Research articles

By Dr. Radhika L Sundararajan , Dr. Andrew L Miner , Dr. William Paolo, Jr , Dr. William Chiang
Corresponding Author Dr. William Chiang
New York University Department of Emergency Medicine, - United States of America
Submitting Author Dr. Andrew L Miner
Other Authors Dr. Radhika L Sundararajan
New York University School of Medicine, - United States of America

Dr. Andrew L Miner
New York University Department of Emergency Medicine, 4801 Chevy Chase Dr - United States of America 20815

Dr. William Paolo, Jr
New York University Department of Emergency Medicine, - United States of America


Emergency Medicine, Prisoners, Law Enforcement, Hospitalization

Sundararajan RL, Miner AL, Paolo, Jr W, Chiang W. Police Detainees In The Emergency Department: Who Do We Admit?. WebmedCentral EMERGENCY MEDICINE 2012;3(1):WMC002849
doi: 10.9754/journal.wmc.2012.002849

This is an open-access article distributed under the terms of the Creative Commons Attribution License(CC-BY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Submitted on: 03 Jan 2012 01:43:51 AM GMT
Published on: 03 Jan 2012 08:11:03 AM GMT


Police detainees are at high risk for illness or injury after arrest, but often suffer from limited access to medical care, including disruption of chronic medication use. To describe the medical complications among arrestees in one urban, public hospital after modest improvements in medical screening at the central lock-up, we performed a retrospective chart review of electronic discharge summaries for all detainees admitted to a medical or surgical service during 2006. Among 173 admissions, there was a high rate of underlying chronic medical conditions (most common: substance abuse 68%, hypertension 26%, asthma 15%, and diabetes 14%). The most common reasons for admission were: To evaluate for acute coronary syndrome in the setting of chest pain (25%), drug withdrawal (20%), and trauma (10%). There were fewer serious diabetic complications than had been previously reported, but more work is needed to determine how greater medical access can improve outcomes for this population.


Prison officials are legally obligated to provide treatment for “serious illness or injury” suffered by those in their custody.[1] A number of studies have identified shortcomings in the provision of this care.[2-5] Nationally, there is a trend toward more limited health resources for those in shorter-term custody and at local facilities. One recent survey found that over 2/3 of inmates in local jails had not even received a medical examination.[2]
This trend suggests that police detainees, who are held at a central lockup or local jail for a matter of hours or days prior to arraignment, likely experience the greatest isolation from medical services. This is particularly problematic as these detainees in particular suffer a number of threats to health associated with arrest, including recent trauma, drug intoxication, and decompensation of chronic illness after lack of access to medications following arrest.[3-5] Twenty years ago, a landmark study from our hospital identified 54 recent arrestees who had been admitted for diabetic ketoacidosis (DKA), in most cases precipitated by a lack of access to insulin while in custody.[3]
Since that publication, there have been some changes in the city’s approach to detainee medical care. An emergency medical technician now administers a medical screening questionnaire to all detainees upon arrival at the central lock-up.Those with concerning medical problems are often referred to local emergency departments for further evaluation.Detainees are permitted to take chronic medications in their possession at the time of arrest or if provided by the emergency department, though this system is variably applied and there is no mechanism for the storage of insulin at the central lock-up.
We sought to provide a current and broader evaluation of this population by describing all police detainees admitted to our hospital for medical conditions during a recent year.


Study Design: This was a retrospective cohort study of all police detainees admitted to one urban public hospital during 2006. The study was approved with waiver of written consent after a full review by the medical center’s institutional review board (IRB).
Study setting and population. This hospital is a preferred referral center for the emergency care of police detainees in one geographic subdivision of the city, resulting in an estimated 4000 emergency department visits during 2006 [unpublished data]. Individuals in this system are typically held by police for 12-48 hours in a central lock-up while awaiting arraignment. Arrestees may be referred to the hospital at any point during their detainment. All admissions are initially evaluated in the emergency department. Psychiatric admissions are handled differently and are subject to more complicated referral patterns, so for simplicity this evaluation was limited to medical admissions.
Study protocol: Candidate admissions for review were identified electronically by means of an insurance code indicating police custody. We included all non-psychiatric admissions that began during the year 2006. All available electronic discharge summaries for candidate admissions were obtained and reviewed for inclusion. We excluded those that summarized only care by a psychiatric service and those that did not specifically reference police custody during the admission. This latter criterion was necessary because insurance codes tended to also identify patients who had presented in police custody at some earlier visit but were not detainees at the time of admission. Equivocal candidate admissions were reviewed by three authors (RS, WP, and AM) and inclusion or exclusion was determined by consensus. Multiple admissions of a single person during 2006 were allowed and treated separately. All included electronic discharge summaries were reviewed for patient demographic data, length of stay, highest level of care required, outcome of admission, and reason for admission.
Data Analysis: All data except reason for admission were considered objective and so categories were defined prior to chart abstraction. This review was done independently by two authors (RS and AM) and discrepancies were resolved by a third review. The reason for admission was considered a more subjective data element and so was determined by a more complicated process. Broad clinical categories of common reasons for admission were identified through notes made by RS on an initial review (e.g. chest pain admitted to rule out acute coronary syndrome). Subsequently, WP and AM independently reviewed each discharge summary and identified the reason for admission according to these clinical categories. The validity of this review is supported by the agreement between these reviews (89%). An “other” write-in option was used during this review but no additional reason for admission was identified with a frequency of greater than two. As this was a descriptive study, results were summarized with mean, median, or range as appropriate.


