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What We Can Learn from the Nurse Incident in Utah

A nurse was dragged out of a Utah hospital in front of patients and coworkers and then handcuffed against the wall.  Her crime?  She refused to draw blood from an unconscious victim of a motor vehicle accident. A Salt Lake City police officer investigating the car accident demanded that she draw blood, and when she said no, he arrested her for obstruction of justice.  Key Question - How can we avoid a situation like this in EMS?

1. Know Your State Law   

Some states have passed laws authorizing or requiring EMS providers to draw blood at the direction of law enforcement.  Typically the blood draw is from a person suspected of DUI, or if the individual caused a serious injury or death, but these laws vary.  Some laws require that the patient be under arrest, or that the officer have a warrant.  Other states permit law enforcement to direct an EMS provider to forcibly draw blood if the officers can reasonably restrain the individual. 

Make it clear to providers what the law permits law enforcement officers to do in your state.  You can also consider having a copy of your state’s “blood draw law” on board the ambulance along with official guidance from your state department of health.   

2. Be a Patient Advocate

A forcible blood draw may run contrary to what providers learned about patient consent and refusal of care. Some laws say that blood shouldn’t be drawn in situations that could jeopardize a person’s life or cause “serious injury.” The problem is, the officer could be the one who is authorized to determine whether the blood draw is appropriate. 

When the patient’s health could be jeopardized by the blood draw, don’t be afraid to speak up and tell the officer about potential threats to the patient’s health.  There may also be alternatives, such as having the patient’s blood drawn in a more controlled environment at the hospital.   If law enforcement is obstructing care, providers should tell the officer about the need to treat the patient and cite specific reasons why.  Providers should document discussions with the officer and consult medical command where appropriate.  

3. Protect the Patient’s Privacy

HIPAA permits disclosures of protected health information whenever state law requires such disclosure. So, it isn’t a violation of HIPAA to conduct a blood draw at the direction of law enforcement where state law permits the blood draw.  But, HIPAA generally doesn’t permit providers to discuss details of the patient’s condition. 

Unless required by state law to release the information, providers shouldn’t divulge details concerning the patient’s physical or mental health.  Law enforcement can get a subpoena or a warrant for the trip report, and they can speak with others who aren’t covered by HIPAA – including the patient.  It’s not a HIPAA violation if the patient releases the information to the officer.   

4. Plan Ahead

EMS agencies should work out difficult issues surrounding blood draws in advance with local law enforcement agencies. That means sitting down with local law enforcement and having a discussion about the needs and concerns of both sides.  Although these laws typically don’t include penalties against health care providers who refuse to follow the directive of a law enforcement officer, an EMS provider could be arrested for obstruction of justice or other similar offense.  If the parties are clear about what’s supposed to happen in blood draw situations, there’s a much smaller chance that the provider will end up in cuffs.