Recommendation - Metropolitan Police Service, October 2020
An 18 year old was arrested following a stop and search, as he was found to be carrying a knife like object and a bank card suspected to be stolen. After arriving at custody, the man was found to have a second knife hidden in his clothes. A strip search of the man was authorised but, while waiting for a suitable room to use for the search, the man reached down the front of his trousers and was seen to place an item, believed to be a package of drugs, into his mouth and swallow it. The man was treated in custody before being taken to hospital. In hospital he denied swallowing any item and he did not seem unwell. As a result he was returned to police custody after approximately four hours. During his second period in custody, prior to completion of the booking in process, the man became unwell and collapsed requiring further medical treatment.
IOPC reference
Recommendations
The IOPC recommends that the Metropolitan Police custody policy (Risk Management, section D5) should be amended to include specific reference to the Royal College of Emergency Medicine (RCEM) guidance on the Management of Suspected Internal Drug Traffickers (2020) which advises hospital emergency departments that a person suspected of swallowing drug packages should be observed in hospital for a minimum eight hour period, even if the patient refuses treatment.
This recommendation follows a serious injury incident when a detainee in custody was observed swallowing an unknown item which was suspected to contain drugs. Although taken to hospital, the detainee told medical staff they had not swallowed anything and they were discharged back to police custody after approximately four hours. Approximately six hours after the detainee was believed to have swallowed the item, they became unwell in custody and collapsed requiring medical treatment and a return to hospital.
Do you accept the recommendation?
No
Accepted action:
For the reasons explained below, the MPS will be unable to implement the recommendation due to conflict between the recommendation and guidance. Despite the best intentions, the MPS are placed in an unfortunate position whereby we cannot accept the recommendation for implementation in its current form.
The Healthcare Director for Met Detention has reviewed the Royal College of Emergency Medicine (RCEM) guidance on the Management of Suspected Internal Drug Traffickers (2020) and has raised some concerns about its implementation, and therefore its inclusion in the Risk Management Section of the MPS Custody Policy.
Persons suspected of swallowing drugs are referred to in the RCEM document as packers, stuffers and parachuters and the algorithm on page 12 (Appendix 1) also includes pushers. It differentiates between symptomatic and asymptomatic patients. All symptomatic patients need to be in hospital, and this is implied in the algorithm. The algorithm for asymptomatic stuffers does state the requirement for observation for at least 8 hours post ingestion, and therefore this is in line with the IOPC’s recommendation.
However, the document does not require 8 hours observation in hospital in all circumstances such as for asymptomatic body packers who have either refused a scan, or have had a positive scan and are passing packages. The document states that these patients can be returned to custody, and therefore this would not be in line with the IOPC’s recommendation.
The algorithm only refers to admission to hospital if there is a positive scan and the individual is not passing packages. If the patient refuses treatment, the hospital is unable to detain the patient, and therefore current practice is that the individual would be returned to custody and placed on constant supervision. This would be against the IOPC recommendation of being observed in a hospital setting for a minimum of 8 hours.
Currently many Emergency Departments are unaware of the guidelines and the earlier 2014 version. However, if we were to refer them to these guidelines, they would find the anomalies mentioned above.
Whilst the aim of the recommendation is clearly to protect our detainees, implementation is difficult as the document is contradictory and patients are able to refuse treatment. Our Healthcare Director is aware that some Police Forces retain the detainee in the van on the hospital grounds for the observation period, so that they have fast access to hospital treatment if needed. Some hospitals have used the Mental Capacity Act having assessed that the patient refusing treatment does not have the capacity to refuse. However, this assessment would be made on an individual basis.
With regard to the last part of the recommendation that a person suspected of swallowing drug packages should be observed in hospital for a minimum eight hour period, even if the patient refuses treatment, it is almost impossible to enforce this.
Whilst we can accept the recommendation that requires us to refer the hospital emergency departments to the RCEM guidance on the Management of Suspected Internal Drug Traffickers (2020), the document does not clearly support detainees being observed in hospital for a minimum of 8 hours. It is likely that the MPS will therefore be required to observe and care for detainees in Custody who potentially could die without immediate hospital treatment.
Recommended next steps:
A learning conference call is set up between the IOPC, Met Detention Healthcare Director and OCU Commander in order to progress this recommendation satisfactorily.