When arresting officers arrive with their charges at a certain large urban jail, the first person they see when they come through the doors is a nurse. The nurse quickly evaluates the arrested person to determine whether a medical clearance is needed before the person can be booked. If a clearance is needed, the arresting officer has to transport the prisoner to a local ER and then return with the medical clearance in hand.

One evening (so the story goes), an arresting officer arrives at the jail bodily dragging a prisoner through the pre-book door by the backseat of his pants and coat. “This guy’s an a**hole,” the officer says. “He won’t do anything I ask. He just ignores me.” He then dumps the prisoner on the floor. The nurse kneels down by the prisoner briefly, looks up and says, “That’s because he’s dead!”

Medical clearances are a hugely important and often neglected part of the jail medical process.

Many people who are arrested need urgent medical attention before they are booked into jail. An easy example is the person arrested for drunk driving but who was seriously injured in the motor vehicle accident they caused. Another is the person who has a heart attack as they are being arrested. No one would argue that it is wrong and cruel to take these people to jail for booking before they receive medical care.

The problem is that arresting officers often do not like to take the people they arrest to the ER for a medical evaluation and clearance. Since they have to escort these prisoners, it takes them out of service–sometimes for several hours. They complain that often, the ER docs don’t really do a real exam. They glance briefly at the patient and fill out the Medical Clearance form. They consider this to be a waste of time.

Everyone will agree, though, that there are some people who clearly belong in the hospital rather than jail–like the severely injured trauma victim. Others are not really sick and can be safely delivered to the jail, where they can be evaluated by the jail’s medical team. The problem is that the decision as when to take an arrestee to the ER for a medical clearance and when to go directly to the jail is a decision that must be made by a non-medical person–the arresting officer. It would be helpful to them to have written guidance as to which prisoners need a medical clearance and which do not. To this end, I have added a sample guideline on medical clearances to the Guidelines section of JailMedicine.

I think that is important for arresting officers and jail personnel to understand that There are three reasons for obtaining a medical clearance before taking a person to jail.  The first is that it is best for the patient. Taking an arrested person with urgent medical needs directly to jail delays necessary medical care and can lead to bad outcomes. The difference between going directly to the ER and going to the jail first for processing and then to the ER can be hours. Sick patients can deteriorate rapidly in that amount of time. Second, going directly to the ER for a medical clearance saves money because it is more efficient to get urgent medical care before booking. The final reason to obtain medical care before booking is that this markedly decreases legal liability should a bad outcome occur.  No one can always predict how sick an injured patient or a patient with chest pain really is, especially if they are intoxicated or upset at being arrested. Obtaining a medical clearance before booking shows that the arresting officer is not being deliberately indifferent to a potentially serious medical need.

I would recommend that every jail develop a guideline on which patients should be medically cleared before coming to jail and then set up a conference to discuss that guideline with all of the arresting agencies that bring prisoners to the jail–city police, county deputies, State Police, Probation and Parole–as well as the jail’s legal council. If all of the arresting agencies adopt the guidelines, this will absolutely improve medical care, decrease overall costs and reduce legal risk for the jail.

As always, what I have written here is my opinion, based on my training, experience and research. I could be wrong! If you think that I am wrong, please say why in comments!

Do you have a written policy in your facility for who needs a medical clearance before booking? How well does it work? Please comment!

You can find a JailMedicine sample Guideline of Medical Clearances here.