By Todd Duncan, Law Enforcement and Safety Specialist
For law enforcement officers and jail staff, interacting with individuals under the influence of alcohol or drugs is a common occurrence. Whether responding to a disturbance at the local bar, stopping a swerving car on a dark county road at 2:00 AM, or working as the jail intake officer, dealing with intoxicated persons is just part of the job. However, when law enforcement or corrections officers take a person, intoxicated or otherwise, into custody for any reason it triggers a clear constitutional duty to protect the individual from harm as long as they remain in custody.
There are many ways that detainees have been injured or died while in custody that have resulted in federal civil rights violation lawsuits, including medical emergencies following prolonged face down positioning and restraint after an arrest; vehicle crashes during unrestrained transport to jail; suicide; assaults by other inmates; untreated serious medical issues; and acute alcohol toxicity, drug overdose, or withdrawal. It is the last set of scenarios, acute alcohol toxicity, drug overdose, or severe withdrawal that are the focus of this article.
Intoxicated individuals in police or jail custody are at greater risk of injury or death from dangers such as falls, asphyxiation (vomit), assault by other inmates, respiratory arrest from high BACs (.300+), and potentially fatal withdrawal symptoms to name just a few. In 2019, there were 184 deaths in local jails due to drug or alcohol intoxication, the highest recorded in the 20 years that the Bureau of Justice Statistics has collected mortality data1.
A sheriff’s office in Colorado recently reached a $3.2 million settlement in connection with the death of a 33-year-old inmate, Zachary Moffitt, who was arrested and booked into jail by deputies after causing a disturbance at a local hospital while seeking treatment for alcohol poisoning (.392 BAC at hospital). Attorneys for Moffitt’s estate allege jail staff ignored Moffitt’s repeated requests for medical care and obvious symptoms of delirium tremens (DTs) were ignored for three days before he died in his cell.
Earlier this year, an Illinois county reached a $3 million settlement following the death of a 28-year-old woman, Elissa Lindhorst, who died in custody from complications related to opioid withdrawal within a few days of being arrested on an outstanding controlled substance warrant. Sheriff’s office jail staff allegedly observed Lindhorst’s health decline and received several requests for help from Lindhorst and fellow inmates but failed to take any steps to provide medical attention leading up to Lindhorst’s death. The sheriff, 17 sheriff’s office employees, and the third-party medical vendor for the jail were all named in the lawsuit. Unfortunately, NIRMA members are not immune to this risk, as several inmates have died in Nebraska jails under similar circumstances.
As a result, courts have put law enforcement officers and jail staff on notice that they must exercise due caution in caring for intoxicated individuals in their custody. This seems straightforward, but it can be easy to grow complacent given that many contacts with intoxicated persons in the field or booking area of the jail are relatively uneventful. It is also easy to become distracted by the intoxicated person’s bizarre or disruptive behavior and overlook potentially serious underlying safety or health concerns created by the alcohol or drugs.
Ensuring the safety of intoxicated individuals in custody while reducing risk and liability begins with identifying detainees who are at increased risk of injury or death. Unlike DUI laws where a defined blood alcohol level dictates whether enforcement action can or should be taken, the decision of whether to arrange medical care or require medical clearance for confinement based on a subject’s level of intoxication is not always obvious. Deputies and jailers should take a case-by-case approach and consider the big picture when evaluating the risk posed by the individual’s level of intoxication. Factors to consider include the subject’s size, age, gender, experience with alcohol or drugs (tolerance, dependency, etc.), rate of alcohol consumption, last meal, underlying medical conditions, whether BAC is on the way up or down, subject’s request for medical care, etc.
When determining whether to seek medical attention for an intoxicated detainee, it is better to be safe than sorry. If in doubt, have the inmate checked out. Furthermore, NIRMA recommends that agencies have a written policy requiring deputies and jail personnel to obtain medical clearance from an emergency room provider prior to admission to the jail for arrestees who are suspected to be under the influence of alcohol or drugs and have one or more of the following:
- BAC of over 300 mg/dl (potentially life threatening),
- Recent loss of consciousness,
- Unable to walk unaided,
- Unable to speak intelligibly,
- Incontinent (has peed or had a bowel movement on themselves),
- Confused as to what is happening, or
- Violent
While preliminary assessments in the field by emergency medical services personnel may be helpful or even necessary, they should not be relied upon as a means of determining whether a highly intoxicated detainee is fit for confinement. Emergency room providers are better trained and equipped to make this determination and identify potentially life-threatening levels of drug or alcohol intoxication.
Once admitted to jail, proper classification, close observation, and timely, appropriate medical care are crucial to ensuring the safety of the inmate. Thorough documentation of these processes is also important, especially when defending claims of deliberate indifference or negligence later should they arise.
Alcohol and drug withdrawal can also create significant risk to an inmate’s physical and mental health, particularly in the days immediately following admission to jail. Inmates who drink every day or are actively abusing opioids often suffer from Alcohol Use Disorder (AUD) or Opioid Use Disorder (OUD) and as such have become physically dependent so that their body chemistry will undergo dangerous, sometimes deadly changes after alcohol or drug use is stopped cold turkey. For individuals suffering from AUD and OUD, the only safe way to detox is under closely monitored medical supervision and treatment. It is important to identify these inmates during the initial screening process and arrange the necessary medical supervision to prevent serious illness or death.
It is no surprise that “care, custody, and control of inmates and detainees” is considered a high risk – critical task for law enforcement and jail operations. Add alcohol or drugs to the equation and the risks only go higher. With more than 20 million adults and adolescents in the United States experiencing substance use disorder in the past year, law enforcement and jail staff will continue to encounter intoxicated individuals on a regular basis, many of which will be taken into custody. While these situations present greater risk to law enforcement, jail staff, and detainees, much can be done to mitigate those risks. Taking time to properly assess the
individual’s level of intoxication, current circumstances, and history and erring on the side of caution when deciding whether to arrange medical care can go a long way towards preventing unnecessary injury or death while simultaneously reducing liability.
Additional Resources:
U.S. Department of Justice, Civil Rights Division, Disability Rights Section Technical Assistance document: The Opioid Crisis and the ADA
1Mortality in Local Jails, 2000–2019 – Statistical Tables | Bureau of Justice Statistics (ojp.gov), https://bjs.ojp.gov/library/publications/mortality-local-jails-2000-2019-statistical-tables
Please contact Todd at 531-510-7446 or tduncan@nirma.info if you have any questions or would like to request training.
