Public Emergency Room Overcrowding in the Era of Mass Imprisonment

Abstract

Although sociologists have long studied public emergency rooms (ERs) and their service delivery to the urban poor, little is known about how crime control and criminal justice contact affect ER admission decisions—a critical oversight given the documented increase in incarceration rates, intensification of policing, and proliferation of crime control language in public institutions. Using ethnographic methods and a count of ER admission decisions ( N = 1,114), this article describes the continual rushing and delaying of medical resources to patients based on their perceived criminality or actual relationship to the criminal justice system. These dynamics develop through four processes: (1) widespread administration of pain medication, which associates waiting patients with criminal narcotics; (2) deployment of criminal stigma along race and gender lines to select some qualified patients over others; (3) patrolling of waiting rooms by police; and (4) rushing of beds to vast numbers of arrestees, inmates, and witnesses. Key to these findings is that if the urban poor happen to be wards of the criminal justice system, they receive rushed health care resources, but if they enter health care organizations on their own accord they are policed, delayed, and deterred from accessing care.