Wednesday, September 12, 2007

Law and Medicine Rounds

By Dainius A. Drukteinis, M.D., J.D.

“The only real mistake is the one from which we learn nothing.”
- John Powell

Search and Seizure in the Emergency Department
The Case of the Double Crack

Imagine working in the Emergency Department and a patient with handcuffs is escorted by police officers into one of the bays. The officers state that during a strip search, they witnessed the patient remove rocks of crack cocaine hidden in the patient’s rectum, place the crack rocks in his mouth, and then swallow them. The officers tell you that they would like the patient’s stomach pumped. The patient states that under no circumstances does he want his stomach pumped. The officers insist you comply or they will arrest you for obstruction of justice. How would you proceed?

This was the situation in Stokes v. Porretto, 2006 U.S. Dist. LEXIS 71060 (September 2006). The physician performed the requested gastric lavage and removed the crack cocaine against the patient’s will. The patient sued the physician arguing, among other things, that the gastric lavage violated his Fourth Amendment protection against unreasonable search and seizure. The federal district court held that the gastric lavage did not violate the patient’s constitutional rights.

In this case, the record demonstrated that the physician performed the procedure because the patient’s heart rate and blood pressure were markedly elevated to 138 beats per minute and 197/100 mm Hg, respectively. The patient also became increasingly disturbed, and started thrashing, flailing, and screaming. The physician believed that the patient could suffer serious injury or death if the contents were not removed from his stomach. Furthermore, he felt that the patient was unable to make a rational decision regarding his treatment due to his condition. The court agreed with the physician.

The federal district court distinguished the facts of this case from the landmark Supreme Court case Rochin v. California, 342 U.S. 165 (1952). In Rochin, police officers witnessed the patient-suspect swallow two capsules containing morphine. When the suspect was brought to the hospital, the physician gave the patient an emetic by nasogastric tube to remove the capsules. There was no evidence that the capsules posed a physical threat to the patient. There was no evidence that the patient lacked capacity to refuse the procedure. The nasogastric tube was placed, and the emetic was administered, solely for the purpose of obtaining evidence. In Rochin, the Supreme Court held that the physician’s actions violated the patient’s constitutional rights stating that this method to obtain evidence would “offend even hardened sensibilities” and is “too close to the rack and screw to permit constitutional differentiation.”

For the Emergency Medicine Physician, both of these cases could be handled properly without any prior knowledge of the law. The critical question is:

What is best for the health of the patient?

Admittedly, there are more appropriate methods for handling cocaine ingestion than gastric lavage. Nevertheless, gastric lavage is still performed by some physicians to remove harmful substances, and this was the method that the physician felt was appropriate under the circumstances. Therefore, because the physician’s actions in the first case were justified from a medical care standpoint, his actions were also justified under the law.

Dainius A. Drukteinis, M.D., J.D. is a fourth year Emergency Medicine Resident at NYU/Bellevue Hospital. He may be contacted at

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