 Welcome everyone. We're going to let you begin to make your way into our session today. So we'll get started in just a couple of moments just to give everyone the opportunity to join in with us. I'm really excited about today's conversation. I'm with Professor Ji Seon Sang, who's my colleague at the University of California, Irvine, and we're going to have a great conversation for you today. So today, this is the third in our three-part series on contemporary issues in health, law, and bioethics. And we're going to be talking about criminalizing in the emergency room. It's an area that probably those of you who are medical professionals have actually probably had to think about in an era where criminal law becomes such a vibrant part of our society and how we manage issues. While you're coming in, I'm going to turn to a little bit of housekeeping. So as you have questions today, please submit them in the Q&A feature. You'll find that in the meetings control at the bottom of your screen. And I'll try to get to as many of your questions as I can. And if there are questions that you would like for Professor Song to consider later, we're happy to share those with her if we don't get them, get to them during today's presentation. And then also if you have any technical considerations or concerns, then please use the chat feature to do that. Now, as we've seen throughout this series, you all put a lot of love in the chat. So I'm not going to deny you that if you want to say wonderful things about Professor Song and this series, please feel free to use the chat. That's all right. And finally, if you're interested in upcoming events, news or education programs, then please do subscribe to the Center for Bioethics at the email that you find on the screen, which is bioethics.hms.harvard.edu forward slash subscribe. And with that, I'll take the opportunity to introduce myself and to say a little bit more about Professor Song. So I'm Michelle Bratcher Goodwin. I'm a chancellors professor at the University of California Irvine with my main faculty home being in law, but also being in several other departments on our campus, including our Public Health Department School of Medicine Stim Cell Research Center and our departments that address gender and sexuality studies and also criminal law and society. At Harvard, I'm a senior lecturer at the Harvard Medical School and our Center for Medical Ethics, and I'm so pleased to bring these programs to our community, and I couldn't be more thrilled than to have with me Professor Ji-Sheng Song. And she teaches and researches and focuses on criminal law, criminal procedure, and policing. And her scholarship examines the deployment of policing authority and corresponding effects on people of color and marginalized groups. And her research informs interventions that address race and class-based disparities in policing practices. And what I find so important and interesting about the work that she's doing at the intersections of medicine and policing. What does it mean when police come into the emergency room making demands of hospital personnel? What are the conflicts that surround that? What are the legal constraints that surround that? What are the obligations? All of those issues we will get into discussion today. And if you want to reach her apart from this, I'm just going to ask her, she wouldn't mind putting her social media handles in the chat so that you can follow her and her brilliant work, and it really is important work. And what she's going to be talking about today actually builds from an article that she's had published in the Harvard Law Review. It's called Policing the Emergency Room. It was published in 2021 in the Harvard Law Review. And coming up next, or this one has actually been published too, an ethical legal and structural framework for law enforcement in the emergency department. Right, we've got lots to talk about today. So if you don't mind Professor Song, if I can just use Jisong as we talk today. All right, so I want to get started. What motivated you to write in this area? So I was a public defender before I transitioned to academia. Okay, stop, stop. I'm glad, you know, I will be much kinder than the Senate. I'm glad that you are a public defender. I am, I am not so pleased with what we have seen before United States Senate with Judge Jackson, who was a public defender, but I digress please go on. And that there has been a lot about the confirmation hearing the that has resonated with me and in part because of our shared experiences but yes it's, I think I was a juvenile public defender which I think some of my, some of my mentors when they've kind of had to excavate the reasons why I gravitated to something when I'm not a medical specialist or trained at all. And there's one particular story that actually dedicated my, my law review article to one particular client. He was shot in the head by a police officer, and he was 15 years old. He was a foster child as well so he's in the dependency side so he didn't and he had run away from a group home so he didn't have any formal guardian. So I got the call from my supervisor, and she was like he's at this hospital. Perhaps you should go try to figure something out. Now, I will have to say that I'm probably the reason why I had to leave public defense is I didn't really quite have the boundaries probably necessary to have like, like, to maintain my own mental health but I rushed to the hospital it was Highland Hospital in Oakland. I was not able to see him they would not let me see him they told me it's because the police would not let me see him. I knew that he had no pending charges that he had no violations that would prevent me, and especially because I was attorney I said, there's nothing you can do to prevent me from seeing but lo and behold, I wasn't able to go. So it wasn't until I sent very strongly