Q&A: The hospital, the law, and the patient

Controversy flared this fall in Salt Lake City after police body camera footage of the July 26 arrest of University Hospital nurse Alex Wubbels went viral. Wubbels had refused a police request to draw blood from a patient, citing hospital policy. Salt Lake City police detective Jeff Payne responded by shouting at Wubbels and handcuffing and arresting her on suspicion of obstruction of justice.

Wubbels was released after 20 minutes, according to The Salt Lake Tribune, and returned to the burn unit approximately 10 days later. Payne was later fired over the arrest, and his watch commander, Lt. James Tracey, was demoted to the rank of officer.

The University Hospital in Salt Lake City announced in August that police will no longer have contact with nurses, but rather deal with hospital administrators instead. In addition, law enforcement officials will no longer be allowed to enter the emergency room, burn unit, or other patient areas.

The Utah case was an example of everything that could go wrong in a law enforcement/healthcare interaction. However, these two groups often have to work closely together. And if a patient comes in who is under arrest, providers need to know the extent and constraints of the law.

The following is a Q&A with Lisa Terry, CHPA, CPP, vice president of healthcare consulting at US Security Associates, Inc. and author of HCPro’s Active Shooter Response Toolkit for Healthcare Workers. She spoke with PSMJ about police/provider interactions and the rights of patients under arrest.

Q: How often do hospitals have to work with the police? How closely do these institutions work together?
Terry: Generally, they work in the emergency department very often. Level I and II trauma centers generally have a police officer there 24/7 in response to injuries sustained in vehicular collisions, fights, or other instances where individuals are injured in a public setting.

Law enforcement also bring individuals seeking behavioral health/mental health assistance to the ED in an effort to obtain medical treatment for them.

Q: When it comes to interacting with the police, should that be done by a specific person (e.g., a hospital liaison officer)? Or should all staff be trained for it?
Terry: In my experience, in order to comply with HIPAA [the Health Insurance Portability and Accountability Act] and the respective state laws, hospitals should have written policies and procedures which detail how and when information is released to external law enforcement agencies. I’ve found these policies to be most successful when they are written in concert with the hospital legal team and the local law enforcement legal teams.

The policy/procedure should [have] a specific position 24/7 to serve as that contact for all external law enforcement agencies. Typically, that designated individual is a leader from the hospital security department, a clinical house supervisor, etc. All hospital staff should have a general working knowledge of HIPAA, but the policy could perhaps designate your “superusers.”

And even superusers should have quick reference guides due to the fact that HIPAA and state laws regarding patient health information are very lengthy and very specific; a lot of legalese. A quick reference guide is very necessary to quickly look, review, and determine whether information may be released.

Q: How does being placed under arrest affect a patient’s rights? What if the patient isn’t under arrest but is in police custody?
Terry: A patient’s freedom of movement is the most obvious right that is affected when he or she is under arrest. The patient may not be able to refuse certain treatments based on the situation (if he or she is contagious, etc.).

In many states, the patient may still have certain rights as far as making sure their privacy is maintained. Generally, most hospitals have a policy in place from a safety standpoint for all concerned to cloak (protect) the custodial/forensic patient’s information from being public. A hospital is a place where the security of the custodial/forensic patient is vulnerable. It’s obviously not as secure as a prison.

Most custodial/forensic patients originate from the Department of Corrections (prisoners who have already been adjudicated) or from state/local law enforcement (individuals under arrest but not adjudicated). Regardless of the type of custodial/forensic patient, most hospitals require that the custodian remain with the patient at all times and that the patient is restrained with a forensic restraint (law enforcement) at all times.

The only exception to this requirement would be due to a medical necessity or procedure for the custodian to remove the restraint. At that time, a determination would be made (for safety) if a medical restraint (chemical, etc.) should be utilized to ensure that the patient remains secure.

This is an excerpt from members-only content. Please log in or become a member to access the full content.