In emergency departments — a place of care for people at their most vulnerable — police presence is pervasive. Roughly 35% of security officers are uniformed police in public hospitals (where Black patients are mostly likely to receive care), compared to 18% at private hospitals. As an emergency medicine physician and assistant professor of emergency medicine, I urge hospitals and communities to revisit who provides security in emergency departments. A police presence may not only interfere with health care but could also be dangerous for patients.
For instance, undocumented immigrants fear that an encounter with police could result in deportation, or a citizen with warrants may rethink an emergency visit if sharing personal information could result in arrest. In many ways, the courts view the emergency department as an extension of the streets and street encounters with police often end in violence for Black patients.
Most emergency departments in hospitals around the country are staffed by some kind of security officer — with good reason. They can be dangerous places. About half of emergency medicine physicians and 70% of emergency nurses say they’ve been physically assaulted on the job. Having worked in these departments, I know how important it is to protect the safety of health care workers and patients. I support states that have made it a felony to assault health care workers, and wish that others would follow suit. But there are ways to provide a safe work environment without increasing the fear, anxiety and wellbeing of patients.
This was yet another reminder of the carnage Black victims of police brutality experience on the streets, following the Minnesota Court of Appeals upholding the second-degree murder conviction of Derek Chauvin, the former police officer who killed George Floyd in 2020, last week. Tyre Nichols, Breonna Taylor, Michael Brown: these victims remind Black citizens of their vulnerability when interacting with police.
I’ve seen police officers collect identifying information from patient wristbands, inspect or confiscate cell phones and personal property, and gather health information about diagnoses and procedures of patients who aren’t in custody.
A police presence complicates Black patients’ willingness to visit the emergency department for care. Since Black people are more likely to experience violence at the hands of law enforcement, having police there exacerbates existing mistrust in the health care system, which has its own deep-rooted history of abuse toward vulnerable populations. Many Black patients remember the Tuskegee syphilis study that withheld treatment for syphilis without participants’ consent. Of greater significance, anecdotal experiences confirm countless studies supporting that Black patients experience discrimination and worse health outcomes for the same diseases compared to their White counterparts. This amplified mistrust can impact their decision to seek or receive care.
This mistrust is often completely warranted. In many well-documented cases, improperly trained police officers have interfered with treatment, violated privacy or otherwise behaved in ways that hurt patient wellbeing. For instance, in 2015, off-duty officers working as hospital security guards shot Black patient Alan Pean in the chest in a Houston hospital where he was receiving care for bipolar disorder. Pean survived the shooting, only to be charged by police with assault and reckless driving on his way to the hospital. The Houston Police Department chose not to discipline the officer involved in the shooting, and eventually Pean was awarded $902,500 by the city of Houston.
In addition to potential violence, patients may be subject to illegal search and seizure because many courts often view hospital staff as third parties whose actions are not subject to constitutional limitations. If they search a patient’s belongings or body in adherence with the respective hospital’s policy and find illegal contraband that is then turned over to police, some courts have allowed this evidence to be used against the patient in criminal charges. In Schmerber v. California, warrantless searches of patients’ bodies have been deemed constitutional if police are justified in requiring an individual to comply with the procedure.
At times, police officers even intervene in caregiving. In one extreme example in 2017, police arrested a nurse in Utah who refused to draw blood from a patient who wasn’t in custody and was unable to give consent, even though she was in compliance with hospital policies and they didn’t have a warrant. Let us not forget that health care workers can also be members of communities with long histories of trauma as it relates to police presence. And if those workers are stressed, that can also negatively impact patient care.
From my own experience working in the emergency department, I’ve seen police officers collect identifying information from patient wristbands, inspect or confiscate cell phones and personal property, and gather health information about diagnoses and procedures of patients who aren’t in custody.
Hospitals need a multipronged approach to ensure the safety of patients, faculty and staff who interface with law enforcement.
Hospital administration must develop clear protocols for interacting with the police, patients in custody and security guards in a health care setting. This policy should be readily accessible in hospital electronic medical records, and should outline patient’s rights and the extent to which providers must assist in acquiring evidence or sharing information.
Administrators must also require law enforcement and security guards undergo focused implicit bias and diversity, equity and inclusion training before dealing with vulnerable populations. In addition, hospitals should deploy community liaisons within the emergency department to assess patient concerns regarding potential police interactions. Providers should feel empowered to report any concerning activity from police and have a clear process by which to handle grievances, which will vary depending on the hospital. If these processes don’t exist or staff isn’t aware of them, this should be the administration’s first priority.
Lastly, emergency providers and the public need education about their rights to treatment, privacy and safety. Faculty and staff need training in assault laws in their state and how to protect the privacy of patients in custody. The public needs to understand their own rights to privacy in the emergency department, even if they find themselves in police custody or other precarious situations. Policymakers should introduce legislation protecting the medical rights of patients in custody, clearly establishing minimal standards of acceptable care for the incarcerated.
Emergency department patients are often in defenseless states and unable to advocate for themselves. The public and private sectors must create an environment where providers can safely care for patients without fear of being co-conspirators in the perpetuation of police violence against society’s most vulnerable populations.
Katrina Gipson, M.D., MPH, is an emergency medicine physician, an assistant professor of emergency medicine at Emory University School of Medicine and a Public Voices Fellow of AcademyHealth in partnership with The OpEd Project.