worded emails to the general counsel the counsel over at Highland that I was let in and he was shot in the head, he lost one day. He was pretty much blinded in the second he was 15 years old and he was complaining of pain he was an enormous amount of pain. And what was so striking to me is that in just so many conversations I was having with the his care team who were fantastic. But it was so clear to me that the narrative that he had deserved the shooting from the police had come in. And so I spent ended up spending three weeks at that hospital by my patient at my client's bedside. And through that I began to uncover this tangle of legal regulatory moral ethical problems at this intersection of policing and medicine that I had yet not yet seen before and and that just I could not let it go. And so it has now then turned into this multi year research project. Well, I want to build on this because I want to take this opportunity and conversation with you to tease at something that some members of our audience might have in fact many people in this country may very well have given that we've just been partnered to witness several days of a confirmation hearing for someone who may come on to the Supreme Court Judge Katanji Brown Jackson, who worked as a federal defender, serving indigent clients who would end up in the federal system. And if one were to come away from those hearings, you might think why would anybody do that serve in that capacity. These are people who are just simply criminals. Why should we care about them. In fact, we heard one senator say that an 18 year old who did possess something that was penis and graphic, but that that 18 year old should get 50 years in prison. Can you help to explain a bit before we go deeper into the emergency room, just help to level set why do people become a public defenders, why does criminal defense matter and why does criminal defense matter for indigent people and why is it so important that the framers of the Constitution, especially for people who think about originalism and textualism well why was it that the original framers of the Constitution thought it was so important to include in the Constitution, the kinds of protections that were central to your work. Yes, and I think that has also struck me that here is a constitutional right that is guaranteed, your right to counsel is enshrined in the Constitution yet Judge Jackson Katanji Jackson has had to undergo a battering because of her upholding that constitutional right that is so central to our liberties and I think you know I'm not a historic legal historian but I do think that there is, there is the at the at this country's founding a sense that there was the power of the crown and then the people and how so much of going into court and happened without having the aid of someone next to you who understood the language of the law, who could help you in this very complicated set of legal rules that you know govern our conduct and to be able to speak and defend right and I think that you know Gideon versus rain right wasn't decided until the 1960s, but then at that point I think they're, especially when you saw at the same time in the 1960s a broadening of law enforcement. It's a great right for our medical audience that may not. So Gideon versus rain right was it says that the constitutional right to counsel is something that you're guaranteed so if you're indigent, even if you're poor, you have a right to have counsel that you don't have. This is our United States Supreme Court so we have both the Constitution which was not written by a bunch of women of color. We would have had that in there I think a lot of, but this was a Constitution that was written by framers who were property wealthy people that wrote the Constitution that guaranteed the right of counsel, because it was understood as important and this was not seen as a right to counsel for your civil disputes which that too does matter and I think that that's an important distinction right this right to counsel not just when you're suing over something which is different, but that actually having a right to counsel, when the state says you did something, and then take away your liberty, right that you, that you could be put in prison, that you could be put to death. Right for what the state is alleging that you did and that amongst public I mean people come at public defender work for a variety of reasons right but many do because they strongly believe in this, the mission that it's only by protecting those who are charged criminally can we make sure that all our constitutional rights are protected right so like, and they're I think part of what emanates from my research about the fourth amendment in the hospital space and Ed's is that what happens is people who are so vulnerable if we're acutely vulnerable in our bodies, and the court is not recognizing our fourth amendment rights there against police. And I think that has been that is one of the most motivating questions for me is, when you have acute vulnerability, the power of the state, and then how is it that the court fails to see suffering, right. And then one more piece with that which actually comes to mind in the wake of you know your article published in the Harvard law review and congratulations again it's a big deal to be published in the Harvard law review it really really is. And with your work, it's published at a time in which the sort of we've seen a me to movement, sort of recognizing the ways in which women's voices are often overlooked when women are complaining about sexual assault. And that raises all sorts of issues about policing in the emergency room and also just sort of criminal law response in the emergency room rape kits and all of that right so that's what maybe you'll be writing next articles on those issues. So, so that that gets implicated, and then racial justice is