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===Risk Management===
* RM is automatically notified when safety intelligence event (SI) is placed
* For any adverse events that warrant family/patient notification, the physician needs to do it
* RM at HUMC:  Lan Soeur or Haya Nemtzov
** x66330 or pgr x1277


===Filming in the Hospital===
[https://library.municode.com/ca/la_county_-_bos/codes/board_policy?nodeId=CH3ADGEGO_3.125COFIPO Board of Supervisors County Filming Policy]

===OK to book===
* Once the patient is medically cleared to be in custody, fill out the 'OK to book' form and give to law enforcement
* If the patient has an ongoing medical need, such as home O2 or dialysis, then contact the 'Medical Command Center' 213-893-5544 so arrangements can be made for continuing care (such as LAC+USC Jail ED/Ward)
* Contact AOD if issues, may need to escalate to Jail CMO, Dr. Henderson


===Law Enforcement Requested Blood Draw===
[https://wikem.org/wiki/Harbor:ED_policy_manual##12_Consent_for_Blood_Alcohol_Tests_Requested_by_Law_Enforcement| DHS and Harbor ED policy on Blood Draws Requested by Law Enforcement '''#4.3''']


===Law Enforcement in the ED===
* Any outside police agency can be directed to the HUMC Sheriffs for questions
** In the event of a large law enforcement presence due to an officer involved incident, the HUMC Sheriffs Sergeant should be involved to direct vehicle and personnel traffic and keep the treatment areas clear 


* '''ICE Tips'''
** Maintain usual practice environment and flow - do not alter your medical care, do not engage or impede ICE agents
** Although ICE agents should only be in public spaces, the Department of Homeland Security rescinded the "sensitive areas" protections. 
*** Do NOT physically interfere if the officer insists on gaining access to a sensitive area.
*** Do NOT actively assist the immigration enforcement officer.
*** Do NOT help anyone, hide, lie, or flee the area. 
*** Do not video record any encounters
*** No social media posting with HUMC/DHS affiliation 
*** Please do not hand any information that is not related to patient's medical care to patients in custody (even if requested)
** Consider Rx pick-up from HUMC to provide to the patient prior to DC
* '''If you encounter an immigration officer attempting entry into a patient care space:'''
** '''Notify the OCN''' who will contact:
*** '''Harbor’s Risk Management Office''' (66330, p1277);  Risk Management will immediately notify DHS Risk Management and County Counsel.
*** Securitas should notify their supervisor immediately
*** The Sheriffs are our typical law enforcement liaisons
** Call the '''Physician AOD''' (on ByteBloc)
*** [[File:SLP - Script and Incident Report Form.pdf|thumb|Sensitive Location Policy Script and Report Form]]
** Provide the officer with a copy of the policy and ask if they have a warrant. [[File:MB NO. 25-02 - Los Angeles County Sensitive Locations Policy (ICE - Safe Spaces).pdf|thumb|HUMC Sensitive Spaces Policy]]
*** If the officer has a warrant, obtain a copy, and provide to Harbor’s Risk Management; they will forward it to DHS Risk Management and County Counsel
*** If there is no warrant and the officer insists on entering a sensitive location, please tell them “The County does NOT consent” or “I am granting access under protest”.


* Sensitive Locations Policy
** [https://lacounty.sharepoint.com/sites/DHS/SitePages/Immgration.aspx DHS Immigration and Sensitive Locations Policy Page]
** [https://lacounty.sharepoint.com/sites/DHS/SitePages/Immigration-RedCards.aspx?csf=1&web=1&e=AMS6TH&CID=411341d8-69da-4e37-9ab2-d67419596233 DHS Red Cards (printable in 20 languages)]
** [https://library.municode.com/ca/la_county_-_bos/codes/board_policy?nodeId=CH3ADGEGO_3.175LIACCOSELOLAENOFENIMENIMINAC County Policy 3.175]
** HUMC Policy 451 - Outside Law Enforcement Agency Contact with Patients
** 1/24/2025 - Harbor-UCLA Management Bulletin 25-02
*** Board of Supervisors affirmed all county departments must comply with the California Values Act (SB 54) limiting the use of local resources for immigration enforcement and designating hospitals as "safe spaces"; under this direction, HUMC does not collaborate with ICE. 
**** ICE is not welcome in any treatment space without a law enforcement warrant 
** [[File:ACEP_Navigating_Immigration_Enforcement.pdf#filelinks|ACEP - Navigating Immigration Enforcement]]


* HIPAA and Law Enforcement
** It is acceptable to notify officers of the patient's status (stable/unstable), dispo (admit/DC), but you should not divulge health information details without a written consent by the patient
** [https://www.acep.org/state-advocacy/state-advocacy-overview/law-enforcement-toolkit ACEP - Law Enforcement in the ED]

