Judicial Agents

Last week I was at the airport and was called to a sick case.  At the airport, I work alone (no partner) from a golf cart or Suburban, which makes calls fun and interesting.  But it also makes in-call collaboration much more difficult.

I found a 20-year-old female sitting on the uncomfortable seats that airports provide.  She was sitting with her hands behind her back and her head tilted back.  She was conscious, but pale and very diaphoretic.  The patient had been walking from the car to the terminal when she felt lightheaded, fainted, and was helped to the ground.  She still felt presyncopal, so I tried to move her to the floor where she could lie down.  Unknown to me, this was apparently a hassle.  You see, she was a prisoner being transported by two other people.  Those two other individuals were not willing to take her handcuffs off.  They showed me badges with the title “Judicial Agent,” as though that should clear up all my handcuff-related questions.

What the hell is a judicial agent?

(At this point, my temper was starting to rise a little.  It is a pet peeve of mine when someone shows me a badge.  Badges can kiss my ass.  Anyone can pay to get a badge stamped.  I want to see credentials.  Apparently, credentials were a hassle for the “judicial agents.”  Good.)

Let me jump around a little to tell the story.  Apparently, my patient was under arrest being extradited to another state by the two judicial agents.  They were not U.S. Marshals, sheriff deputies, or anything like that.  They were "judicial agents" and they had a ton of paperwork that might or might not have shown that they weren’t nefarious kidnappers.  It looked like a living will, where there is 30+ pages of stuff I don't care about, but somewhere in there is the one line that answers my question.  I didn’t have time for the paperwork, so I called for some police assistance; maybe police officers have seen warrants and extradition paperwork before and knew what to look for.  I sure didn’t know.

The patient had no medical history (that she would tell me about) and took no medications.  She had never had fainting spells before.  I eventually got her laid down and got a blood pressure of 70/40 and heart rate of 110.  Sinus tach without changes or ectopy on the TV.  The physical exam was normal, outside of the pallor and diaphoresis (both of which were starting to ease up).  She was fully down with going to the hospital and was appropriately concerned that she didn’t feel well.

What needs to be done?

That’s right – she needs to go to the hospital.  So I called for a transport ambulance, an action that was met with resistance when overheard by the judicial agents: “What? Oh, no.  She ain’t going to the hospital.  No.  She is getting on the airplane and going to [unnamed state] with us.”

At this point I had a problem that I have never run into in 20 years of EMS.  See, when people are under arrest, they can’t refuse transport.  A law enforcement officer gets to decide where your body is physically located when you are in his or her custody.  If the law chooses that your arrested body is located in jail, you go to jail.  No refusal is allowed – try telling the cop cuffing you that you have decision making capacity and would like to refuse his arrest.  If the officer wants your body to be at a different jail, off you go from the first jail to the second one.  If the law enforcement officer chooses to locate your body at a hospital, off you go.  Arrested people with decision making capacity can still refuse procedures – they can refuse medical treatments performed on their bodies when they have decision making capacity – but they cannot refuse where their body goes.  Does that make sense?

But what happens when the “cop” says the sick body that needs hospital attention cannot go to the hospital?  Would forcing transport against the stated will of the officer be the equivalent of aiding escape?  Could I get into legal trouble, as though I had helped in a jailbreak? 

That’s what had never happened to me in my career.  I have never had a cop deny transport when I said it was needed, especially in a patient that was visibly ill-appearing.

I still don’t know the answers to the questions.  The police officer that showed up on my scene to help answer such questions had a badge number from the age of disco and a revolver.  He was grandly and exuberantly uninterested in rendering an opinion other than shrugs indicating inscrutable apathy.  So if you are looking for education from this week’s blog post you are going to be disappointed.  I never have really definitively found out what a “judicial agent” is and what their powers are, either.  Apparently, sometimes it can be a fancy name for a bounty hunter.  But these “agents” didn’t have mullets, tattoos, excessive jewelry, leather vests, or fire extinguisher-sized cans of OC.  I didn’t get a bounty hunter vibe.  Sometimes “judicial agents” are investigators for district attorneys, judges, or judicial districts.  These people were probably along that line of work.  They looked like professionals.  But what rights and responsibilities go along with that?  I didn’t know and still don’t. 

Of course, this is how I picture all bounty hunters. Source

So on this call, I utilized my only weapon: Being a pain in everyone’s ass.  After several minutes of that irritating course of action, one of the “agents” got fed up and stepped away to get on the phone.  After a few more minutes, he came back and uncuffed the patient.  The warrant was cancelled and the patient was free to go.  Apparently his boss felt the patient was a serious-enough offender to require paying for multiple airline tickets and hotel stays, but not serious-enough to pay for an ED trip via ambulance.  [Unnamed state's] tax dollars at work.  The patient got into the ambulance for her trip to the hospital, the “agents” got into the TSA security line to catch their flight, the police officer wandered away, and I returned to service.

Weird call, I told you.

My best guess was that the patient got herself busted and missed a few doses of something that she was unwilling to admit to me.  Maybe she was withdrawing a little.  I don’t know what happened to her in the end.  I'm just glad I didn't have to facilitate a jailbreak in order to get a patient the care that she needed.