Personally, I don’t see why this guy was so adamant against rectal exam, why it was such a big deal for him. But I also believe, that our right to refuse is very important, especially in this era of defensive testing.

I think how the police got involved is important. Even if the policeman was in the ED, he wasn’t present at the examination itself, so he couldn’t have witnessed the incedent. If the doctor or nurses gave evidence about the incident, did they mention they thought the guy wasn’t of the right mind because of his head injury?

Next.

Ah, the irony.

Must… resist… commenting…

I have the facts you have (and those reported in the three or four stories published online about this case.)

The conclusion of the doctor in the ER does not automatically have to be the same as the prosecutor reviewing the case. Certainly it makes for a better case if there is agreement about competence. And where have I said it was the job of the police to determine culpability or guilt? It seems you are the one over-reading my post. The question of the police officer is whether the patient is assaulting the doctor (versus exercising self-defence, I suppose) and should he be arrested and restrained.

As for who can be tried or not, the issue of competence is one of degrees, as you probably know. One can indeed be mentally ill and still be prosecuted and further still be convicted, provided the accused is thought able to know what he was doing was wrong. That is really besides the point, because the decision to prosecute is not the privilege of the police, or for that matter the victim wanting to press charges but that of the state’s/district attorney. (And why you aren’t questioning that decision makes me wonder.) But the police can still arrest persons who aren’t competent if they are thought dangerous or are engaged in acts that would be criminal if done by a competent person (no news there, I hope.)

As for who goes to jail, I defer to my experienced colleagues in forensic psychiatry who tell me what I have written above: mentally ill criminals do indeed get convicted and sentenced. And there are a lot of them behind prison fences, not just in state hospitals.

To Kitty:

It is not unusual for police to be posted in city emergency rooms; they certainly are in DC and Detroit. Some ER’s actually have jail cells for injured suspects. In this case,the stories don’t say how exactly the police became involved. Who called them probably isn’t important. And the fact that the doctor could call the patient’s competence one way and the cop, ignoring questions of competence and only dealing with a combative citizen punching doctors in the emergency room deciding to arrest that person is precisely my point. When it comes to deciding what to do with the patient once arrested, others can parse the issues of competence, which evidently the magistrate did.

Was the doctor right and the patient not competent? I think that question will be germane if this civil case goes to trial. If the doc loses, though, it will be the patient/plaintiff/former-accused who, to paraphrase you, will be the one to have it “both ways.”

You clearly have more facts than we do–do you mind sharing your source?

…concern of the police officer: “is this citizen/patient who is assaulting E.D. staff a dangerous criminal?”….And as for violent persons who commit assault; they can be rightfully arrested, prosecuted and punished, even when they suffer from mental illnesses that would make a reasonable ethicist question their competence to make significant personal decisions. Our jails are full of such people.

Um, no. First of all, police officers don’t determine who is and who isn’t a “criminal;” the courts do. Second, the very fact that you yourself say “question their competence” automatically means they can’t be prosecuted until that’s resolved, since 1) non-competent individuals can’t be tried, and 2) even if we were to overlook that point of ignorance, the burden of proof in a criminal setting is “reasonable doubt,” (oversimplified, obviously) which “a reasonable ethicist” questioning competence kinda takes care of. Our jails are NOT full of such people (though a few of them certainly could have fallen through the cracks); our mental institutions are.

Thank you Grunt Doc for your interesting blog.