===EMTALA Concerns/Problem Transfers===
* [https://lacounty.sharepoint.com/sites/dhs-harbor-env_safety/Policies/Forms/AllItems.aspx?id=%2Fsites%2Fdhs%2Dharbor%2Denv%5Fsafety%2FPolicies%2FHarbor%2DUCLA%20Medical%20Center%20Policies%20and%20Procedures%2F309%2DProblem%20Transfer%20Report%20and%20Follow%2Dup%20Rev%2001%2D15%2Epdf&parent=%2Fsites%2Fdhs%2Dharbor%2Denv%5Fsafety%2FPolicies%2FHarbor%2DUCLA%20Medical%20Center%20Policies%20and%20Procedures DHS Policy 309:  Problem Transfer Report and Follow-up]
** Receiving HUMC ED physician forward concerns to Dr. Claudius or ED Chair '''within 24 hours'''
*** '''DO NOT DIRECTLY SUBMIT THE FORM TO THE EMS AGENCY OR HEALTH FACILITIES INSPECTION DIVISION'''
** Dr. Claudius (the ED Designee) or Chair will email the Problem Transfer Form to risk management within 3 calendar days
*** [https://lacounty.sharepoint.com/sites/dhs-harbor-ed/Staff%20Information/Forms/AllItems.aspx?id=%2Fsites%2Fdhs%2Dharbor%2Ded%2FStaff%20Information%2FForm%20%2D%20Problem%20Transfer%20Form%202015%2Epdf&parent=%2Fsites%2Fdhs%2Dharbor%2Ded%2FStaff%20Information Problem Transfer Form]
** Risk management will investigate and review the case



*HUMC Policy 451
** Securitas provides orientation informational pamphlet, get visitor sticker (to differentiate from Harbor LASD staff)
*** Securitas calls HUMC LASD to check in outside LEP 
*** Outside LEP then directed to OCN or Area Charge
*** OCN/Area Charge checks with physician if patient is stable for LEP interview
*** If patient it is not medically appropriate to have LEP interview the patient, please document in your note, communicate to LEP. 
** '''Patients NOT in custody'''
*** Patients who are NOT in LE custody have a right to refuse interviews and/or photographing by law-enforcement agencies.  (This policy does NOT apply to psychiatric patients on a hold; they are covered by different laws.)
** '''Patients in custody'''
*** Harbor will provide emergency and stabilizing care to in-custody patients; when these patients are stable for transport, in accordance with EMTALA, they should be transferred to the LAC+USC Medical Center Jail Ward for continued care/treatment.
*** For critical patients who require emergent medical intervention and stabilization, law enforcement will remove the patient’s handcuffs, at the request of the attending physician.  
*** Outside LE may be asked to leave the patient’s room during the patient care to ensure patient privacy and confidentiality, unless doing so would cause an unsafe situation.  The officer must remain in the immediate vicinity and keep the patient in view throughout the provision of medical care or treatment. 
*** Any requests by the patient’s family/friends to the clinical staff for contact with an in-custody patient shall be directed to the involved LE agency and/or Harbor Sheriff.
*** '''If any issues arise related to the presence and/or behavior of outside LE, staff should contact Harbor Sheriff for assistance.''' 
*** If outside LE fails to comply after discussion with Harbor Sheriff, the issue should be referred to Risk Management.
** LE will be cleared to detain the patient once the full evaluation and urgent treatment of the patient are complete, and at the discretion of the ED or admitting attending physician.

{{Harbor Law Enforcement Escorting Patients Out Of the Emergency Department}}


===Weapons in ED===
*As a general rule, no patients should have weapons on them (INCLUDING PEACE OFFICERS), even if they have concealed weapons permit. 
*No visitors should have weapons. The only exception to visitors carrying weapons are active peace officers. 
*Patients and visitors are screened by Securitas with metal detectors at the front entrance of the S/E building and ambulance entrance.
**If a patient is unstable and is rushed in, then once the patient is stabilized, Securitas will be contacted to then screen the patient and his/her belongings. 
*If you encounter issues, call the Sheriffs Department for assistance. 


===ILLICIT DRUGS/MARIJUANA IN ED===
* Marijuana less than an ounce (plant) or 8 gms (concentrate) and patient at least 21 years old - keep with patient belongings
* Marijuana quantity more than above (or not sure), or possessed by person under 21 - Call Sheriff
* All other illicit drugs (or suspect as illicit) - Call Sheriff


===[[AB 2760: Naloxone for patients at risk for opioid overdose]]===

===[[SB 1152 - 2019 California homeless patient discharge planning law]]===

===[[Harbor:Involuntary holds|Involuntary holds]]===

===[[Harbor:Adverse event mandatory reporting|Adverse event mandatory reporting]]===


{{Family Viewing of Deceased Patients}}

{{Harbor Ebola precautions}}

{{Contacting attending consultant}}

{{Harbor Elective Transfers to MLK Hospital}}


===OBSERVERS IN THE ED===
*There can never be an observer of any type in the ED without the prior permission of hospital administration or the chair, or one of the vice-chairs in the department.
*Observers must be introduced to any patient whose care they observe and the patient must be given the opportunity, in a non-coercive and open manner, to not have the observer present during their care.
*Observers must never be present during sensitive parts of medical care (e.g., genital exams, during history taking regarding abuse or sexual assault, etc.).
*Observers must wear a clearly visible name tag that provides their first and last name and identifies them as an “Observer” or using a more descriptive label (e.g., “Medical Student” or “Residency Candidate”).

Chair, EM 9/2017

==See Also==
*[[Harbor:Main]]

[[Category:Admin]]