Use of Force on Persons in Medical Emergencies

With the number of violent encounters between citizens and police on the forefront of the news, significant attention has been given to what a law enforcement officer can do to subdue a violent person who may be mentally ill. EMS personnel are often entangled in these encounters while trying to treat mentally ill or cognitively impaired patients. Whether force can be used by police, or chemical restraints used by EMS, is an issue courts have recently considered.

At the EMS Today conference in February, the use of Ketamine in such situations was discussed at length. Often, EMS providers rely on police to subdue a violent patient, sometimes resulting in cardiac arrest subsequent to excited delirium. Other medical emergencies, such as hypoxia and hypoglycemia, may also place EMS personnel in danger when trying to care for patients.

Estate of Corey Hill v. Miracle

In the case of Estate of Corey Hill v. Miracle, the 6th Circuit Court of Appeals considered the proper analysis of use of force by law enforcement where the officer was not making an arrest, but instead used his taser in stun mode to control a subject in need of medical assistance, but who was fighting the EMTs trying to provide assistance. The decedent’s estate brought a §1983 claim against the deputy who employed force to restrain him.

The court initially reviewed the factors articulated in the landmark use of force case, Graham v. O’Connor.  The first factor is the severity of the offense, the second was whether the subject posed an immediate threat to the officer or anyone else present and the third was whether the subject was actively resisting arrest or attempting to flee.

The court noted that these factors, well known by law enforcement officers, do not necessarily fit medical and mental health emergencies, noting that there are two strikes against the officer’s use of force before the analysis even begins. Since Hill had not committed a crime, nor was he resisting arrest, only the third factor applies.

The Case

In June of 2013, Deputy Christopher Miracle was called to assist EMS at a call for a diabetic emergency. A paramedic was able to obtain a blood glucose level of 38, and began attempting to initiate an IV. The patient became extremely combative, ripped out his IV causing blood to spray, and began swinging and kicking at the paramedics as they tried to restrain him. The deputy deployed his taser in drive-stun mode to Hill’s right thigh. Hill calmed down enough for the paramedic to re-establish the IV and administer dextrose. Hill then became alert and apologized for any problems.

Hill later filed suit, alleging that as a result of the taser deployment, he suffered burns on his right thigh, and that his diabetes worsened. In May of 2015, Hill died of complications of his diabetes.

Findings

The Michigan federal district court found that Deputy Miracle violated Hill’s clearly established rights to be free of excessive force. The trial court initially granted summary judgment on Hill’s emotional distress claim, but denied dismissal of the remaining claims. Deputy Miracle filed interlocutory appeal.  

The Sixth Circuit addressed the appeal and held that “Where a situation does not fit within the Graham test because the person in question has not committed  a crime, is not resisting arrest, and is not directly threatening the officer, the court should employ the following analysis:

  1. Was the person experiencing a medical emergency that rendered him incapable of making a rational decision under circumstances that posed an immediate threat of serious harm to himself or others?
  2. Was some degree of force reasonably necessary to ameliorate the immediate threat?
  3. Was the force used more than reasonably necessary under the circumstances?

As in Graham, the court went on to say that these questions should guide the answer as to whether, under the totality of circumstances, the officer’s actions were objectively reasonable.

The court ultimately found that in this case, Miracle’s use of the taser was objectively reasonable, noting that Hill was incapable of making rational decisions and posed a threat to the EMTs trying to take care of him. The court rejected an argument that Miracle could have avoided the threat by walking away, noting that this argument ignored the fact that Hill was a threat to himself if left untreated.

This is an important decision that could also affect EMS personnel employed by government agencies who use chemical restraints on individuals presenting as violent patients, or with mental health emergencies. The appropriate use of force by law enforcement, or chemical restraints by EMS, could prevent escalation of these events into officer involved shootings, or excited delirium deaths.

Estate of Corey Hill v. Miracle, 853 F3d 306 (6th Cir. 2017)

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Winnie Maggiore began her career in fire and EMS back in 1973 when she became one of the first women firefighters. She was an assistant chief of the Placitas Volunteer Fire Brigade for nearly 20 years, having helped to start the volunteer fire department in her home town. She has been an EMT since 1978 and a paramedic since 1981. She has worked as a firefighter and EMT in the field and as a state EMS administrator. She obtained her Bachelor's degree from the University of New Mexico in 1989 before moving on to obtain a law degree with a focus on health law in 1992. She is a shareholder at the law firm of Butt, Thornton & Baehr, PC where she defends physicians, dentists, oral surgeons, nurses, paramedics and other health care providers, as well as law enforcement officers, against lawsuits. Besides helping to build the Fire Brigade, one of her most important contributions was the revision of the New Mexico EMS legislation to provide broader protection and due process for licensed EMS personnel, and to make changes to allow EMTs to work in facilities such as clinics and hospitals as well as in the prehospital setting. She also made major contributions to the development of DNR regulations that allowed DNR orders to be recognized by EMS. Winnie is on the volunteer faculty at the University of New Mexico's Department of Emergency Medicine, where she teaches on legal issues for emergency medical providers. She is on the faculty of the National EMS Medical Director's Course put on by the National Association of EMS Physicians. She coauthored an important article on legal issues for EMS medical directors and has played a significant role in teaching about the legal relationship between EMS providers and their medical directors. She is a member of the JEMS editorial board and a frequent national speaker on EMS legal topics. Winnie was the proud recipient of the prestigious James O. Page award for EMS leadership in 2011. Winnie enjoys hiking in the mountains near her home with her two Dalmatians, and her husband, Dave, who is a retired emergency physician and stroke survivor.

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