There were 173 included admissions during the study period. Of 389 candidate admissions, 16 were excluded for absence of an available discharge summary, 12 were excluded because only a psychiatric discharge summary could be found and 188 were excluded because they did not reference the patient’s status in police custody. There were four second admissions by a single patient during 2006. No patient had a third qualifying admission.
The demographic information, past medical history, length of admission and outcome, are all reported in Table 1. Almost all patients who underwent operative procedures were admitted for trauma. Table 2 summarizes the reason for admission of all 173 patients with those appearing two or fewer times grouped as “other”. The complications of diabetes included DKA (four admissions) and hyperglycemia (seven admissions). Five patients (three percent) were admitted with no new medical problem, but simply because a chronic medical condition, e.g. need for dialysis, could not be cared for at the lock-up.


The 173 admissions we observed during a single year supports our understanding of police detainees as a medically high-risk population. While we do not have enough data to determine a true admission rate, we can estimate a lower threshold for this number. There were 79,969 arrests in our geographic subdivision of the city during 2006.[6] Estimating conservatively that the average time of holding was no more than two days these admissions occurred in just 438 person-years. As we studied only one of several hospitals to which detainees were brought and considered medical but not psychiatric admissions with conservative inclusion criteria, this population certainly has a multiple-fold increase in hospital admissions over the baseline rate of 132/1,000 population.[7] Estimating from unpublished data which suggest that there were 4000 emergency department visits by police detainees during the study time period, the admission rate from the emergency department was just under five percent, well under the national average of 12.8%, likely due to this system’s heavy use of the emergency department to screen those who might have need for any care. [8]
No single medical need explains the majority of admissions in this population. Some admissions, like those for trauma, were clearly the result of the high-risk environment of arrest. Others, especially admissions for complications of diabetes, asthma, seizure disorders, and even chest pain, were potentially related to a lack of access to chronic medications. Another concern, more important in the recently-arrested population than among those with longer-term incarceration, is withdrawal from alcohol or drugs. This group accounted for a substantial portion of the admissions.
Without data on the total number of arrests or on changes in referral patterns among hospitals in our area, it is not possible to make a direct comparison between the number of patients in DKA that presented during Keller’s study at this hospital and our own.[3] Still, his 54 patients in a 2.5 year period between 1989 and 1991 represent a far greater annual rate than the four found in our study. Perhaps the screening process and aggressive emergency department referral has reduced the rate of progression to DKA in custody. Although Keller did not report on patients admitted for hyperglycemia without DKA, the seven in this category on our review suggests that greater awareness of this issue may be prompting emergency physicians to admit patients at high risk for DKA rather than simply providing insulin and returning them to police custody, as was noted in seven of Keller’s patients eventually admitted in DKA.
It is unclear how well these findings would generalize to other communities, and this would likely vary especially with the amount of medical care available at the location where police detainees are held. We are not aware of any systematic description of these facilities, but based on the findings of Wilper, it is unlikely that a greater medical presence than that we have described is standard at police lock-ups.[2] It is important to note for any assessment of the health needs of this population that the admissions we report are likely an underestimate because of our conservative inclusion criteria, the lack of data from other area hospitals that also admit police detainees, and the exclusion of primarily psychiatric admissions.
Despite enhanced medical resources for police detainees in our city, this population clearly remains at risk for acute illness and complications of chronic conditions that are out of proportion to that of the general community. Further work is needed to determine if greater attention to the health needs of arrestees—including more reliably providing them access to their chronic medications—can prevent some of the complications that resulted in the admissions reported here.


1.Estelle v Gamble, 429 US 97 (1976).
2.Wilper AP, Woolhandler S, Boyd JW, et al. The Health and Heath Care of US Prisoners: Results of a Nationwide Survey. Am J Public Health. 2009;99(4):666-672.
3. Keller AS, Link RN, Bickell NA, et al. Diabetic ketoacidosis in prisoners without access to insulin. JAMA. 1993; 269:619-21.
4.Amnesty International USA. United States of America: police brutality and excessive force in the NYPD. AI Index: AMR 51/036/1996, June, 1996.
5.French HW. Drug Deaths After Arrests Draw Scrutiny. New York Times. June 14, 1989:B4.
6. Computerized Criminal History system. Albany, NY: New York State Division of Criminal Justice Services, 1/27/2010. Available at:
7.Levit K, Stranges E, Ryan K, et al. HCUP Facts and Figures, 2006: Statistics on Hospital-based Care in the United States. Rockville, MD: Agency for Healthcare Research and Quality, 2008.
8.Pitts SR, Niska RW, Xu J, et al. National Hospital Ambulatory Medical Care Survey: 2006 Emergency Department Summary. National Health Statistics Reports; no 7. Hyattsville, MD: National Center for Health Statistics. 2008.

Source(s) of Funding

This project was funded by the Department of Emergency Medicine of the New York University School of Medicine.

Competing Interests



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