If you've worked in an emergency department for any length of time, you have undoubtedly treated at least one person who had injuries sustained during an encounter with the police. And if the patient — then or later — claims that the officers used excessive force, your chart notes could be among the few pieces of evidence available to bolster or discredit his claim.
New research from a University of Washington emergency physician who studied use-of-force claims in the ED, however, indicates that emergency department charting for patients who have clashed with police is often incomplete, vague, and full of subjective terminology.
Jared Strote, MD, an associate professor of emergency medicine at the University of Washington, and Mimi Walsh, PhD, who recently retired as policy advisor to Seattle's chief of police, reviewed a year's worth of Seattle ED and police records to find patients who had come to the emergency department within 24 hours of an encounter with police and complained to their doctor about the force used by law enforcement. (Am J Forensic Med Pathol 2013;34:363.)
They, along with Erik Verzemnieks, MD, ultimately winnowed the data down to a pool of 13 patients on whom they conducted a detailed chart review. Nearly 40 percent of the charts did not provide a complete description of how the injury occurred, and more than 20 percent did not even fully describe the injury. More than half of the charts used subjective, non-medical terminology (such as “drunk” rather than “altered”), more than half of the charts documented the police description of events as fact, and nearly 40 percent used language that assumed that the complaining patient was guilty of an offense.
These gaps are likely because most emergency physicians have received little to no education or guidance in how to document patient injuries appropriately after an encounter with police. A 2009 paper published in Emergency Medicine Journal by Dr. Strote and a multicenter team of colleagues found that more than 90 percent of 315 surveyed emergency physicians reported having no training in or departmental policies on management and documentation of such cases although nearly all respondents had treated cases where patients complained of excessive force by police. (Emerg Med J 2009;26:20.)
One of the challenges is that patients in police custody may not always be treated with the same patience or trust afforded to others, Dr. Strote pointed out. “Furthermore, law enforcement has a close relationship with EPs, and we appreciate the extremely difficult split-second decisions they need to make under dangerous conditions. Any talk about excessive force is both politically and emotionally charged, and there's the concern that it will take away law enforcement's ability to protect both themselves and the public.”
It is not the job of an emergency physician to make a judgment on whether excessive force was used. “We should be honest documenters, clarify what everyone is saying, and document a good physical exam including any inconsistencies with the history, and then let other people who are qualified make the judgment as to whether the force used was excessive or not,” he said.
Dr. Strote noted that claims of child abuse and domestic violence were documented with similarly poor detail in decades past. “Now the expectations for documenting these cases are spelled out in textbooks and emphasized in training,” he said.
Despite the clear differences involved in alleged excessive use of force, such claims still represent potential assaults. Detained suspects are a “vulnerable population,” and emergency physicians need better education in managing and documenting their care, he said. The article suggests developing documentation guidelines that include complete and objective descriptions of injuries, use of the patient's own words, and identification of potential inconsistencies. Dr. Strote called for a group with representation from emergency medicine and law enforcement to develop the guidelines.
This suggestion, and the comparison with child abuse and domestic violence, has raised alarm bells in the law enforcement community. “Things will be far worse if the rhetoric about better documentation transitions to a hospital or legal mandate requiring medical personnel to report suspected excessive use of force, as has been the case with child abuse, elder abuse, and domestic violence,” said Michael Brave, a use-of-force instructor and litigator in a February article in Force Science News. (http://bit.ly/1dSr5iE.)
But Dr. Strote said he is not calling for mandatory documentation. “I wouldn't advocate for required reporting, as we see with things like child abuse,” he said. “But there should be guidelines for how we as emergency physicians document any alleged assault or inappropriate use of force.”
Better documentation in these instances is just as important for law enforcement officers as it is for the suspect, Dr. Walsh added. She noted that formal complaints of excessive or unnecessary force made to the Seattle Police Department's Office of Professional Accountability were regularly “unfounded.”
“This does not mean that the complaint could not be substantiated in a ‘he said/she said’ scenario. Rather, this outcome classification means the complaint was shown by documented evidence — on-scene witnesses or police car dash cameras — not to have occurred at all as claimed. I see no reason why ED documentation would operate any differently from these other types, which regularly uphold the actions of officers,” she said.
Good ED documentation, Dr. Walsh said, could further protect police officers against unjustified claims of excessive force. “Municipal risk managers are often too eager to settle such claims, especially if down the road they determine that they have what can be regarded as a sympathetic plaintiff,” she said. “ED documentation could, it seems to me, head off such claims, thereby not only supporting the actions of officers, but also having the potential to save their jurisdictions money.”
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