500 signatures reached
To: The Board of Supervisors and Department of Health Serivces
End Law Enforcement Abuse in L.A. County Hospitals
On October 6, 2020, Los Angeles County Sheriff’s Department personnel fatally shot Nicholas Burgos, a patient in mental health crisis at Harbor-UCLA. This was the second incident of a patient in a mental health crisis being fatally shot by law enforcement at the Harbor-UCLA Medical Center campus in the last 5 years. On October 27th, the Board of Supervisors unanimously passed a motion, Promoting the Health and Safety of Patients, Visitors and Employees on the County of Los Angeles’ Medical Campuses. The motion mandated that the Department of Health Services (DHS) identify the most effective means of ensuring community safety while exploring the Board's legal authority to restrict or limit law enforcement presence in care settings.
On June 22, 2021 DHS made public its recommendations to increase community safety in our care settings. While two of the recommendations demonstrate an awareness of the dangers of stationing law enforcement in care settings, the majority of the recommendations fall short of protecting patients and providers, ignore the root causes of harm in care settings, and further entrench and empower the Los Angeles Sheriffs department to harm patients and undermine the authority of clinicians whose primary mission is to do no harm.
The Frontline Wellness Network (FWN) is calling on the county Board of Supervisors and Department of Health Services to take a more firm stance in protecting Black and Brown patients who rely on our safety net hospitals and are most policed in our systems of care. We demand that the county do the following:
1) End the LASD/DHS contract and reallocate those resources to established and new community safety strategies that have proven to be successful and address the root causes of harm and law enforcement intervention.
2) Fund dedicated community safety and crisis response strategies, which include full-time Code Gold and PMRT, trauma-informed de-escalation teams at all DHS facilities.
3) Review & revise all policies that explicitly or implicitly authorize law enforcement to harm or criminalize patients and/or healthcare providers, interrupt the practice of care, or undermine community trust in care facilities as places of safety.
4) Create a system of mandatory reporting of law enforcement abuse.
5) The Department of Health Services should engage the community and healthcare providers to outline the best way forward to eliminate law enforcement from DHS facilities and reimagine how to promote the safety of community members in these care settings.
On June 22, 2021 DHS made public its recommendations to increase community safety in our care settings. While two of the recommendations demonstrate an awareness of the dangers of stationing law enforcement in care settings, the majority of the recommendations fall short of protecting patients and providers, ignore the root causes of harm in care settings, and further entrench and empower the Los Angeles Sheriffs department to harm patients and undermine the authority of clinicians whose primary mission is to do no harm.
The Frontline Wellness Network (FWN) is calling on the county Board of Supervisors and Department of Health Services to take a more firm stance in protecting Black and Brown patients who rely on our safety net hospitals and are most policed in our systems of care. We demand that the county do the following:
1) End the LASD/DHS contract and reallocate those resources to established and new community safety strategies that have proven to be successful and address the root causes of harm and law enforcement intervention.
2) Fund dedicated community safety and crisis response strategies, which include full-time Code Gold and PMRT, trauma-informed de-escalation teams at all DHS facilities.
3) Review & revise all policies that explicitly or implicitly authorize law enforcement to harm or criminalize patients and/or healthcare providers, interrupt the practice of care, or undermine community trust in care facilities as places of safety.
4) Create a system of mandatory reporting of law enforcement abuse.
5) The Department of Health Services should engage the community and healthcare providers to outline the best way forward to eliminate law enforcement from DHS facilities and reimagine how to promote the safety of community members in these care settings.
Why is this important?
A) The movement of LASD personnel out of the hospital and into the perimeter of the care setting is a positive step (DHS recommendation 1). The presence of LEP in our care settings increases the likelihood of deadly use of force and that legal protections such as patient privacy as well 4th and 5th amendment constitutional protections will be violated. However, this does not address the actions of LEP who frequently come in and out of county hospitals nor how LEP presence deters the use of hospitals by our community.