implicated given the tragic death of Ahmad Aubrey being tracked down and killed in cold blood, Breonna Taylor in the middle of the night, shot multiple times falsified relief police reports, and then the whole world over saw George Floyd tragically murdered. People say lynched under the knee of an officer also police reports falsified the only reason why I mentioned that before we lead up to this wonderful piece of yours is again to level set. And I think about it makes me think about the deaths of Goodman Cheney and Schwerner years ago, who had gone south to help people register to vote. And the end result sadly was a burnt out car, multiple bullet wounds, and the demands of their spouses and mothers of Goodman and Schwerner saying you must find our sons. Our sons are down there they were down there to uphold civil liberties of other people, which was important for voting and whatnot, and we have not heard from them. And police were implicated in that right and so when we are just simply honest a bit more honest about the kind of entanglements of where we are. Right, it's it's not all just black and white there's a whole many levels of beige and gray in between gets us back to why it was so important when the framers recognize that sometimes the state will make mistakes, and sometimes the state will act intentionally in wrongful ways. Yes. And, you know, I just came out of teaching my one first year criminal law class where it's always exciting when the students suddenly start seeing where all the great is, and it is in that, and it's interesting that you talk about the great because I just gave a grand rounds this morning to a bunch of physicians and saying well what is happening in the emergency room is that there is just great and law enforcement has occupied that gray. And I think, and if you think about the right to counsel right as being a way to really highlight the gray and forest courts to reckon with when power is being abused when a person is being subject and criminally prosecuted wrongfully, or even not right, but that those things have not been protected. Yes, that goes to like these fundamental values that you know I was just so struck by Cory Booker's defending of judge Patanjia Jackson yesterday just thinking like it's just fundamentally if we believe and I do believe that that is about hope in America is about progress than in essence the work of a public defender is always hopeful. Right. It's always hoping that we will, even in the face of what we think of as despicable behavior or just really awful human behavior, but we can still, at that moment, see how we can all benefit more by making sure that those who are vulnerable and weak are not not exploited by the state. Right. Well with that foundation and I think our audience very much for sticking with this I know that they've come to hear you talk about being in the emergency room but I also think and I saw a little bit of love and some hearts coming into their appreciating that we could do a little bit of level setting here. Yeah, so tell us about this work I want to just turn the stage over to you to tell us about your article and this research, which really comes significantly out of your experience as a public defender. Yeah, so I am. I just wanted to give this just a broad just some overview of how I've been thinking about this so at this juncture of policing and hospitals I have especially looked at emergency care. You see an area where constitutional laws don't protect individuals as much health privacy laws don't protect individuals as much. And where the discretion of this profession that we just talked about law enforcement is accorded great difference. And then there's this desk discretion of other professionals the medical practitioner is stymied by that law enforcement so in my research I've uncovered I've uncovered that courts generally view emergency departments as an extension of the street so that policing in the ED are just like policing encounters on the street with willing and do to full medical providers to aid and police work, and hence that individuals ultimately are subject to less protection. And I argue that this rendition by the courts ignores the reality that emergency department physicians trauma surgeons hospital staff know, which is that emergency departments are actually a place for policing regularly occurs where police are routinely among medically vulnerable patients and that this space that is for patients has been turned into a space of policing, and we're policing actions often come into contradiction with the healthcare mandate to provide care, and the fundamental ethic of do no harm. I especially the reason why I focus on the ED is for three primary reasons so one it's a widely used healthcare setting in our healthcare system. It's also widely used by particular subset of our population, low income and minority communities that also overlaps with the groups that are subject to the most police and most vulnerable. And just one moment on that too. I'm glad that you mentioned that right the the communities that are more likely to be police which doesn't mean that they're more likely to commit crimes right just simply more likely to be police which is a very interesting and important point because I think sometimes people look at the data as to what prison populations look like. As in how many tickets are given out and what are the demographics that they interpret that as well. It's because those people are committing most of the crimes and what we know for people who study in this area and you know as your research like no that's not it. It's just that some groups get policed more. Other people get ticketed more other people get passes police police more outside of the gates of Yale than inside the gates of Yale. And if you're looking at the same populations by age. If you policed inside the gates, you'd