"medical clearance" for jail....how to handle?

[JKL33]

Hi, everyone - -

Can anyone offer insight on your ER's procedure for patients who are brought to ER (en-route to jail) for medical clearance? Or how does your area law enforcement handle this issue? I can be more specific with a recent example:

Intoxicated individual brought to ER under arrest and handcuffed, the jail will not admit individual until he is 'medically cleared for jail'. Pt is alert/oriented, ambulates into triage with steady gait, is a little bit loud-mouthed but otherwise completely cooperative; answers questions appropriately. Has not been forcibly subdued or tased had any other known traumas prior to ER; they want clearance because of the ETOH on board. Pt refuses to sign Consent for Treatment form. Refuses anything invasive to be done. What would your ER personnel do in this situation?

Some of the docs grumble about this formality (medical clearance) and I have to say that I think I agree with them.....they are being asked to sign that the patient is 'safe' for jail or not safe, and they hate being put in that position. Obviously this is no easier if the patient refuses to be seen. I'm not understanding why, when they (law enforcement) bring someone in for a 'legal draw' they must have a court order, but if they want a whole big work-up (potentially, depending on the situation) for 'medical clearance', they do not need a court order to subject the patient to this. Am I right in thinking that that patient could have left the ER without being seen if he really wanted to?

Thanks,

JKL

[Dalzac, LPN, LVN, RN]

Our attending ER doc would have sent them straight to jail if they refused to sign consent.

[MN BigJ]

It's all a CYOA deal. The jail doesn't want someone to die in jail from some freak thing and then have family sue. The ER doesn't want someone to necessarily go through without a proper exam. The police also are afraid of lawsuits. Everyone trys to cover themselves and the taxpayer gets stuck with the bill.

[rjflyn, ASN, RN]

It's the ole rock and a hard place. We have to determine if the pt is able i.e. competent to refuse treatment. If he is obviously chemically impaired or has a head injury we generally don't allow them to refuse treatment. The same goes if he is showing signs of mental illness. In most cases thats almost everyone that the police bring in with few exceptions. As far as the clearance part, well what would you do with the pt if they were not arrested, you would send them home, so I just give the d/c instructions to the police officers.

[JBudd, MSN]

If they can walk, handle their own secretions, maintain an airway; they can go to jail.

[wndblws]

If their VS are stable and they have no complaints they go. Unfortunately we usually get the ones with the "I don't want to go to jail chest pain" after a cardiac panel comes back OK off they go!

[Altra, BSN, RN]

Is this a new phenomenon your ER is seeing just recently? Because this is a standard part-of-the-deal category of patient in most ERs, in my experience.

Medical clearance for incarceration is by no means a major medical workup. It is not a system by system assessment. It simply involves treatment of any acute injuries, and r/o of anything big & bad happening in the immediate term (i.e. ... an amazing number of folks develop "chest pain" on their way to jail ... ) It is often cursory, and that is not inappropriate because these patients will be screened by medical staff at the jail and monitored if necessary.

[JKL33]

Sorry for the dumb question. No this is not a 'new phenomenon' of course.

Simple question of how much rights has a person lost when they are under arrest. Do they no longer have the right to refuse a medical exam (no matter how cursory)? Obviously they are not convicted of anything yet at the point that they present to the ER.

FWIW, this is a small county jail and there actually is not a doctor or nurse in house there in the middle of the night, so really we can not expect that someone else might pick up something we miss. As with other issues, I'm beginning to see that everything is magnified in a smaller ER/smaller town. People here freak out if we have to discharge a patient to the street! :icon_roll I have no doubt I would not even be here asking this question if I were working in a bigger ER with much 'bigger fish to fry' :)

Didn't mean to make the question so complicated. Can they refuse to be seen in ER if there is nothing wrong with them other than intoxication, or not?

Thanks!

[JBudd, MSN]

If they are intoxicated, as indicated by slurred speech, nystagmus, odor of ETOH, any of the street tests the police do; they are presumed to be incompetent by reason of being under the influence of alcohol, and therefore not capable of making good or rational decisions about their own safety. That's why refusal is not allowed.

Having come under the eyes of the law or medicine, we (and the PD) then become responsible for their safety until sober. Having declared them medically safe to go to jail, we release them to PD who will then keep them safe from themselves(wandering into traffic, falling and freezing to death or getting a subdural hematoma, etc.).

[JKL33]

Thanks! :)