B) FWN has called on DHS to establish dedicated behavioral response teams to increase de-escalation capacity in our hospitals. A Non-LEP Psychiatric Mobile Response Team pilot (DHS recommendation 5) that addresses response needs campus wide, rather than limiting the team to emergency rooms, is a critical step towards protecting patients and community members in and around our care facilities. The county should scale this model to meet the needs of community members in all DHS facilities by reallocating funds from currently assigned Sheriff personnel.
C) While DHS recommendations 4, 6, and 7 aim to address policies and procedures that will impact LEP who come in and out of the care setting, they are vague and reference revised Harbor-UCLA policies which further entrench LASD in the care setting and put patients at risk.
Policy 138 empowers LASD deputies to determine the disposition of a subject according to the alleged crime and ascertain if medical care is needed. LASD personnel are not trained clinicians. Between 2012 and 2015 a common theme amongst lawsuits brought against LASD was the denial of medical care totaling over $6.3 million in settlements during that time period. A FWN survey of medical doctors at Harbor UCLA, found that 42% have had an experience where LEP attempted to influence their medical decision making in a manner that did not benefit their patient. An additional 85% said that they have had an experience where LEP presence or actions made it more challenging for them to care for a patient.
Under Policy 451, all psychiatric patients arriving at the hospital and who are on a 5150 mental health/legal hold are considered to be "in custody." The care first visions, specifically intercepts 0 and 1, stress the need for alternatives to incarceration and will likely result in an increase in self-admission or family/community supported admission to the hospital. Policies that remove the rights and protections of patients who are seeking help while increasing the reach and authority of LEP personnel are dangerous to Black and Brown communities.
Policy 451 states that “patient consent is not required for LEP interviews or photographing of in-custody patients.” The policy also states that clinical staff “must witness patients consent” to an interview but fails to state that clinicians assure patients are aware of their right to refuse. Anyone in custody has the right to remain silent, right to legal counsel, and right to refuse questioning. The policy fails to acknowledge patients' rights, fails to endow healthcare providers with the authority to enforce these rights, and provides blanket authority to LEP to interrogate patients in custody. Patients who are receiving medical care are particularly vulnerable, susceptible to LEP intimidation, and may be unaware or unable to exercise their legal rights.
Policy 451 states that “law enforcement personnel must remain in the immediate vicinity at all times, even if asked to step outside the treatment room, in order to take control of the in-custody patient, if needed. This constant presence of LEP in close vicinity to patients not only greatly increases the risk of LEP overhearing protected health information, but also disrupts the physician-patient therapeutic relationship.
D) While increased training for LASD personnel (DHS recommendation 3) may seem positive, the reality is that culture and function of LASD personnel will always override training. The department has been the subject of federal investigations, consent decrees, officer convictions but continues to practice corruption and misconduct and is currently under investigation by the CA Attorney General’s office for violations of people's constitutional rights. The officer who shot and killed Nicholas Burgos chose to use deadly force despite over a decade of reforms. More training for LASD only serves to legitimize further investment in LASD and entrench inappropriate LEP in our care settings while obscuring the ongoing violence and harms of the department.
E) DHS’ stakeholder engagement failed to meet the standard set by the Care First roadmap by assuming that LEP and/or security are the only means to achieve safety or prevent harm. The roadmap instructs the county to implement strategies that reduce LEP contact, reduce incarceration, and address the root causes of harm. Clinicians who participated in FWN surveys and interviews identified a multitude of prevention strategies that address the root causes of harm, police intervention, and incidents that require de-escalation. The most common themes included increasing the number of clinical staff and reducing staff patient ratios, improving clinical and de-escalation response times, investing in addressing the social determinants of health on site including service linkage, and increased training in de-escalation for clinicians.
DHS should move beyond narrow and polarizing engagement to generate solutions; specifically as it relates to assumptions about people who use drugs. The harm reduction field locally and internationally has demonstrated that people who use substances are not a threat to public safety. The success of safe consumption sites, overdose prevention centers, and other user centered spaces demonstrate that how we design care can increase or undermine. The County should improve hospital safety by learning from and adopting harm reduction strategies to DHS facilities.
