An Ethical Dilemma- Outstanding Warrants

[rkirk89]

Hi All,

I am currently a BSN student working on an ethics project, and I came across an interesting scenario that I am struggling to find concrete guidlines for. Basically I am wondering what the nurse's obligation is to a patient with multiple warrants out for his arrest. The crimes alleged are non-violent in nature. The patient is admitted for acute psychosocial and physiological impairments, so going AMA would be dicey regardless of the patient's legal status. As it stands, the plan is to discharge the patient into police custody. Due to a staffing issue, the police are unable to come to the hospital to retrieve the patient (seems odd but this is not the focus of my project).

So the questions are; When does the nurse inform the patient that they are going to be discharged into police custody? When providing reasons that the patient should not leave AMA is the nurse obligated to discuss the patients legal status? More importantly, if the patient wishes to participate in discharge planning, what should the nurse disclose to the patient as far as his treatment options after being released?

There is a large body of ethical research on the importance of honesty and transparency with terminally ill patients, but I am wondering if that applies to knowledge the nurse has that doesn't directly affect patient care.

[Sour Lemon]

Hi All,

I am currently a BSN student working on an ethics project, and I came across an interesting scenario that I am struggling to find concrete guidlines for. Basically I am wondering what the nurse's obligation is to a patient with multiple warrants out for his arrest. The crimes alleged are non-violent in nature. The patient is admitted for acute psychosocial and physiological impairments, so going AMA would be dicey regardless of the patient's legal status. As it stands, the plan is to discharge the patient into police custody. Due to a staffing issue, the police are unable to come to the hospital to retrieve the patient (seems odd but this is not the focus of my project).

So the questions are; When does the nurse inform the patient that they are going to be discharged into police custody? When providing reasons that the patient should not leave AMA is the nurse obligated to discuss the patients legal status? More importantly, if the patient wishes to participate in discharge planning, what should the nurse disclose to the patient as far as his treatment options after being released?

There is a large body of ethical research on the importance of honesty and transparency with terminally ill patients, but I am wondering if that applies to knowledge the nurse has that doesn't directly affect patient care.

I've never heard of discharging someone into police custody. If they're in custody, the police are already there.

Did you make this scenario up or find it somewhere? It seems all sorts of crazy, to me.

[Night__Owl, BSN, RN]

They're either in police custody, or they arent.

Patients in prison or jail (or headed there upon discharge) are not discharged into police custody. They are in police custody the whole time, with a guard present. They are simply discharged to a prison or jail LOCATION.

If they are not IN the custody of a police officer, a nurse has no training or responsibility to keep a mentally competent patient from leaving AMA. If the police are unable for whatever reason to come and take custody of the person, then the person is not in police custody.

[AnnieOaklyRN, BSN, RN, EMT-P]

I don't think you can tell the police where the patient is because that would be a violation of the patent's privacy.

Annie

[MunoRN, RN]

We don't "discharge into police custody", either the patient is placed under arrest while still in the hospital, in which case the police can either staff an officer to be with the patient which is what makes them "in custody" or they can release the patient with a requirement that the patient report to an appropriate facility to be placed into custody after discharge.

If in your scenario the patient has been cleared for discharge and there is no legal hold on the patient, then them leaving would not be "AMA".

[chare]

You've asked a lot of questions without providing any of your thoughts on this. Since this is an "ethics project" why don't you start by telling us what you think.

[canoehead, BSN, RN]

I did work in a hospital that had an arrangement with local police, their policy stated we would call police when a person of interest was discharged, and they would come take custody. But without that policy, the police are on their own.

If I saw a known murderer walking out of the hospital while I was on my break though, I wouldn't hesitate to call. I couldn't call though, if he was a patient in the ER.

[LovingLife123]

The police will often wait for a suspect to be discharged before taking them into custody. The reason for this is, if they are in police custody, the state pays the medical bills. If they wait, the student is responsible. We run into this from time to time on trauma.

[JKL33]

I did work in a hospital that had an arrangement with local police, their policy stated we would call police when a person of interest was discharged, and they would come take custody.

Ditto - history of same, here. However, that has gone by the wayside because of rethinking about the facts as stated by Muno. They can come and place the patient under arrest if they have independent knowledge of the patient's whereabouts, or instruct the patient to report. We need to be involved in all of this a lot less than what some employers teach.

I too would like to hear what you think, OP, but I'll say this: If the patient is discharged, s/he's discharged. If they're leaving AMA, that's not a standard discharge, although we should piece things together (discharge and follow-up instructions, any prescriptions, etc) as best we can for patient safety. But none of it (the discharge or whether or not they are leaving AMA) has something to do with their legal difficulties/warrants. Discharge instructions and follow-up recommendations should always reflect what is felt to be in the patient's best medical interest - that has nothing to do with whether they're going to jail or not.

What do you think about all of this?

[Daisy4RN]

If a minor crime the police would sometimes wait to arrest until the patient was ready for discharge (to save money). When the patient was ready for DC we called and notified the police who would come and pick up the patient and place them under arrest, we then give DC instructions like any other patient, but then the police take the paperwork etc. If they wanted to leave AMA prior to that we could also call at that time but they could be gone before the police arrive, thus they only did it for minor crimes.

[psu_213, BSN, RN]

I've never heard of discharging someone into police custody.

This is probably splitting hairs on the wording, but I've seen it happen from the ED. Pt was going to turn himself in to authorities for a court appearance for something he had previously been arrested for...I forget the exact charges. The crime was not the "reason" he was in the ED. Before going to wherever one turns themselves in, he overdosed on heroin, narcan in the field, A&O when he got to the ED. Pt wanted to leave to go turn himself in, hospital police wanted municipal police to come and take him into custody. Much like the OP, the police couldn't make it right away for some reason. Pt politely waited for the police to come and was discharged into police custody without incident. Not sure if they formally arrested him in the ED--I'm not really an expert on police matters and what constitutes a formal arrest.

[City-Girl]

Unless the patient is already in police custody, how would the nurse know about the warrants? The nurse's obligation is to tend to the patient's medical needs. If the patient is under arrest, there will be officers at the bedside and the patient will have at least one extremity shackled to the bed.