Nurses around the country are noticing a disturbing trend: Some patients suspected of violent crimes are admitted for medical care but are not arrested.
Danisha Jenkins, MSN, RN, CCRN, manager of the trauma stepdown unit at UC San Diego Health, explains that this might be an unintended consequence of well-intentioned prison reform.
In California, newly passed legislation moved people with selected felonies from state prisons to local county jails, affecting local budgets. To offset the shortfall, it appears that suspected criminals injured during a crime are at times not placed in custody for the duration of hospitalization, with the goal of arrest upon discharge. “In this manner, the city does not pay for the hospital stay or the guard to protect the healthcare workers,” says Jenkins. “But where does that leave the clinicians?”
Law and Ethics Collide
When a man with a gunshot wound presented for medical care, a police officer notified inpatient nurses that the patient was a dangerous felon. He further explained that police intended to arrest the patient upon discharge. The nurses were asked to facilitate this by giving updates on the patient’s condition and time of discharge.1
This put nurses in an ethically difficult position. Nurses are duty-bound by a code of ethics, while police are focused on the law. “The two collide in the middle in these situations,” says Judy E. Davidson, DNP, RN, FCCM, FAAN, a nurse scientist at UC San Diego Health.
This was not the first case that nurses had seen. “We struggled trying to figure out how to handle these situations,” says Davidson. Nurses turned to security, privacy, risk management, and legal counsel; however, all of these hospital resources were accustomed to viewing issues from a legal perspective.
“It wasn’t until we refocused the work as an ethical issue and pulled everyone together to evaluate the case through an ethics lens that we were able to make real progress,” says Jenkins.
Nurses saw a clear conflict between their ethical obligation to care nonjudgmentally for patients and the request to act as agents of the law by guarding and reporting alleged criminals. The safety of clinicians and other patients was another obvious concern, as were patient privacy regulations. Nurses called ethics for help.
Since there were recurring cases, ethics took a systemwide approach. “The ethics consult team helped mediate how the organization as a whole should handle these situations, instead of consulting on just one case,” says Davidson. After ethics got involved, the nursing division, privacy office, legal counsel, and security department together created the following process:
• the primary nurse is removed from the responsibility of calling for the arrest of patients;
• all law enforcement inquiries will be directed to security, with strict adherence to patient privacy regulations;
• if an in-hospital arrest appears likely, an emergency meeting is held. “Unit leaders, security, and clinicians would determine what interventions are needed to ensure everyone’s safety while maintaining the rights of the patient,” says Davidson.
The hospital now has a solution in place to address the issue with law enforcement. “But there is still more work to do to negotiate the relationship between law enforcement and healthcare during these austere times,” says Jenkins.
Nurses should not be expected to guard patients, says Jenkins: “The larger societal issues need to be addressed through collaboration between our professional clinical organizations, law enforcement, and elected officials.”
1. Jenkins, D, Davidson J, Cederquist L. The ethics of law enforcement in the inpatient setting. Critical Connections 2018 (June/July).
• Judy E. Davidson, DNP, RN, FCCM, Nurse Scientist, UC San Diego Health. Phone: (858) 254-2390. Email: email@example.com.