In Trauma Bay, Surgeons Can Protect Patient Rights during Active Criminal Investigations

Surgeons often encounter patients in their most vulnerable states. This is particularly true in the case of trauma and acute care surgery, where surgeons must treat patients with potentially life-threatening injuries or illnesses.

At times, the circumstances that lead the patient to the emergency department (ED) may require the involvement of law enforcement due to suspicion of violent acts, traffic offenses involving alcohol or other drugs, or other criminal acts. In these cases, police have a legal duty to chaperone suspects and victims of crime, secure evidence for ongoing investigations, and protect medical personnel from possible violence.

Yet, the presence of law enforcement also may incite fear and mistrust, especially in patient populations who are disproportionately affected by both violent crime and previous experiences with police.

But how does the presence of law enforcement officers affect surgeons treating patients in the ED and, more importantly, their ability to provide equitable care without violating patients’ rights to privacy or autonomy?

Members of The American Association for the Surgery of Trauma (AAST) were surveyed by Kaufman and colleagues and determined that less than 30% of respondents found the presence of law enforcement officers helpful or very helpful.¹ Those who perceived a negative effect on patient care cited reasons such as “interruptions to clinical care, including difficulties that emerge when patients are handcuffed or shackled; potential violations of patient privacy when law enforcement officers are within earshot of clinical procedures and conversations; and most commonly, added emotional distress and agitation in patients.”¹

Without clear policies to guide the presence of law enforcement in the ED and trauma bay, surgeons leading resuscitation teams must learn to navigate the intersection of law and healthcare. While there are no established societal guidelines regarding the presence of law enforcement during the care of acutely ill patients, the AAST Injury Prevention Committee provides a bioethical framework, and here we aim to provide practical guidance to surgeons navigating these interactions.²

Competing Priorities for Law Enforcement and Surgeons 

Law enforcement and surgeons share the goal of protecting the public and preserving the sanctity of life. However, in an acute patient setting, they may be faced with competing priorities (see Figure 1).

The surgeon’s primary duty is to the patient. Over centuries, the Hippocratic Oath has been adopted by physicians as a public declaration to uphold professional ethical standards and “abstain from whatever is deleterious and mischievous,” often paraphrased as the well-known adage “Do no harm.”³ Translated to modern times, physicians should aim to render timely and appropriate treatment while avoiding unnecessary testing or procedures, undue use of physical restraints, inadvertent invasions of privacy, or triggers driving medical vulnerability.^4,5

 Conversely, law enforcement’s primary duty is to the public. Achieving public safety can take many forms, especially during an active criminal investigation. It may require restraining an individual, limiting communication or visitation with a person until the threat of violence is eliminated and/or once physical or testimonial evidence has been secured.

These competing interests may foster ambiguity during exigent circumstances, sometimes at the detriment of the patient. Therefore, we advocate for surgeons to engage in dynamic and collaborative bedside conversations with law enforcement officers to resolve conflicts in a respectful and expeditious manner.

Three Legal Status Categories 

The appropriate level of law enforcement engagement and degree of their authority over the patient are informed by the patient’s legal status. An individual interacting with law enforcement may be grouped into one of three legal status categories (see Figure 2):  

In Custody (Arrested): An individual placed under full custodial arrest (colloquially “under arrest” or “in custody”) has been formally taken into police charge when there is probable cause of having committed a crime. Probable cause must meet a threshold of factual justification sufficient to convince a reasonable person. The individual is informed of the arrest and advised on their rights or constitutional protections during custody and custodial interrogation (e.g., Miranda rights).

Handcuffs or other physical restraints may be used at this time. Arrest implies a formal legal process has been started through which formal charges subsequently may be brought by a prosecutor. Incarcerated patients also are in custody, specifically under the state Department of Corrections (DOC).

When a patient is in custody, the right to privacy no longer applies. In the medical setting, law enforcement officers are generally obliged to stay in the room with the patient during all discussions and examinations. Communication and visitation with family/next of kin may be restricted by the law enforcement agency or DOC.  

Detained: An individual detained by law enforcement is temporarily held but not arrested. Police may temporarily detain a person if they have reasonable suspicion of criminal activity or need to continue an investigation (e.g., questioning or search). Detainees are not allowed to leave law enforcement’s oversight but are otherwise entitled to bodily autonomy and privacy.

Law enforcement officers can be asked to wait outside the patient’s room to avoid overhearing sensitive medical information or witnessing sensitive exams, but may need to maintain a line of sight to an individual’s location. Law enforcement officers should generally honor these requests by medical providers unless additional concerns for public safety or flight risk arise.  

