This report coming out of St. Louis County sheds a bit of light on the often murky circumstances of managing patients who are in custody of law enforcement. A paramedic recommended transport for an inmate with abdominal pain, but a police supervisor cancelled the order.
Many, if not most EMS providers have had the distinct pleasure – or displeasure – of responding to jails to evaluate arrested subjects who have a medical complaint of one sort of another. Having evaluated countless numbers of these patients over the years, I can safely say that the vast majority of the presentations were very minor in nature, or frankly, fabricated to allow the subject to leave custody prematurely.
In nearly all situations, the responsibility of evaluating the medical condition rested on my shoulders. The law enforcement officer operated under a set of protocols that got EMS involved; we operated under a set of clinical set of guidelines that managed the patient. The patient was ether left in custody, transported by law enforcement, or transported by EMS. Regardless of outcome, once EMS was involved with the patient, the medical complaint was given first priority.
There were rare occasions where the policer officer involved didn’t realize how this relationship worked, causing a conflict of opinion. In these cases I simply let the officer know that by refusing to follow our clinical decision they were de facto taking on the responsibility of the prisoner’s health and well-being.
That wording was often enough for the officer to change his mind; in really rare circumstances a consult with a police supervisor helped the officer to better understand the liabilities involved.
There are two lessons to be learned by both law enforcement and EMS from this article. First, have a set of mutually agreed policies and procedures in place. Second, accurate and complete documentation is essential. It sounds like the EMS provider in this case did a good job recording his efforts to transport the patient to a medical facility. The paramedic’s PCR needs to demonstrate that there was an effort to perform their responsibilities.