get the same number of hits for underage drinking for use of drugs for distribution of drugs as you get outside of the gates, but we don't police inside the gates. It's outside of the gates which gives this false narrative. Yes, that it's black and brown kids who are engaging in this behavior, and others are not. Right and exactly it's this idea for a long time where people criminal scholars have called it like, and jurists, a high crime area right is it really a high crime area or is it just a highly policed area. Right. Is this a high crime group, or is this a highly policed group and I think the emergency department is a place where you have those people who have to go there for a variety of reasons, and then you have police who also end up going there for a variety of reasons So they go there when people are injured because I mean people go to Edie's because they're injured because protect her perhaps because of crime, so then please accompany them please get called in. Maybe police are already there because there's a lot of hospitals that are especially in minority communities where, for whatever reason police operate as security so like for example in San Francisco and then Los Angeles the sheriff's department ends up being serving as hospital security. And the emergency departments my final reason why is because that's where jails and prisons take their incarcerated people when they need to. And so you have this phenomenon where external hospitals and Edie's end up not being just the safety net for all of us but also the safety net for the carceral system because the carceral system is unable to provide adequate health care. So my research has uncovered a number of things one is on the criminal procedure side that the court discounts medical vulnerability they do not see it when it comes to criminal constitutional right questions. They expect an affirm medical professionals to participate they get them kind of like a good citizenship gloss, which totally ignores medical ethics or duties that medical providers owe to patients. And also, and my other research uncovered that there's just a whole bunch of laws and obligations that medical providers are told that they can, should, or must do in the face of law enforcement request, but there's no corresponding countervailing authority that medical providers can lie upon to push back against that. And so this imbalance makes it untenable for medical providers to their job and leads to situations where they perhaps inadvertently become party to abuses of police authority or broadening police authority without their even meaning to. And then when we come back to this idea, this, what we know about racialized policing, right, we know about racialized policing and also racial racial biases in the health care system. This to then provide this kind of like almost free space for policing in a health care setting used by vulnerable populations and minority communities has ramifications not just for the criminal legal system. But for a health care system that has its own problematic past and then issues of mistrust, which we know, and especially now in COVID, I don't know if pandemic or endemic wherever we are now have seen have real consequences. And so just to give you some examples of where the tensions might arise between medical providers and law enforcement so. Yes, please give us an example. Take your notes request for patient, patient information I was just doing a grand round stood at a hospital and they're like well what happens when an officer asks me what the medical condition of the patient is so I can clear it evidence scene and the crime scene What does an ED doctor, why would you have any place in telling a police officer to clear the crime scene. That was a new one to me but it's, there's all sorts of kind of justifications I think law enforcement give and why they need that information now that implicates patient privacy and confidentiality request for diagnostic procedures right so like cavity searches CT scans, I mean, more invasive procedures under anesthesia, usually to discover drugs inside of body, clearly implicates patient autonomy, patient care and then and also patients rights right patients right institutional rights right also very interesting is that physicians and also other medical personnel may not be aware of what is the law in this area. I mean the police are here they've got their guns, I'm feeling kind of intimidated, and they're telling me I have to do this and they may not know there are lots of rights being implicated, including that individuals rights that that individual has a right to bodily autonomy based on the United States Constitution and officer can't just say okay now I want to cut cavity search and doctor I now demand that you do it. That's not supposed to happen that way but oftentimes medical personnel may not know that and feel pressured to or then be served with a warrant and think they have to comply with the warrant when really, if you don't think it's medically indicated. The courts have recognized that you don't have to do it. And then there's request for this thing this new thing that's kind of medical clearance so oftentimes they'll come to the ED because a person has to be medically cleared before they go to the jail. But that implicates a whole slew of things, especially when you're one it's primarily about law enforcement liability there's nothing in the law that says that ED hospitals are supposed to and hospitals are supposed to medically clear a person. And also when you think about it when there is so much that we now know about jail and prison conditions, how violent they are, how they can exacerbate conditions and especially when you think about it's at the height of the COVID pandemic right when outbreaks were happening at the jail because jails and prisons because they weren't following other mandated