Social or Consensual Contact: A social or consensual contact describes any law enforcement contact, including victims or witnesses of crimes or accidents, in which there is no reasonable suspicion or probable cause to detain someone for a crime. These patients maintain their legal rights to privacy and autonomy. They can refuse all forms of law enforcement contact, including during the medical evaluation. Medical personnel are permitted to assist individuals in exercising these rights.

Where Can Potential Disagreements Arise?

Use of Restraints 

Patients in custody are generally restrained (e.g., handcuffs, leg cuffs, belly/transport chains). Some law enforcement department policies require two-point restraints at all times. According to the United Nations Office on Drugs and Crime, handcuffs and limb restraints should be used only “when there is objective reason to believe the offender may escape or…use violence against the law enforcement official or someone else…[and] the condition of the person should be monitored to ensure that there is no particular risk of injury or death.”⁶

The use of restraints presents a spectrum of potential passive harm. In the acute setting, multiple-point restraints (e.g., bilateral wrists, contralateral wrist and ankle, or four-point restraints) may interfere with routine trauma exams or procedures or delay proper positioning in emergent situations (e.g., intubation for respiratory failure, recovery position for seizures, or alleviation of positional asphyxia).^6,7

When restraint removal is necessary to administer lifesaving care, the gravity of the situation should be clearly articulated to the bedside law enforcement officer. Plain language such as, “This is life threatening,” may be helpful.

Restraints also should be repositioned once such a request is issued by medical providers, although law enforcement department policies should be maintained as well. An example of this approach would be to use shackles instead of a two-point restraint, which can be repositioned from bilateral wrists to an ipsilateral wrist and ankle to allow the patient to be turned.

Occasionally, patients who are not under arrest, but are in legal custody may arrive shackled. In such cases, as may occur with agitated patients, the medical team should promptly request the removal of law enforcement restraints and consider the use of soft medical restraints or sedatives, which may be considered more appropriate in these circumstances. 

Patient Privacy 

Respect for patient privacy is a tenet of the Hippocratic Oath: “Whatever I see or hear in the lives of my patients, whether in connection with my professional practice or not, which ought not to be spoken of outside, I will keep secret, as considering all such things to be private.”

Patient privacy also is mentioned in a federal rule under the Health Insurance Portability and Accountability Act (HIPAA). The HIPAA Privacy Rule defines patient-protected health information and limits its disclosure. In certain circumstances, covered entities may disclose protected health information to law enforcement.⁸ These situations could include:

• As required by law, including court orders, court-ordered warrants, subpoenas, and administrative requests
• Limited demographic information needed to identify or locate a suspect, fugitive, material witness, or missing person
• Protected health information pertaining to a victim or suspected victim of a crime, if the individual consents (excludes mandatory reporting for suspected child abuse)
• To alert law enforcement of a person’s death if the healthcare provider suspects death due to criminal activity
• When a healthcare provider suspects that protected health information is evidence of a crime that occurred on their premises
• To inform law enforcement about the commission, nature, location, victims, or perpetrator of the crime in a medical emergency

Finally, patient privacy is legally safeguarded under the Fourth and Fifth Amendments in the US Constitution, which protect citizens from unreasonable search and seizure without a warrant and from self-incrimination, respectively.

The ED presents a unique setting in which patients may expect medical privacy, but the reality is that, from a legal perspective, such privacy is not required.⁴

Police permitted into the ED or trauma bay may be considered “lawfully present,” and as such, anything seen, heard, or obtained from within “plain view” may be submitted as evidence in legal proceedings without being subjected to protections afforded by the Fourth Amendment.⁴ Thus, an officer may use patient information, history, or relationship to a crime overheard in the trauma bay as evidence or the basis for further investigation. This also extends to the procurement of patient belongings in “plain view” (e.g., temporarily discarded on the floor) as they are considered abandoned, and therefore their collection by law enforcement is not considered unreasonable search and seizure.

These legal nuances can place surgeons at odds with the fundamental tenet of patient-physician confidentiality. For in-custody patients, this may be unavoidable; the officers must stay with them. However, for patients not in legal custody, providers can help build trust with the patient and decrease the risk of patient self-incrimination by obtaining patient’s consent to law enforcement presence or requesting the officer step out of the room during the medical interview and examination.

Third-Party Actions 

During legal investigations, law enforcement may attempt to solicit evidence from the medical team.

