would step out for this portion of the exam.” A police officer might say he needs to remain present because the patient has a violent history.
“If we could talk that out, and if we have institutional policies that back us up to have that kind of discussion, we can possibly come up with a good solution,” Levas offers.
Designating a third party who could mediate disagreements also would be helpful. “Often, conversations between the medical team and law enforcement are all that’s needed to come to a satisfactory solution,” Levas says.
Some of the most difficult cases involve youths who die from gunshot wounds. For law enforcement, the priority is evidence collection. “However, to healthcare providers, that body was someone’s child, brother, or sister,” Levas says.
For emergency clinicians, allowing families to see deceased children or allow them to clean up some of the blood, to give the child some dignity, is an ethical imperative.
“But that can be counter to what law enforcement is worried about, in terms of their evidence collection,” Levas explains.
To help sort out these issues in advance, Children’s Wisconsin recently created a group of healthcare providers, quality officers, the hospital’s legal department, security, and local law enforcement. The group meets monthly to discuss actual cases during which there were disagreements between providers and law enforcement about minors in custody. These conversations will inform efforts to revise hospital policies, with the goal of preventing future disagreements.
Clinicians learned about the duties and obligations of law enforcement. “They learned from us that we don’t see patients as evidence or perpetrators or victims — we see them as patients,” Levas says. “Having at least that basic understanding is a good place to start.”
REFERENCE
1. Schultz ML, Winn M, Derse AR, et al. Interactions with police in the emergency care of children: Ethical and legal considerations. Pediatr Emerg Care 2023;39:226-229.
Try gathering healthcare providers, quality officers, the legal department, security, and local law enforcement monthly to discuss disagreements about minors in custody. These conversations can inform efforts to revise policies, with the goal of preventing future disputes.
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content