protocols that the rest of the country was supposed to follow that this idea of medical clearance then I think becomes very problematic. Then there's the use the physical markers, right so handcuffs shekels other restraints that implicate dignity and patient care, and then arguably constitutional rights against cruel unusual punishment, the presence of guards that prohibit a provider from having a private conversation which, you know, not just infringes on patients rights but also prevents may end up preventing adequate or accurate care. And then there's a related but also complicated thing where let's say a police use of force person comes in with the police and one, even though medical providers have mandatory reporting obligations for all sorts of things right like crimes of crimes there is no mandatory reporting when a physician suspects that the police has used force, even though you can imagine police use of force is highly likely to result in a visit to the ED. And so, ultimately right now I'm just really grappling with all the reasons why this is and I think that this is a problem of not just criminal procedure and imbalance of laws like a legislative problem but there's also a problem of like two different systems that are just not really used to being in conversation with one another, and also often just our siloed like it was remarkable how when I first embarked on this project, a bunch of lawyers, including, you know, people in the criminal side were like, What are you talking about this is an issue or it's only an issue in this one discreet area. And then I would go to like, you know, even a dinner party and there's just a bunch of doctors there and every single one of them has like 20 stories to tell me about how this impacts patient care. There's also a problem of mismatch and problem of regulation so if you think about hospitals and medical providers as being a highly regulated subset of our society, and then you have law enforcement who are really under regulated and lots of ways. And so it's also this interesting phenomenon where this like under regulated supersedes that of a more highly regulated entity. I think we I come down to that this is also just a problem of custom, people have been used to it. So you see medical I've talked to medical providers who are like wait this. There's no I have no problem with police like they're my friends or we have a good working relationship. And then it's only when I start prodding a little bit and give some examples that I see an aha moment where sometimes it's a company by deeply regulated looks where they suddenly realize that yeah, maybe I have treated this patient who's under law enforcement custody differently than I would have otherwise. And then you also see this in like right now for medical providers who are trying to push back and maybe those of you who are who have experiences before, where it's so stressful to push back Michelle you talked about the gun and I mean this is not a small consequence. There have been reports of doctors who have been and nurses who have been arrested now I gave one example the other day about a nurse who got arrested in Salt Lake City. She ended up with a multimillion dollar settlement because of it. But you know, other things like I need your employment number, you're going to be investigated you're on my radar, there's something terrifying about suddenly being that's that cross cares. And you know, I think if we're honest about it, there are officers who really care about serving the community, you really do. And I think there's something to be said there's a whole discourse about how women police differently than men do. And that most of the unlawful type of policing happens to occur with men, and that there's still barriers to entry for women and in the debate about police abolition there's some that say well, they don't care, you know, male female, etc. But there are differences there are studies that show the sort of differences in the use of force, women's ability to be able to deescalate serving as good listeners in these spaces. And there's a documentary that came out in 2020 women in blue which actually studied the Minneapolis police department, leading right up to the death of George Floyd when it had previously a woman chief of police. And so, you know, I said I preface that to say that yes, there are those who really care to do a good job. And yet all at the same time we also know that there is a history of policing that dates back to slavery, which was the original policing in this country, right and, and we have to be able to hold complex thoughts at the same time right the ability to see that yes we want our communities to be protected and yet at the same time understand these histories and realities that were associated with policing. I mean let's be clear when we look at the images of the civil rights movement of people who are just trying to get their civil liberties acknowledged. People who were most harmful to them were actually people in law enforcement. Now none of us like that history but that is the reality and that's what's captured in black and white footage right when we think about what led to the 1964 Civil Rights Act in the 1965 Voting Rights Act. It's a bloody Sunday a bloody Sunday that's not necessarily civilians civilians often joined in, but we're talking about law enforcement doing that work of you will not have these rights. You will not get to the place to vote. You will not and we will be on our horses and we will use our batons and we will use our bats and we'll use whatever it is that's necessary to keep you from being able to exercise your constitutional rights. And it seems to me that in a time now where things are just so polarized and it's really difficult to just hold the truth of facts together while we think about pathways forward. Yeah, and I really hear that and I