What is my obligation? How do you generally approach these (frustrating to me) cases?
Frequent frustrations with local law enforcement for patients brought to ED for medical clearance for one reason or another. Wondering what the extent of my medicolegal obligations are:
For example-
Case one: patient presents for medical evaluation under custody by law-enforcement. Patient is asymptomatic but early pregnancy and law-enforcement requires “medical clearance” and some baseline testing including HgbA1c before they take her to jail.
I confirmed with patient that she has zero symptoms of any kind and has no medical concerns. Shared decision w patient to forego any testing and I discharge her with instruction to establish prenatal care but received pushback from law-enforcement stating that they need her to be cleared and needed it “in writing” that she is “cleared to go to jail”
I simply wrote “cleared for law enforcement custody” and refused the verbiage about jail and discharged her.
Case 2:
Young woman with limb injury under arrest with border patrol. Exam and appropriate imaging neg and pt ok for dc.
They repeatedly claimed I needed to put “cleared for custody and for travel with border patrol” which I refused to do and did my usual dc instructions.
In general I do not think these attempts by law enforcement to transfer liability to the medical team are appropriate. I cannot control what happens to these patients in jail and always recommend return to ED for anything new for patients in custody.
But I encounter these cases several times per month so wondering how others approach this?
EDIT! My question pertains to what my legal obligation is to the phrasing they “require” in the dc summ/AVS. I always go above and beyond to get these patients care including substance use and whatever else the need. But the point of my post is that there is NO excuse for jail staff not providing expeditious care for ANY medical concern, and that me “clearing them for jail” is a subtle way of law enforcement transferring liability to me for whatever happens to them once in jail.
As other posters stated, I will happily do a medical screening exam, but my DISCHARGE paperwork will NOT say “cleared for jail” because that’s not my job.
Edited my post since perhaps I wasn’t clear about the intent of it.