Law Enforcement blood draw requests

[chasingdaylight]

I know some hospitals have specific lab techs assigned to do the law enforcement ETOH or other blood draws, but for those of you who have been asked by police to do these, what do you do?
Our hospital policy is very vague, but we do have an agreement that we will help medically clear law enforcement patients and otherwise support them medically. The wording is vague.

I've run into to a few cases in the ER and wanted to see what you all have done.

1. Patient is willing to let you draw - in which case, I've just gone ahead and drawn them.

2. Patient is unwilling and police do not have a warrant - i've tried to refuse, but police have threatened arrest or citation. Police usually take patient to county ward, but after prolonged arguments/threats.

3. Patient is unwilling and police have a warrant - never been in this situation, but am told I generally must do as told by police? even as a private physician?

I'm told the laws are state specific, but in my cursory search couldn't find clear guidlines for CA.

Any thoughts?

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[Siggy]

Are you following the Salt Lake City RN situation?

If anything, I would send an email out to your hospitals lawyer, he would be the best resource... especially since police are apt to arrest medical providers regardless of whether the officer's demand is lawful or not.

 

[chasingdaylight]

yea I read about that case. I heard law enforcement everywhere is now being a little more careful, but our place still doesn't have a clear policy. Wanted to get some ER input and try to develop a policy before we really get put on the spot. I'm emailing our hospital RISK management staff as well. I'll keep you posted if they respond with something interesting.

 

[Siggy]

yea I read about that case. I heard law enforcement everywhere is now being a little more careful, but our place still doesn't have a clear policy. Wanted to get some ER input and try to develop a policy before we really get put on the spot. I'm emailing our hospital RISK management staff as well. I'll keep you posted if they respond with something interesting.

The problem is that it's not a medicine question. It's a legal question. The last thing you want to do is be put into a position where a person is saying that you assaulted them because you forced an unlawful lab draw. This ignores the issue of forensic lab draws (which includes important issues of chain of custody) is different from a regular medical lab draw.

 

[Dr Mantis Toboggan]

Do you mean the police have threatened to arrest/cite you? For what, following the constitution?

If they have a warrant, which happens frequently at our shop as it is just a mile from the county jail, the lab or nurses just draw the blood. Docs don't see those patients automatically, unless a medical complaint arises ("chest pain" etc)

 

[deleted109597]

You cannot obtain the blood without consent or a warrant.
Even with a warrant, they cannot make you do anything (you're not an agent of the state). You may have to spend the night in jail to prove this, but you'll also become famous and wealthy (maybe not the last part).
Your physician staffing group should write a memo to the effect that "physicians are not to be used in the obtaining of specimens for law enforcement" as you will get subpoenaed approximately 100% of the time. Every hospital I've worked at doesn't even have the nurses do it because they don't have enough to cover the court time. It's up to the techs.

 

[migm]

The patient in the emergency department is under my care and my license for things I think they medically need. Anything else is not my problem and I will not order or do anything i don't think is indicated. The nurses can do whatever their policy says.

 

[WaffleSyrup]

I know some hospitals have specific lab techs assigned to do the law enforcement ETOH or other blood draws, but for those of you who have been asked by police to do these, what do you do?
Our hospital policy is very vague, but we do have an agreement that we will help medically clear law enforcement patients and otherwise support them medically. The wording is vague.

I've run into to a few cases in the ER and wanted to see what you all have done.

1. Patient is willing to let you draw - in which case, I've just gone ahead and drawn them.

2. Patient is unwilling and police do not have a warrant - i've tried to refuse, but police have threatened arrest or citation. Police usually take patient to county ward, but after prolonged arguments/threats.

3. Patient is unwilling and police have a warrant - never been in this situation, but am told I generally must do as told by police? even as a private physician?

I'm told the laws are state specific, but in my cursory search couldn't find clear guidlines for CA.

Any thoughts?

I think you have the right idea for Ca
1. Patient consents - go ahead and draw.
2. Patient does not consent or is unable to consent (Unconscious) - Refuse and take the arrest... try to have someone film the threats and arrest if possible.
3. Patient doesn't consent and police have a warrant - Do the draw as required by law.

Here is a page with some specific info on California law implied consent and recent Supreme Court changes. It also mentions that hemophiliacs are exempt from blood tests and must give urine instead. (Sorry, I can't post links until I get more likes and messages. The page is abc10newslocalcalifornia - what are your california rights when police request a blood a blood test.
Let me know if you can't find it and I will copy and paste the info. It's long but really good information for ED medical personnel in California.

 

[Siggy]

I think you have the right idea for Ca
1. Patient consents - go ahead and draw.
2. Patient does not consent or is unable to consent (Unconscious) - Refuse and take the arrest... try to have someone film the threats and arrest if possible.
3. Patient doesn't consent and police have a warrant - Do the draw as required by law.

Here is a page with some specific info on California law implied consent and recent Supreme Court changes. It also mentions that hemophiliacs are exempt from blood tests and must give urine instead. (Sorry, I can't post links until I get more likes and messages. The page is abc10newslocalcalifornia - what are your california rights when police request a blood a blood test.
Let me know if you can't find it and I will copy and paste the info. It's long but really good information for ED medical personnel in California.

It's important to note that the California Implied Consent law also requires that the person be arrested for it to come into affect. If the patient isn't in police custody, then implied consent does not apply. This was also a component of the Utah incident.

"23612.

(a) (1) (A) A person who drives a motor vehicle is deemed to have given his or her consent to chemical testing of his or her blood or breath for the purpose of determining the alcoholic content of his or her blood, if lawfully arrested for an offense allegedly committed in violation of Section 23140, 23152, or 23153. If a blood or breath test, or both, are unavailable, then paragraph (2) of subdivision (d) applies.