think that, you know, that's also something that has come up a lot of my research about you know there are there are reasons why law enforcement have legitimate reasons to go to places there are law enforcement who recognize and when they work with in the ED who exercise their allowable discretion to reinforce patient care to work with the medical provider but I think it's also really important to think about, as you said the I've actually been doing some digging into slave hospitals in the south and thinking and it's interesting how a lot of the kind of dual loyalty problems that I'm seeing right now in the healthcare spaces mimics so much of this kind of dual loyalty that the medical providers had at the time of slavery when, for example it was like one writer I think describes as a triangulated relationship where you'd have the slave, and then you have the slave owner as being part of the relationship with the doctor you know and I think things like that just always give me such a stark reminder of what where we where we're coming from right or like what we have to reckon with deeply historically and our institutions and how it's not it's not about saying at this moment that you are the same right but it's saying that our institutions are built from such foundations and and frankly I think that part of the reason I keep engaging this work is because it's also very motivating and inspiring I've been I've now talked to so many doctors across the country who are like engaging and phenomenal organizing work with communities right and so where they're giving ground rounds where they're giving their fellow physicians on the structural discrimination that occurred in their neighborhood or where they're hospital for them to understand the kind of community care that they should give patients to students too. Yeah, you know exactly to to think about this conversation also and include aspects of sex and gender to I don't know if your research is taking you in that domain but you know in my work as I've covered the intersections of policing and also sex and race and so forth we've seen a number of areas women being threatened with police being called if they refuse a C-section. Yeah. There have been cases of women being subjected to the police call because they fell down steps and then came to the ER room. There have the cases that I've yet to write about but that I've collected which really just are horrific are the cases of vaginal searches on the side of the road I don't know if you like though I mean it's just really in the spaces of policing or the shackling of women who are incarcerated I think few people understand that the face of incarceration often looks male and so we don't pay attention to the fact that policing also happens with women and that in the United States it is the country that has the largest number of incarcerated women in the world. The US incarcerates more women than Russia, China, India, Thailand combined and you can toxin Mexico too. And I think people really feel to see that and understand that and then what happens when women are incarcerated they don't stop you know the biology doesn't stop right so the incidences of breast cancer and ovarian cancer and pregnancy sometimes through rape from a garden and so forth. And then the questions of medical neglect what doctors are able to do or what they're not or in the state of California. Just recently all of the work about coercive sterilization in our jails and prisons here in California right so you know this has many different layers this intersection between criminal justice and then also the medical space. Yeah, absolutely and yeah I do, I do spend time on the, like exactly the California program which is not that long ago. No, no wait like this is not what we're not talking about 15 years ago we're talking about just a few years ago. And a shackling of pregnant women like why do you I mean actually so there's another story that brought me I didn't talk but I had a young woman who was pregnant and then gave birth, but she was incarcerated and then ends up going when she gets birth she goes to the hospital and they have like her ankle bracelet on the whole time like you know people. And then that night, she has the baby, she gets up she makes a call call to the nurse test asked the nurse for help to put on the diaper on the baby because she's afraid to touch the umbilical cord. The nurse sees her I'm assuming this is I mean, wait so the next person in the cell or no this is like out in an external but sees the ankle because this this is the only way she was able to go out right so a lot of people go out to have their their child, and then calls CPS on her immediately because sees a young black brown black girl, and then with an ankle bracelet and then that she clearly cannot because she asked me how to put the diaper on. I'm like, what kind of first time mother would not have that same question, and that also. So, but there's that but then there's also the extreme use of like shackling during pregnancies now there's been a bunch of laws to say oh this is outlawed except for. And this is mimics everything else right and these laws that you might have laws that seem more protective but they have a big public safety caveat. So the narrative is this this protects public safety by having her shackled while she's giving birth. Well no you can take it off, except if there's some public safety concern. And so you can see how the exception swallows the rule. Well, because then it would be like my public, you know the safety concern was that she was what she was going to overtake the guard overtake the doctors and the nurse and so I mean but imagine then you know that that sort of indignity of that right the indignity of being shackled during pregnancy and delivery. And then the indignity of being born while your, you know, parent is, you know, I mean, it just unpacking that we need to so one last bit and I'm going to share screen I hope this works Ashley if it doesn't work then I'll be needing your technical help, but I want to share screen to show this short video clip. This was a couple of years before George Floyd passed away before he died before he's killed murdered lunch. And it involves the case of Barbara Dawson and I think that it helps to put this conversation in context I'm going to share screen and hope that everything ends up working. Okay. Can you hear sound is calling for a federal investigation. 