Information freely provided to these officers through a third party, such as a healthcare worker, may be used as evidence regardless of whether a warrant was granted. The American College of Emergency Physicians policy statement, titled “Law Enforcement Information Gathering in the Emergency Department,” describes three situations in which physicians may provide clinical information to law enforcement: (1) the patient consents to the release of information; (2) the law mandates physicians report such information; or (3) law enforcement provides a subpoena or court order.⁹

Surgeons may release general patient status (e.g., stable, serious, critical). Regarding requests for further clinical information or the procurement of physical bodily evidence from the patient (e.g., blood draws), the surgeon should first ascertain the patient’s legal status. If the patient is not in custody, law enforcement should be advised to obtain a warrant or court order via the usual administrative channels before any release of medical information can occur. Otherwise, any disclosed information can be admissible in court. If there is any ambiguity or conflict during these discussions, surgeons should contact hospital administration and/or legal counsel. Most centers will have an administrator, clinical, or security supervisor on call who can field such policy-related questions.

It is important to note that aspects of these laws may vary by state. Several states exercise implied consent for blood draws when patients are under arrest, intoxicated, or involved in motor vehicle accidents with suspected intoxication. Others mandate reporting of nonaccidental injuries secondary to suspected abuse, arson, or substance abuse during pregnancy.⁹ As such, surgeons should familiarize themselves with local and state mandatory reporting and assisting laws.

Outside Communication and Visitation 

Generally, there is no legal basis that allows law enforcement to interfere with hospital visitation for patients not in custody or to prevent the surgeon from sharing medical information with a patient’s next of kin. Law enforcement officers may, however, attempt to limit communication and visitation with the patient during an active investigation in the following scenarios:

1. They cannot yet confirm if visitors are potential suspects or involved in the criminal act.
2. Evidence must be collected from the patient before being contaminated by others.
3. There is still a threat to be eliminated.

If such restrictions are requested by law enforcement, they should be time limited, allowing a reasonable amount of time to complete the tasks described in this article. Any restrictions placed on the clinicians may be in accordance with specific state or local guidance, or explicit policies or agreements between a hospital and the local law enforcement or corrections agency.

It is important for surgeons to understand the precise language and reach of those policies and to involve both hospital and law enforcement agency supervisors, if needed, to ensure they are applied correctly. In instances where family visitation of a deceased patient is prohibited by an officer, surgeons should adhere to these requests as the patient’s body is considered evidence under the law.¹

Law enforcement officers are often present in the ED and trauma bay due to their role in investigating crimes and protecting public safety, yet their presence has the potential to violate patient rights and privacy. The level of access law enforcement has to patients should be informed by the patient’s legal status (e.g., in-custody/under arrest, detained, or social contact).

Surgeons must take an active role in protecting the patient’s rights to privacy and autonomy within the confines of their established legal status. Specifically, patients who are not in custody can refuse law enforcement presence during their medical evaluations, and staff may help them exercise this right. Surgeons also should be familiar with state and local reporting regulations to remain in compliance and be prepared to escalate cases of ambiguity around the release of medical information and use of restraints to ensure policies are followed.

Disclaimer

This article has been prepared by the authors for informational purposes only and does not constitute legal advice. The American College of Surgeons expressly disclaims all liability with respect to actions taken or not taken based on the contents of this article.

Dr. Hannah Shin is a surgical critical care and acute care surgery fellow at The University of Arizona Banner Health University Medical Center in Tucson. She is part of a working group of trauma surgeons, case management, and local law enforcement. 

References

1. Kaufman EJ, Khatri U, Hall EC, et al. Law enforcement in the trauma bay: A survey of members of the American Academy for the Surgery of Trauma. Trauma Surg Acute Care Open. 2023;8(1):e001022.
2. Tatabe LC, Kaufman EJ, Nappi T, et al. Walk the line: An ethical framework for interactions with law enforcement in trauma care environments. J Trauma Acute Care Surg. 2023;94(2):e20-e22.
3. Encyclopedia Britannica. Hippocratic oath. Available at: https://www.britannica.com/topic/Hippocratic-oath. Accessed May 19, 2025.
4. Song JS. Policing the emergency room. Harvard Law Review. 2021 Jun;134(8)2647-2720.
5. Boldt J. The concept of vulnerability in medical ethics and philosophy. Philos Ethics Humanit Med. 2019;14(1):6.
6. United Nations Office on Drugs and Crime and the Office of the United Nations Human Rights Office of the High Commissioner. 2017. Available at: https://www.ohchr.org/sites/default/files/UseOfForceAndFirearms.pdf. Accessed July 1, 2025.
7. Haber LA, Pratt LA, Erickson HP, et al. Shackling in the hospital. J Gen Intern Med. 2022;37(5):1258-1260.
8. US Department of Health and Human Services. Health information policy. Available at: https://www.hhs.gov/hipaa/for-professionals/faq/505/what-does-the-privacy-rule-allow-covered-entities-to-disclose-to-law-enforcement-officials/index.html. Accessed July 1, 2025.
9. Simon JR, Derse AR, Marco CA, et al. Law enforcement information gathering in the emergency department: Legal and ethical background and practical approaches. JACEP Open. 2023;4(2):e12914.