(B) A person who drives a motor vehicle is deemed to have given his or her consent to chemical testing of his or her blood for the purpose of determining the drug content of his or her blood, if lawfully arrested for an offense allegedly committed in violation of Section 23140, 23152, or 23153. If a blood test is unavailable, the person shall be deemed to have given his or her consent to chemical testing of his or her urine and shall submit to a urine test.

(C) The testing shall be incidental to a lawful arrest and administered at the direction of a peace officer having reasonable cause to believe the person was driving a motor vehicle in violation of Section 23140, 23152, or 23153."
Law section

 

[link2swim06]

I would not do a procedure without patient's consent.

Reminds me of the case where the police go a warrant for a colonoscopy to look for drugs (except warrant was accidental wrote in the wrong county). And the patient refused the colonoscopy but the physician did it anyways.

Nurses aren't employed by me and can do whatever they want/the hospital agree to do.

If the nurses couldn't get blood, I would not do a fem stick in the above scenario.

 

[Nikj]

Even with a court order/hospital policy, doesn't forcing a Physician, or anyone for that matter, to do any kind of task violate the 13th amendment?

Edit: Never mind, I found the Supreme Court ruling saying that the Government can call upon individuals to act.

 

[Birdstrike]

It's your job to diagnose and treat your patients. It's not your job to be a lab tech for the local police department or to collect evidence for a cop. It's the cops job to collect evidence, of any sort. If a cop orders a physician to start doing procedures, that's inappropriate, they shouldn't do it, and you shouldn't have to do it. It's no more appropriate for a cop to demand a physician do portions of the police officers job, that it would be for a physician to demand a cop do portions of his. Police evidence collection (blood or otherwise) is not a physician's duty.

If a cop wants blood for evidence they can draw their own blood. However, I've never had a cop demand I do this, in over 30,000 patient encounters in the ED and another 15,000 outpatient encounters. If the cops state they (or their department lab draw officer) are going to draw blood from a patient, I feel my former residency director (now-retired and former ABEM president) gave me damn good advice by saying, "State the policy and don't stand in the way of what a cop insists on doing. If they draw blood and their blood draw gets thrown out of court later, it gets thrown out of court. So be it. It's not smart to fight with a cop in the ED." She was smart. She knew that getting into it with a cop on an ED shift was not likely ever going to end well. Rarely, if ever, did that woman give me bad advice.

And if your hospital administration thinks it's a good idea and your role to be mixing it up with demanding cops, the first thing you need to do is start looking for a new job. If your administration thinks it's a good idea, they can send down an unarmed administrator to get between the armed cop and what he wants. And you can bet your a-s that never, never, never in a million years would an adminiatrator personally risk their hide to defy an angry cop. Never.

We didn't go to medical school to fight with armed cops. We didn't go to medical school to interpret law like a judge. We didn't go to medical school to learn how to be bodyguards or human shields. We went to medical school to provide medical care to patients.

Also, remember there's a huge distinction between a cop demanding a physician or nurse take blood for them, and a cop wanting to draw blood himself and medical personal standing in his way. Everyone seems to want to confuse the two. Don’t.

Bottom line: Do your job. Don't try to be a cop, judge, or security guard. And don't go to a gun fight armed with only stethoscope.

 

[Siggy]

It's unfortunate that no one wants to advocate for patients anymore. The police obviously don't give a damn about even the law anymore. Heck, the officer that frog marched the nurse out of the hospital is still on paid vacation.

Salt Lake City police chief has yet to decide whether to discipline officers in Utah blood-draw case

 

[Birdstrike]

It's unfortunate that no one wants to advocate for patients anymore.

I advocate for my patient's every day, always have, always will, and so does every physician, nurse, PA and NP that I know. But to say that not being willing to fight armed law enforcement, while armed with only a white coat and a stethoscope means "no one advocates for their patients anymore" is hyperbole, to say the least. Again, I've never, in 45,000 patient encounters had a cop demand I do anything in a medical setting, let alone demand I do a blood draw or any other procedure on a patient. Conflating that scenario with one where medical staff actively try to prevent law enforcement from drawing blood themselves, is apparently what everyone wants to do. But they are vastly different scenarios, with different implications.

Heck, the officer that frog marched the nurse out of the hospital is still on paid vacation.

Salt Lake City police chief has yet to decide whether to discipline officers in Utah blood-draw case

My guess is that with all the press around this case, there will be discipline, but like any other time a government agency tries to fire someone, it takes forever, with review panels, board decisions, and other red tape. Wrongful termination lawsuits with big payouts are common (governments have the deepest of all pockets) and they want to prevent that by following their protocols and crossing every "t" and dotting every "i." Give it some more time. I'd be surprise if there aren't some consequences for this officer given all the bad press, but I could be wrong. Much stranger things have happened.

 

[Birdstrike]

My guess is that with all the press around this case, there will be discipline, but like any other time a government agency tries to fire someone, it takes forever, with review panels, board decisions, and other red tape. Wrongful termination lawsuits with big payouts are common (governments have the deepest of all pockets) and they want to prevent that by following their protocols and crossing every "t" and dotting every "i." Give it some more time. I'd be surprise if there aren't some consequences for this officer given all the bad press, but I could be wrong. Much stranger things have happened.

Cop who forcibly arrested nurse for refusing to draw blood is fired http://nyp.st/2yfihSx via @nypost

 

[WilcoWorld]

Here are the principles necessary to handling these situations in the ED:

1 - Take good care of the patient.
2 - Don't willfully or wantonly mishandle the evidence.

If you cover those two, you're doing a good job.