Use of Force: The Correlation between Law Enforcement and Clinical Care

Article excerpt

The use of force is a way of life in any correctional setting. Force comes in varying degrees of constraint and crosses professional disciplines in its application. Examples of its application can run the scale from OC (pepper spray) deployment by an officer, to the clinical order of four-point restraints by a physician.

Force comes with a negative connotation, as it often involves physical power or violence to accomplish its goal. If not done correctly, force often extracts a high price from those involved through costly litigation, guilt and shame in the court of public opinion. As a result, law enforcement agencies and health care professionals have developed mandatory standards for its use. While the two disciplines' philosophies are opposite, they share common ground in its justification to "protect."

Oath of Office

The term "sworn staff" comes from the oath law enforcement officers take when they become public servants pledging to "serve and protect" the public. For those staff who work in a correctional institution, that includes the safety and security of the institution and it is implied that, when necessary, force will be used to fulfill that duty. (1)

Likewise, the mission statement of health care is seen as taking its roots from Hippocrates and the oath physicians take upon graduation, vowing to keep their patients from harm, injustice and to follow the best treatment plan for them. It is implied that force will not be used in rendering that care in respect to the patients' rights.

Although these may seem divergent and contradictory mission statements, they are very similar in the way each discipline establishes policies and practices, and the outcomes are likewise similar in the attainment of the mission.

Governing Bodies

Each discipline has governing provisions that are used to establish the key elements in the development of its respective practices. When developing professional standards, many things play a role in determining their constitution. The driving factors consist primarily of a code of ethics, case law and regulatory agencies.

Each state regulates law enforcement through a governing body known as POST--Peace Officer Standards and Training. It acts to certify that members of the law enforcement community are competent in their knowledge and application of law enforcement for public safety.

When establishing policy and procedure on the use of force for law enforcement, the U.S. Supreme Court decision in Graham v. Conner is viewed as the seminal case that defines constraint and is where the application of "reasonable force" originates. (2)

Likewise in health care, each state has a body known as the Division of Occupational and Professional Licensure. It acts to license health care professionals and set competency levels to practice in each respective field. The driving factors of standards in health care are similarly drawn from a code of ethics, case law and regulatory agencies.

When establishing the policies and practices for the health care version of force or restraints, hospitals and health care professionals write their policies and practices to comply with regulatory agencies and third-party reimbursement. This results in the standard of "community practice," which is the common level of care given throughout the jurisdiction of the governing agency. The largest national source and influence of community practice comes from the Centers for Medicare and Medicaid Services in the Code of Federal Regulations, the governing body for Medicaid and Medicare reimbursement.(3) As its use and acceptance is uniform across state lines, it becomes the standard for negligence and the definition for the least restrictive level of care.

Reasonable Force Or Least-Restrictive Intervention

When an officer is confronted by a situation where force will be required to protect public safety or the safety of the institution, attempts to restore order should begin through a continuum of force that includes verbal commands, use of hands, chemical agents, baton or other impact weapon, canine, less-than-lethal projectiles and finally, if necessary, deadly force. …