Emergency Physician Watchdogs for Law Enforcement: If We Are the Hammer, Everything Will Look Like a Nail

Abstract

We read with interest the editorial by Smith et al1Smith H.P. Hutson H.R. Alpert G.P. et al.Reporting use of force injuries by law enforcement officers in the emergency department.Ann Emerg Med. 2010; 56: 424-425Abstract Full Text Full Text PDF PubMed Scopus (8) Google Scholar promoting intersecting emergency medicine and law enforcement. It endorses emergency physicians as watchdogs for law enforcement by reporting perceived incidents of excessive force by law enforcement officers in the interest of public health. It equates this action with the mandatory reporting requirements for child abuse. As practicing emergency physicians and sworn law enforcement officers, we believe that the authors' suggestions are simply untenable. They call for the emergency physician to “document his or her interpretation of the event,” after “minimal training.” We think this is a bad idea. Injury documentation is not the same as causation analysis, and in most instances, emergency physicians simply are not qualified, nor do they have sufficient information, to determine the propriety of law enforcement action. The use of force by a law enforcement officer requires assessment of many complex variables, and an emergency physician assessing such actions after the fact is akin to “Monday morning quarterbacking.” The implication that an accurate interpretation could be made by an emergency physician demonstrates a lack of appreciation for the complexity of law enforcement officer decisions. Equating this to mandatory reporting for child abuse is like comparing apples to bowling balls. Child abuse is illegal. Legitimate use of force by law enforcement officers to control a person committing a crime or a dangerous action is not. Society empowers law enforcement officers to use force when necessary to protect others. The United States Supreme Court has held that “[T]he ‘reasonableness' of a particular use of force must be judged from the perspective of a reasonable officer …,” not a reasonable emergency physician.2Graham v Connor, 490 U.S. 386 (1989), United States Supreme Court. Available at: http://supreme.justia.com/us/490/386/. Accessed October 10, 2010.Google Scholar We do not condone force usage in excess. However, interpretations of excessive force are not easily made. A logical fallacy of the editorial is that emergency physicians treat injury; therefore, they can accurately interpret causative excess. In reality, most emergency physicians with additional “minimal training” could not do this accurately. Emergency medicine's model training curriculum does not include usage of force, statutory law, or any other concepts used by law enforcement officers in these situations,32007 Model of the clinical practice of emergency medicine.http://estest.cordem.org/2007%20EM%20Model.pdfGoogle Scholar nor should it. Perception and interpretation are not accurate absent subject matter expertise. The survey by Hutson et al4Hutson H. Anglin D. Rice P. et al.Excessive use of force by police: a survey of academic emergency physicians.Emerg Med J. 2009; 26: 20-22Crossref PubMed Scopus (24) Google Scholar showing that emergency physicians believe they have observed cases of law enforcement officer applications of excess force underscores this.4Hutson H. Anglin D. Rice P. et al.Excessive use of force by police: a survey of academic emergency physicians.Emerg Med J. 2009; 26: 20-22Crossref PubMed Scopus (24) Google Scholar It is similar to the offensive, professionally demeaning occurrence of non–emergency physicians believing they understand emergency medicine by virtue of having rotated in an emergency department previously in training. Imagine the outrage we as emergency physicians would feel if organized law enforcement promoted reporting emergency physicians that they perceived were overprescribing narcotics according to their “interpretation” of how many prescription bottles they came across in the community. Law enforcement officers receive no training allowing them to understand the process that occurs in a physician-patient relationship and would not understand what occurs before a prescription is written. Uninformed law enforcement officer interpretations would lead to numerous bad reports, albeit made in good faith. Emergency physicians should have mandatory reporting roles for certain illegal acts. This is different from being a surveillance specialist for another profession. Emergency medicine monitors itself on many issues and should expect no less from other professions or we risk starting down a very slippery and complicated slope. Reporting Use of Force Injuries by Law Enforcement Officers in the Emergency DepartmentAnnals of Emergency MedicineVol. 56Issue 4Preview[Ann Emerg Med. 2010;56:424-425.] Full-Text PDF In replyAnnals of Emergency MedicineVol. 57Issue 5PreviewWe are pleased to have Drs. Ho, Dawes, and Metzger join the dialogue concerning emergency physicians' evaluation and care for those subject to law enforcement use of force. They correctly identify the complexity of police use-of-force decisionmaking and the problems associated with determining the reasonableness of such force. We all agree that the more we know about these issues, the better they can be assessed and managed. However, we disagree on the role of the emergency physician when there is a concern for excessive use of force. Full-Text PDF