We had two officers injured in a fight this week with a person refusing medical treatment at a local hospital. The situation highlighted what can be a gray area for the police officer, which is the question of when to provide hands on assistance in the involuntary detainment of medical patients.
In debriefing the troops, we found that there was confusion with some of the officers over an “incapacitated person” verses a Baker Act when it comes to dealing with uncooperative patients–either on the street or at a hospital facility.
“Chapter 401.455, F.S. governs situations when an “incapacitated” person appears to have an emergency medical condition in a pre-hospital or ED situation, as follows:
“F.S. 401.445 Emergency examination and treatment of incapacitated persons.
(1)No recovery shall be allowed in any court in this state against any emergency medical technician, paramedic, or physician as defined in this chapter, any advanced registered nurse
practitioner certified under s. 464.012, or any physician assistant licensed under s. 458.347 or s. 459.022, or any person acting under the direct medical supervision of a physician, in an
action brought for examining or treating a patient without his or her informed consent if:
(a)The patient at the time of examination or treatment is intoxicated, under the influence of drugs, or otherwise incapable of providing informed consent as provided in s. 766.103;
(b)The patient at the time of examination or treatment is experiencing an emergency medical condition; and
(c)The patient would reasonably, under all the surrounding circumstances, undergo such examination, treatment, or procedure if he or she were advised by the emergency medical
technician, paramedic, physician, advanced registered nurse practitioner, or physician assistant in accordance with s. 766.103(3). Examination and treatment provided under this subsection shall be limited to reasonable examination of the patient to determine the medical condition of the patient and treatment reasonably necessary to alleviate the emergency medical condition or to stabilize the patient.
(2)In examining and treating a person who is apparently intoxicated, under the influence of drugs, or otherwise incapable of providing informed consent, the emergency medical
technician, paramedic, physician, advanced registered nurse practitioner, or physician assistant, or any person acting under the direct medical supervision of a physician, shall proceed wherever possible with the consent of the person. If the person reasonably appears to be incapacitated and refuses his or her consent, the person may be examined, treated, or taken to a hospital or other appropriate treatment resource if he or she is in need of emergency attention, without his or her consent, but unreasonable force shall not be used.
(3)This section does not limit medical treatment provided pursuant to court order or treatment provided in accordance with chapter 394 or chapter 397. (chapter 394 and 397 don’t provide authority for medical treatment except as cited above)”
For the purposes of F.S. 401.445, the attending physician must be on the scene of the emergency for police officers to operate under this statute and circumstance.
On the street, officers are frequently called to assist the medical first responders with a combative person who needs to go to the hospital because because they have injured themselves, but then refuse consent. Many times, they do not reach Marchman Act criteria. They just don’t want to have that nasty gash on their forehead looked at. The paramedics, on the authority of the “doc-in-a-box” or emergency medical director, insist the patient has to get ED treatment.
The injured person is clearly not a Baker Act, because there is no mental health component to his condition or behavior. F.S. 401.445 would make using any physical detainment or use of force by law enforcement officers improper and leave them open to civil liability (recovery).
Without a physician actually at the scene, the police have no standing to force the person to get treatment against their will at the request of EMT/paramedics. Florida Attorney General Opinion 92-46 addresses this:
“Thus, it is my opinion (AG) that a law enforcement officer acting pursuant to directions given by an emergency medical technician or a paramedic under the circumstances described in s. 401.445, F.S., would not be a “person acting under the direct medical supervision of a physician[.]” Therefore, a law enforcement officer who becomes involved in the emergency examination and treatment of an incapacitated person pursuant to s. 401.445, F.S., at the direction of a paramedic or emergency medical technician is not afforded the protections of the act.”
However, if the EMT’s or paramedics attempt to deal with this incapacitated person and they are assaulted in our presence or battery upon them takes place, we have the option to arrest the “incapacitated” person. He or she would then get medically treated, in addition to the criminal charges.
If the situation unfolds on the street and the person is in your estimation meeting Baker Act criteria and in need of medical treatment, then you may do what is necessary to effect an involuntary custody by BA-52 for their mental health examination. Again, they will get the medical treatment as well.
If you are unsure about this gray area, seek further training and information. As always, safety first, but know where your boundaries lie.