Identifying and addressing points of contention between emergency department (ED)
staff and law enforcement could significantly improve experiences for survivors of
violence (SOV), according too a new study published in JAMA Network Open.1
Law enforcement officers (LEOs) are a common presence in EDs,notably in
urban,safety-net hospitals.However, a lack of clarity regarding regulations
governing their authority, coupled with insufficient training, can create tension
and potentially harm SOVs, especially Black patients.1
Hospital-based violence intervention program (HVIP) representatives are
increasingly utilized to mediate interactions, but challenges persist, with reports
of unintended harm still surfacing.
Even the routine presence of law enforcement can heighten stress for survivors of
violence, potentially deterring them from seeking care or fully engaging in
treatment.2 This concern extends beyond SOVs to include immigrants, who
may fear encountering Immigration and Customs Enforcement (ICE) within or around
the ED. Historically, hospitals were considered “sensitive” areas, offering
protection from ICE and Customs and Border Protection (CBP) actions. Though,
protections rescinded under the Trump administration have broadened ICE access,
potentially discouraging vulnerable populations from seeking necessary medical
attention.3,4
Understanding the Landscape: Voices from the ED
The JAMA Network Open study sought to understand the perspectives of those
directly impacted by law enforcement presence in the ED – SOVs, HVIP
representatives, and LEOs themselves.1 The research, conducted between
September 2020 and September 2023 at an urban level 1 trauma center, involved
interviews with 60 individuals (23 HVIP representatives and 21 SOVs) and focus
groups with 16 LEOs.
Researchers identified three key themes: limiting interactions with law
enforcement, particularly during acute treatment and recovery; formalizing
training for both ED staff and leos on patient rights and trauma-informed care;
and integrating SOV advocates to support patients and protect their rights.
A central concern raised by sovs and HVIP representatives was the inadvisability
of LEO questioning patients during the critical acute phase of resuscitation,
when they may be unable to provide accurate details. As one HVIP
representative noted, patients in this state “can’t provide or be able to share
necessary information most accurately.”
While LEOs acknowledged alternative methods for obtaining information, SOVs and
HVIPs emphasized the poor timing of such inquiries. A family member of an SOV
expressed the sentiment that law enforcement should allow families space to cope:
“I think they should give family members their moment and their space. We are
already hurting. You keep asking all these questions, and it’s hard for us to be
there.”
Lack of clarity surrounding HVIPs’ scope of practice and confidentiality
obligations also emerged as a challenge. Such as, there was uncertainty
regarding what information HVIPs could share with law enforcement during an active
investigation. One issue highlighted was the legal ramifications of LEOs taking
possession of patients’ belongings, with HVIP representatives unsure of how to
intervene.1 Under the Plain View Doctrine5,
LEOs can legally seize items if they are lawfully present and the incriminating
nature is promptly apparent.
A patrol officer participating in the study articulated the need for specific
training: “There is no training.There is no point in the academy where you’re
role-playing, ‘This is how you conduct yourself in the hospital with this kind of
scene.’… You go approach this shot-up kid, who’s probably not in the mood to
talk.… There’s no training for it.”1
Stakeholders uniformly agreed on the value of providing legal depiction for
SOVs to mediate interactions with LEOs and ensure accountability. LEOs also
acknowledged that advocates could serve as a buffer, protecting patient rights
while concurrently facilitating investigations. As one detective stated, “that
[advocate] is there for [the survivor’s] level of comfort and to help them
through it, because [the advocate’s] role is totally just to take care of the
[survivor], versus our role, which is to extract patient information so we can
try to get the perpetrator.”
These findings underscore the critical intersection of law enforcement, patient
safety, trauma-informed care, and health equity, particularly within marginalized
communities. The study suggests that SOV advocates play a vital role not only in
mediating interactions but also in prioritizing patient recovery.
Implications, challenges, and the Path Forward
This research highlights the potential for unregulated law enforcement presence in
EDs to negatively impact the health, legal rights, and privacy of SOVs.
Addressing knowledge gaps among HVIP representatives and LEOs is a crucial step
toward fostering more collaborative and patient-centered care.
However, the study’s limited scope – focusing on a single urban level 1 trauma
center – restricts the generalizability of its findings. The qualitative nature
of the data collection, while providing rich insights, introduced the potential
for response variation, complicating cross-group comparisons.
The study authors conclude that “Optimizing hospital environments in emergency
medical settings through formal policies and training on managing law
enforcement presence in the ED has the potential to prioritize SOV recovery,
limit interactions between SOV and law enforcement, and improve information
sharing and job effectiveness for different stakeholders.”
Key Takeaways:
- clear protocols for law enforcement interactions in EDs are essential.
- Complete training for both ED staff and LEOs on patient rights and trauma-informed care is critical.
- The presence of SOV advocates can significantly improve patient experiences and protect their rights.
- further research is needed to assess the impact of law enforcement presence in diverse ED settings.
Moving forward, healthcare institutions, law enforcement agencies, and advocacy
groups must collaborate to develop and implement best practices that prioritize
patient safety, respect, and equitable access to care within the emergency
department.
References
1. Bhatnagar P, Ramdath C, Pinto D, Hall E. Navigating law enforcement presence
in emergency departments. JAMA Netw Open. 2026;9(1):e2551804.
doi:10.1001/jamanetworkopen.2025.51804
2. Pearson LD. Factsheet: Trump’s rescission of protected areas policies
undermines safety for all – NILC. National Immigration Law Center. February
26, 2025. Accessed january 13,2026.
https://www.nilc.org/resources/factsheet-trumps-rescission-of-protected-areas-policies-undermines-safety-for-all/
3. Statement from a DHS spokesperson on directives expanding law enforcement and
ending the abuse of humanitarian parole | Homeland Security. Department of
Homeland Security. January 21,2025. Accessed January 13, 2026.https://www.dhs.gov/news/2025/01/21/statement-dhs-spokesperson-directives-expanding-law-enforcement-and-ending-abuse
4.McAmis NE. Responding to ICE in emergency departments: Protecting patients
and navigating legal obligations. EMRA. February 11, 2025. accessed January
13, 2026.https://www.emra.org/emresident/article/ice-in-the-ed
5. Law enforcement presence in the emergency department: A toolkit by the State
Legislative & Regulatory Committee developed in collaboration with the
diversity, equity, & inclusion committee. ACEP. October 3,2024. Accessed
January 13, 2026.
https://www.acep.org/state-advocacy/state-advocacy-overview/law-enforcement-toolkit
