EXECUTIVE SUMMARY

The shocking arrest of a Utah nurse following an emotionally charged interaction with a police detective has prompted heated discussions among frontline providers and policy reviews at hospitals across the country. The arrest occurred after the nurse refused to supply a blood sample from an unconscious accident victim, citing hospital protocol. The nurse was not charged in the incident, and support for her has poured in from nursing leaders, but the incident remains under investigation.

  • Legal observers suggest the nurse was correct to stand her ground in the incident, but fault her for resisting the arrest.
  • Most experts agree the detective demanding a blood sample was derelict in his aggressive handling of the case, and should not have arrested the nurse.
  • Experts urge ED leaders to review the case with staff and to clarify how to handle such incidents in the future so that disagreements are minimized, and interactions between law enforcement and hospital workers are collaborative and respectful.

Hospital workers and law enforcement officers often drill together, and they generally work cooperatively to ensure safety and security. Consequently, while disputes are not unheard of, the well-publicized arrest of a Utah nurse on July 26 who refused to comply with a police detective’s request for a blood sample is a reminder that frontline providers must be well-versed in how to handle such requests. These requests must be handled in accordance with a hospital’s legal counsel, and hospitals should create specific guidelines and put resources in place. This will help frontline providers when law enforcement personnel make improper requests or resort to bullying tactics.

Leading up to the Utah incident, police were in a high-speed pursuit of a suspect on a state highway. The chase ended when the suspect’s vehicle collided with a truck, killing the suspect and severely injuring the driver of the truck, who then was expedited to the University of Utah Hospital in Salt Lake City.

Reports indicate that although the truck driver was not suspected of being at fault in the crash, police requested a blood sample from the patient to definitively rule out the existence of any illegal substances in his blood. However, the patient was not conscious and therefore could not consent to the blood draw.

For this reason, Alex Wubbels, RN, a nurse on duty in the burn unit where the patient was receiving treatment, refused to provide the blood sample without a warrant, citing hospital protocols. A heated argument, lasting several minutes, ensued on the floor of the burn unit. Then, with the apparent support of his supervisor, Jeff Payne, the detective who was demanding the blood sample, took hold of Wubbels, shoved her out of the building, and then cuffed her hands behind her back. While Wubbels screamed that she was being assaulted, the detective insisted that she was interfering with an investigation. Hospital security reportedly did not intervene in the incident.

Open Lines of Communication

Ultimately, Wubbels was not charged, but she told the press that she was angry and confused, and that she felt betrayed. Further, video of the incident circulated widely, generating considerable support for the nurse’s attempts to stand up for her patient, particularly among fellow frontline providers. Karen Wiley, MSN, RN, CEN, president of the Emergency Nurses Association (ENA), calls the incident shocking, upsetting, and disappointing. “We applaud Alex for her commitment to doing what’s right for the patient, and for using her platform to advocate for patient safety,” she explains.

Wiley adds that the incident was a hot topic at ENA’s annual conference in St. Louis in September, and that Wubbels made a surprise appearance at the conference. Further, Wiley notes that while the situation in Utah appears to have been grossly mismanaged, it presents an opportunity for ENA members to focus on patient safety and advocacy. “Secondly, we encourage emergency departments to open the lines of communication with hospital security and local law enforcement officials in a productive and meaningful manner,” she says. “The police responsible for what happened to Alex should be held accountable for their actions. However, that situation is not indicative of our historically collaborative working relationship with law enforcement.”

In fact, the ENA has reached out to the International Association for Healthcare Security and Safety (IAHSS) and the National Association of Police Organizations. Wiley says both organizations are supportive of efforts to work together with the ENA to ensure that a situation like the incident in Utah never happens again. “We are encouraged at the opportunity we have to collaborate with these groups on a common goal and additional education as needed,” Wiley observes.

In addition to advocating for patient rights, there are other lessons emergency personnel can learn from the incident, Wiley offers. “Alex remained calm and professional. She knew to bring in hospital administration and to clearly communicate her hospital’s protocols and procedures,” she says. “Starting a conversation with hospital security and law enforcement now can help build relationships and education in an effort to prevent this type of situation from happening in the future.”

In a statement about the incident, the American Nurses Association (ANA) offered harsh reviews of law enforcement’s actions in this case. “It is outrageous and unacceptable that a nurse should be treated in this way for following her professional duty to advocate on behalf of the patient as well as following the policies of her employer and the law,” said Pam Cipriano, PhD, RN, NEA-BC, FAAN, president of the ANA. “Nurse Wubbels did everything right. It is imperative that law enforcement and nursing professionals respect each other and resolve conflicts through dialogue and due process.”

Be Professional

Generally, legal observers agree that the nurse in this case was correct to stand her ground. “We had a very experienced officer here, but it also sounds like [Wubbels] is an experienced nurse as well, which is fortunate,” notes Jennifer Brobst, JD, LLM, an assistant professor of law at Southern Illinois University School of Law, serving as a faculty member in both the schools of law and medicine. “Had a nurse actually violated her own licensure ethics, she could lose her job.”

The nurse is not beholden to law enforcement; she is beholden to the law and hospital policies, Brobst contends. However, from the video of the incident, Brobst believes that Wubbels could have done a better job in handling the arrest. “The video showed her kicking and screaming. Even if a person is inappropriately arrested, there is no reason to resist arrest. It is not going to help,” Brobst advises. “That might be something to discuss because everyone is supposed to be a professional in that instance.”

James Hodge, Jr., JD, LLM, director of the Center for Public Health Law and Policy at Arizona State University, suggests that it appears the police officers in this case were very focused on proving that the fiery accident was totally the fault of the fleeing suspect. At the same time, the nurse was just trying to do her job, he says. “She was put in a very difficult situation of having a rather forceful law enforcement officer demanding specific things without checking in with her superiors,” he says. “As a result, you had a situation that across any ED on any given night in the United States could be replicated.”