B) FWN has called on DHS to establish dedicated behavioral response teams to increase de-escalation capacity in our hospitals. A Non-LEP Psychiatric Mobile Response Team pilot (DHS recommendation 5) that addresses response needs campus wide, rather than limiting the team to emergency rooms, is a critical step towards protecting patients and community members in and around our care facilities. The county should scale this model to meet the needs of community members in all DHS facilities by reallocating funds from currently assigned Sheriff personnel.
C) While DHS recommendations 4, 6, and 7 aim to address policies and procedures that will impact LEP who come in and out of the care setting, they are vague and reference revised Harbor-UCLA policies which further entrench LASD in the care setting and put patients at risk.
Policy 138 empowers LASD deputies to determine the disposition of a subject according to the alleged crime and ascertain if medical care is needed. LASD personnel are not trained clinicians. Between 2012 and 2015 a common theme amongst lawsuits brought against LASD was the denial of medical care totaling over $6.3 million in settlements during that time period. A FWN survey of medical doctors at Harbor UCLA, found that 42% have had an experience where LEP attempted to influence their medical decision making in a manner that did not benefit their patient. An additional 85% said that they have had an experience where LEP presence or actions made it more challenging for them to care for a patient.
Under Policy 451, all psychiatric patients arriving at the hospital and who are on a 5150 mental health/legal hold are considered to be "in custody." The care first visions, specifically intercepts 0 and 1, stress the need for alternatives to incarceration and will likely result in an increase in self-admission or family/community supported admission to the hospital. Policies that remove the rights and protections of patients who are seeking help while increasing the reach and authority of LEP personnel are dangerous to Black and Brown communities.
Policy 451 states that “patient consent is not required for LEP interviews or photographing of in-custody patients.” The policy also states that clinical staff “must witness patients consent” to an interview but fails to state that clinicians assure patients are aware of their right to refuse. Anyone in custody has the right to remain silent, right to legal counsel, and right to refuse questioning. The policy fails to acknowledge patients' rights, fails to endow healthcare providers with the authority to enforce these rights, and provides blanket authority to LEP to interrogate patients in custody. Patients who are receiving medical care are particularly vulnerable, susceptible to LEP intimidation, and may be unaware or unable to exercise their legal rights.
Policy 451 states that “law enforcement personnel must remain in the immediate vicinity at all times, even if asked to step outside the treatment room, in order to take control of the in-custody patient, if needed. This constant presence of LEP in close vicinity to patients not only greatly increases the risk of LEP overhearing protected health information, but also disrupts the physician-patient therapeutic relationship.
D) While increased training for LASD personnel (DHS recommendation 3) may seem positive, the reality is that culture and function of LASD personnel will always override training. The department has been the subject of federal investigations, consent decrees, officer convictions but continues to practice corruption and misconduct and is currently under investigation by the CA Attorney General’s office for violations of people's constitutional rights. The officer who shot and killed Nicholas Burgos chose to use deadly force despite over a decade of reforms. More training for LASD only serves to legitimize further investment in LASD and entrench inappropriate LEP in our care settings while obscuring the ongoing violence and harms of the department.
E) DHS’ stakeholder engagement failed to meet the standard set by the Care First roadmap by assuming that LEP and/or security are the only means to achieve safety or prevent harm. The roadmap instructs the county to implement strategies that reduce LEP contact, reduce incarceration, and address the root causes of harm. Clinicians who participated in FWN surveys and interviews identified a multitude of prevention strategies that address the root causes of harm, police intervention, and incidents that require de-escalation. The most common themes included increasing the number of clinical staff and reducing staff patient ratios, improving clinical and de-escalation response times, investing in addressing the social determinants of health on site including service linkage, and increased training in de-escalation for clinicians.
DHS should move beyond narrow and polarizing engagement to generate solutions; specifically as it relates to assumptions about people who use drugs. The harm reduction field locally and internationally has demonstrated that people who use substances are not a threat to public safety. The success of safe consumption sites, overdose prevention centers, and other user centered spaces demonstrate that how we design care can increase or undermine. The County should improve hospital safety by learning from and adopting harm reduction strategies to DHS facilities.