tionally vulnerable and limited in their ability to
speak for themselves due to their age, developmental
immaturity, and fear of consequences. Safeguarding the health, autonomy, and dignity of a patient
remanded to police custody should be the primary
focus of the physician.
At the same time, physicians and law enforcement
have an important reciprocal relationship that is often
beneficial to both patients and health care providers.
Law enforcement personnel frequently accompany
patients to the emergency department (ED) or seek
access to patients for questioning while they are hospitalized. 1 Physicians in the trauma bay rely on law
enforcement to provide crucial initial information
regarding patients as they arrive from the field. Law
enforcement can be critical in protecting the safety
of health care workers and adjacent patients from
someone who is violent or physically threatening.
The urgent nature of emergency medical and surgical
care and criminal investigation, however, may lead
to potential conflicts of interest regarding access to
patients in the ED.
Police officers have a unique set of responsibilities,
primarily concern for public safety, as they focus on
investigating and preventing crime. Obtaining accurate interview information is often time-sensitive,
which is why, in many cases, these individuals remain
at the bedside in anticipation of obtaining information as soon as the patient can provide it.
Despite the frequency with which law enforcement
officers accompany patients into the ED, few hospi-
tals or state and local governments have policies that
regulate their presence. Indeed, the presence of law
enforcement personnel largely falls outside the ethical
and institutional guidelines of health care institutions.
Nonetheless, law enforcement’s presence may distract
from and negatively affect the quality of care provided
to the patient when police and the medical team have
conflicting goals. Such differences can place surgeons
in difficult situations as they attempt to manage a
patient’s care, particularly when the patient is in extre-
mis or needs emergent procedural intervention.
The following article describes a case in which
police have requested that they remain at the bedside
of a shooting victim. The article specifically discusses
potential ways that the attending pediatric surgeon
could respond to the request.
A pediatric surgeon practicing in a large urban, free-standing children’s hospital is called to the trauma
bay to evaluate a 17-year-old male with a gunshot
wound to the abdomen. The patient is a suspect in an
alleged crime and is accompanied by the local police
upon arrival. His wrists and ankles are handcuffed
to the medical stretcher, and several police officers
are surrounding his stretcher.
The initial trauma assessment reveals the patient
sustained a severe spinal cord injury resulting in paraplegia, as well as gastric and pancreatic injuries that
will require emergent surgical intervention. The multiple officers present insist upon going with the patient
directly to the operating room (OR) and to accompanying him afterward to the intensive care unit (ICU)
so that they can immediately interview him when he
awakens from general anesthesia.
Several members of the nursing staff express
concern that the presence of the officers will be detrimental to the patient’s care, which requires medical
staff to have direct physical access to the patient to
reassess his clinical stability and to provide any
needed emergent care. In addition, the presence of
multiple officers could compromise his private health
information because the officers would be able to hear
and witness medical provider conversations about the
patient. The nurses and other medical staff also are
concerned about the effect that the sudden presence
Despite the frequency with which law enforcement officers
accompany patients into the ED, few hospitals or state and local
governments have policies that regulate their presence. Indeed,
the presence of law enforcement personnel largely falls outside
the ethical and institutional guidelines of health care institutions.