Hodge notes that when you take the incident apart, it appears that much of the dispute was driven by pure emotion. “That can always lead to regrettable consequences,” he says. “It got emotional and sensational, and you see that sometimes.”

Understand the Law

While nurses and physicians are entitled to protect the autonomy of their patients against any intrusions related to government interference, there are some caveats, Hodge explains. For example, if law enforcement has a warrant based on probable cause for a search, which in the Utah case would involve a blood draw, then the blood draw should proceed. “The warrant is what a judge issues pursuant to facts, and once that happens, the nurse or the physician must provide the sample. And that is with or without the consent of the patient,” he says.

However, when there is no warrant, the law can be murky in the case of an unconscious patient who cannot provide consent. “There is a Utah state law that is replicated in a number of other places that has a very interesting facet to it,” Hodge notes. “If you are a person who is within the realm of being suspected of being under the influence of drugs or alcohol or other substances and driving on public thoroughfares in Utah or other states ... law enforcement is entitled under statutory law to imply that you consented to this blood draw.”

In fact, the police officer in the Utah case, Jeff Payne, contended that there was implied consent to a blood draw, but Hodge notes that the unconscious patient in that situation didn’t necessarily fit into the parameters of the law because he was not a suspect.

“If the person they were trying to draw flood from had been the actual fleeing suspect who was driving the vehicle that caused the collision, they would get that blood in a heartbeat,” he says. “But the police weren’t trying to get blood from a suspect. They were trying to get blood from a collision victim.”

In fairness, Hodge notes that the Utah law is not crystal clear on precisely when police are entitled to a blood draw.

“That is where the problems arose, and most likely [the police officer] will lose on that point,” he says. This is the case even though every minute counts on these types of blood draws, Hodge adds.

“If I were to walk into court with a blood sample that was withdrawn 24 hours after an accident in which a victim was harmed, it would be worth a lot less than a blood sample that was drawn one hour after the accident,” Hodge explains. “You can see why the officers wanted access to [the blood sample], but you don’t get it under those circumstances lawfully.”

Hodge notes that the officers would have to get a judge to agree that there was probable cause to consider that this unconscious patient was at fault of criminal activity, but he notes that just being in a collision does not render probable cause for anything, especially when there is a fleeing suspect who is probably speeding down the highway. “That is the sort of thing where you have to look and ask whether the police have established any lawful basis for getting a non-consensual blood draw from a victim of a crime scene,” Hodge notes. “The answer is generally no, and that is where things went wrong.”

Provide Real-time Guidance

Hodge allows that the officer probably was under pressure from his superiors to get the blood sample without delays, but he was wrong to arrest the nurse as if she was resisting an active police investigation. “The foundations for that were highly derelict,” he says.

“The reality is this went poorly, and I am sure you would [generally] want to have supervision and/or oversight at higher levels of discretion here.”

To guard against such clashes, Hodge suggests EDs use this experience as an opportunity for review. “First, debrief completely your entire ED staff and exactly how to address this in the future,” he says. “Second, always have on call at any point in time appropriate hospital executives tied into legal counsel who can instantly address the situation and be ready to provide real-time guidance, just as you would expect a physician on call to provide real-time medical guidance.” Five minutes on the phone between the detective and the hospital’s legal counsel might have produced a more positive outcome in the Utah case, Hodge offers.

A third piece of practical advice is to consider carefully how to handle volatile law enforcement personalities, Hodge adds.

“The detective [in the Utah case] had a lot of seniority who had been down this road before. He might have had multiple prior examples of hospitals resisting working with law enforcement,” he explains. “He is not justified in what he did, but [it makes sense] to think about how hospital personnel might have better handled that volatile personality.”

Sometimes, it is important to match a personality with the right arbitrator to makes things go better, Hodge observes.

“I don’t think the hospital was caught off guard [in this case]. These were just two personalities that were not the right match for this specific circumstance,” he says.

Review Policies, Procedures

The University of Utah Hospital already has implemented changes so that nurses no longer interact with police, although the hospital maintains that Wubbels’ actions in this case were “exemplary.” In the future, hospital administrators will interact with police, according to Gordon Crabtree, the interim chief executive officer of the facility.

The hospital also has moved to bar police from patient care areas, although Brobst suggests this policy may be going too far.

“It might be feasible, but it is not pragmatic,” she says, explaining that police often need to get statements expeditiously in the case of sexual assaults, shootings, and other incidents. “That seems like something [the hospital] might want to rethink.”

Hodge agrees, noting that a judge can quickly overrule the policy. “I don’t even know how a hospital would enforce that,” he says.

The accident victim who was unconscious and receiving treatment in the burn unit at the hospital later died from his injuries.

Detective Payne and his supervisor have been placed on leave pending the results of both internal and criminal investigations. Salt Lake City police officials also are considering disciplinary actions.

SOURCES

  • Jennifer Brobst, JD, LLM, Assistant Professor, Southern Illinois University School of Law, Carbondale, IL. Email: jbrobst@siu.edu.
  • Pam Cipriano, PhD, RN, NEA-BC, FAAN, President, American Nurses Association, Silver Spring, MD. Email: pfc4n@virginia.edu.
  • James Hodge, Jr., JD, LLM, Director, Center for Public Health Law and Policy, Arizona State University, Phoenix. Email: james.hodge.1@asu.edu.
  • Karen Wiley, MSN, RN, CEN, President, Emergency Nurses Association, Des Plaines, IL. Email: karen.wiley@ena.org.