LEARNINGOBJECTIVE: Recognize the policies and procedures pertaining to prisoner patients, victims of alleged sexual assault and rape, substance abuse and control, probable-cause searches, and line-of-duty and misconduct investigations.

Some medical conditions, by their very occurrence, will result in the involvement of law enforcement personnel. Individuals who are injured while committing a criminal offense; victims of abuse, neglect, or assault; impaired or injured as a result of drug abuse; or injured as a result of a traffic accident will often be the subject of an official investigation. Many times the investigators will want to question the patient or the healthcare providers treating the patient. Often, the medical records of the patient will be requested by the authorities. Occasionally, officials will want to take the patient into custody.

Under the Posse Comitatus Act, a federal statute enacted in 1956 (18 U.S.C. 1385), it is unlawful for the U.S. military to be used to enforce or assist in the enforcement of federal or state civil laws. There are many exemptions to this act, but the issue for healthcare providers is settled by asking the following question: "Is the medical procedure being done on this patient for a legitimate medical reason, or is it only being performed to assist civil law enforcement?" Provided there is a reasonable medical justification for the procedure, the results of the procedure may be shared with civil law enforcement officials under the circumstances discussed below.

Cooperation with law enforcement officials, to the extent possible, is required. Provided there are no medical contraindications, patients who are either suspected of having committed an offense or who are presumed victims of criminal activity will be made available to speak with investigators. As discussed previously, access to medical treatment records is governed by the Privacy Act and FOIA. Generally, records of patients may be made available to U.S. Navy investigators once they have established a need to know the information. This determination will usually be made by the hospital JAG or public affairs officer. Other Department of Defense, federal, state, or local law enforcement officers may have access to treatment records if access is necessary as part of a criminal investigation and there is no unwarranted violation of the privacy rights of the individual involved. Similarly, local health and social service departments may be provided information from the record. The same guidelines that apply to access to treatment records apply to staff members' discussing with investigating officers the details of the medical treatment provided to a patient.

DELIVERY OF A PATIENT UNDER WARRANT OF ARREST

No patient may be released from treatment before it is medically reasonable to do so. Once it is determined that the individual can be released without significant risk of harm, the following guidelines regarding release to law enforcement authorities apply.

Nonactive Duty Patients-When a nonactive duty patient is released from medical treatment, the facility no longer exercises any degree of control, and normal legal processes will occur. No official action by hospital personnel is required before local authorities take custody of the released patient. There may be occasions, however, when law enforcement officials should be notified of an imminent release of a patient.

Active Duty Patients-The commanding officer is authorized to deliver personnel to federal law enforcement authorities who display proper credentials and represent to the command that a federal warrant for the arrest of the individual concerned has been issued. There are circumstances in which delivery may be refused; however, guidance should be sought from a judge advocate of the Navy or Marine Corps when delivery is to be denied.

Normally, it is the responsibility of the permanent command to take custody and control of an active duty member suspected of committing an offense. If the member is an unauthorized absentee and the command to which he is assigned is not in the same geographic area as the treatment facility, release of the patient should be coordinated with the nearest Transient Personnel Unit or Military Prisoner Escort Unit. Close liaison with the member's permanent command should also be established.

In cases where delivery of an active duty patient is requested by local civil authorities, and the treatment facility is located within the requesting jurisdiction or aboard a ship within the territorial waters of such jurisdiction, commanding officers are authorized to deliver the patient when a proper warrant is presented. Whenever possible, a judge advocate of the Navy or Marine Corps should be consulted before delivery. If the treatment facility is located outside the jurisdiction requesting delivery, only a General Courts-Martial authority (as defined by the Uniform Code of Military Justice, Manual for Courts-Martial, and Navy Regulations) is authorized to arrange for delivery of such the patient. Extradition, return agreements, and other prerequisites to delivery will have to be completed.

When disciplinary proceedings involving military offenses are pending, the treatment facility should obtain legal guidance from a judge advocate before delivering a patient to federal, state, or local authorities. When the commanding officer considers that extraordinary circumstances exist which indicate that delivery should be denied, then the Judge Advocate General of the Navy must be notified of the circumstances by message or phone.

PRISONER PATIENTS
Prisoner patients fall into three categories of eligible beneficiaries:

Enemy prisoners of war and other detained personnel

Nonmilitary federal prisoners
Military prisoners