ERcast: Clinical Perspectives Podcast Preview
The summary below is from an episode of ERcast: Clinical Perspectives
Patients in police custody still require standard informed consent, medical necessity, and professional judgment in the emergency department. Invasive evidence-seeking exams on an unwilling patient sit far outside routine medical clearance, and the safest response is to center the patient, then escalate immediately to hospital leadership and risk management.
Patients in Custody and Invasive Exams
- Medical necessity first: Emergency clinicians are responsible for medically indicated care, not law-enforcement objectives, and that distinction becomes critical when police request testing or exams that do not benefit the patient.
- Refused rectal examination: A forced rectal exam for suspected concealed drugs is framed here as an invasive, non-routine intervention that can require restraint and sedation despite a patient’s explicit refusal.
- Warrant does not decide care: Even when law enforcement presents a warrant, clinicians still have to apply consent, ethics, and medical judgment rather than treating the document as an automatic order to perform a procedure.
- Reasonable versus unreasonable requests: Routine requests such as medical clearance labs or imaging are different from unwanted invasive body searches, and that line is worth hearing in the episode.
- Early administrative escalation: Medical director input, risk management, and hospital administration should be brought in early when police requests conflict with patient interests or clinician ethics. We walk through that escalation instinct in the episode.
- Professional refusal and documentation: When a requested exam is not necessary, reasonable, or warranted, clinicians can appropriately refuse and document the clinical rationale rather than acting as agents of the legal system.
Subscribe to ERcast: Clinical Perspectives to listen to the episode.
References:
- Chao S, Weber W, Iserson KV, et al. Best practice guidelines for evaluating patients in custody in the emergency department [published correction appears in J Am Coll Emerg Physicians Open. 2024 May 26;5(3):e13191]. J Am Coll Emerg Physicians Open. 2024;5(2):e13143. Published 2024 Mar 22. PMID: 38524358
Faculty
- Andy Little, DO
Dr. Andy Little is an emergency medicine physician and educator. He earned his medical degree from the Ohio University Heritage College of Osteopathic Medicine and completed his emergency medicine residency at OhioHealth Doctors Hospital Emergency Medicine Residency, where he served as Chief Resident. He has received multiple national awards, including recognition from the American Osteopathic Association, American College of Osteopathic Emergency Physicians, and Emergency Medicine Residents' Association.
- Drew Kalnow, DO
Dr. Drew Kalnow is an emergency medicine physician and educator based in Columbus, Ohio. He completed his emergency medicine training at OhioHealth Doctors Hospital Emergency Medicine Residency. Dr. Kalnow is passionate about advancing emergency medicine through high-quality education, with a particular focus on simulation, learning theory, and innovative teaching.
- Matthew DeLaney, MD, FACEP, FAAEM
Dr. Matthew DeLaney is an emergency medicine physician and educator based in Birmingham, Alabama. A native of Mobile, he earned his medical degree from the University of South Alabama and completed his emergency medicine residency at Maine Medical Center.Dr. DeLaney has experience in both community and academic emergency medicine and is known for his commitment to teaching and medical education. He lives in Birmingham with his wife, Erin, who is also a physician, and their two daughters.
