Law enforcement officials are often the first to respond to emergent mental health crises and health care providers at hospital emergency rooms are often the first to treat an individual in the midst of a mental health crisis, frequently after a law enforcement official has brought the individual to the emergency room. Questions have arisen about their respective abilities to respond to and treat individuals who do not desire their assistance. A federal court in Iowa afforded relatively wide latitude to the law enforcement officials, but less so to emergency room health care providers.
In January 2001, sheriff's deputies in Iowa detained a man after he was found walking on a highway without a coat. The man's pickup truck had run out of gas and he had initially walked to a nearby farmhouse. Although the deputies were responding to a call of a reported burglary, a subsequent investigation determined that a burglary had not occurred.
Finding the man relatively uncooperative and uncommunicative, the deputies concluded the man was intoxicated from alcohol or a controlled substance and for his own safety and the safety of others could not remain at large. He was handcuffed and placed in the front seat of a patrol car and taken to a nearby hospital's emergency room. After arrival, the man was turned over to the care of the hospital staff but the deputies remained at the hospital to provide security.
Still handcuffed, the man was first seen by an emergency room nurse, who found him in an agitated state pacing about the room. The man would not answer the nurse's questions but she was able to take his pulse, respiration, temperature, and blood pressure. A physician then arrived and also observed the man in an agitated state. The physician concluded that although the man was medically stable, his mental state was not normal or stable and he was most likely under the influence of drugs, alcohol, or both. A urine test was ordered to determine the proper course of treatment and to ascertain whether the man could be treated at the hospital or needed to be transferred to another hospital that was better equipped to treat patients with a psychiatric disorder.
However, the man was unable to urinate and a decision was made to insert a catheter. The man was not asked if he wanted to be catheterized and his consent was not obtained. His pants were removed, his arms were handcuffed, and he was restrained on a cart by the deputies. After completing the test and consulting with a staff psychiatrist, the decision was made to transfer the man to a psychiatric facility. …