57 year old Barbara Dawson was admitted for stomach pain and she later complained of shortness of breath. Well she died less than two hours after a police officer arrived to remove her from the hospital. Elaine Kahano of our digital network CBSN is here with the encounter captured in a police dash cam audio recording. Elaine good morning. Good morning Barbara Dawson was discharged by hospital staff in the early morning hours of December 21. When she refused to leave her room they called police who placed her under arrest for disorderly conduct and trespassing. Barbara Dawson said she was in pain and couldn't breathe. But officer John Tadlock with the Blountstown police department tried to remove her oxygen mask. Dawson arrived by ambulance to Calhoun Liberty Hospital around eight hours earlier. Angela Donar was with her niece throughout the ordeal. And I said well she need her oxygen. No she don't. She fat. She fat. Officer Tadlock suspected Dawson was trying to avoid going to jail. Dawson collapsed outside of the hospital just feet from the police car. She's okay. Dawson remained next to the police car for 18 minutes. Officer Tadlock and medical staff tried to get her in. She's just dead weight. Minutes later a doctor demanded Dawson be readmitted to the hospital where she died. Calhoun Liberty Hospital said they continue to agree the loss of a patient. And we are setting up a medical and community task force to review best practices and better communication. In that tape she was begging for help. Martha Smith-Dixon said her cousin was a pillar of her community. Everyone knew Barbara. She was a jewel. Benjamin Crump is representing Dawson's family. Nobody should die like this. Today it was Barbara Dawson. If we don't speak to this it will be someone else tomorrow. Barbara Dawson was uninsured. A medical examiner found she died from a blood clot in her lung. Hospital staff told police Dawson was okay and had been discharged. Two Florida agencies are investigating. Very disturbing story. Thank you very much. All right. Let me... It's a tragic story, right? It's something that no one should have to encounter or endure and it strikes me. She had a blood clot. Sawed emergency care. She had no prior criminal. It's just striking that someone who seeks medical attention and care ends up having the police called on them. So one version of what you're writing about are police bringing people into the ER. And the other version of it is from within the medical space, the police being called on people where it shouldn't be the logical conclusion of a person who's saying that she can't breathe, that the next thing should be law enforcement getting involved. How does one address that? And then for those of you who have questions, please put them in the Q&A and we'll begin answering some of your questions. I mean, this is part of the problems that... I'm Tala and I'm sorry if it's an acronym, but the emergency medical treatment, which required emergency departments that get some kind of federal funding in order to screen a problem of one, I think, this, that being an unfunded mandate. So like a lot of hospitals doing the bare minimum when it comes to someone who's uninsured and so they're not doing a full medical work up because they... And also combined with perhaps assumptions and perhaps based upon her race and her class and her gender about whether to take her seriously. I mean, I just saw pictures of her, but I was also in another space that I've been just talking about like all the assumptions that doctors bring to patients who they think are obese and how they don't take seriously their medical considerations because they blame it on them just being fat or their diet and think that, oh, well, so how that intersects with the care. And then two, I think this also shows the close relationship that EDs and hospitals have to police that you can feel free to call a police officer to say they're trespassing on my property because they've been discharged, then they won't leave. This happens a lot, especially to homeless patients or people who are mentally ill who may come and then who don't leave right away. There have been reports about them and there was even a lawsuit emanating them in Oregon about this that's ongoing. And then this what I was talking about the medical clearance. So then she was obviously given some kind of sign off that she's okay to be taken to jail and clearly she wasn't. And I, such a tragic story. Well, and the interesting thing is she wasn't like coming from jail. She was like coming from home in an ambulance saying she couldn't breathe. And there's this, I discharged because she won't leave here. Let's call the police and she has a blood clot in her lungs. And this also mean I so one of the trainings I was giving was these doctors who work actually in a jail right so they're employed by a different entity, private entity but they work inside a jail or a nonprofit. And the training that they're explaining the training that they receive so it's like they're in a dark room they have to watch a video and the messaging is they lie. And when I say they write the incarcerated the prisoners the criminals they lie they will do everything they can because they want to avoid jail. And so they want to come to you and get healthcare. And so this narrative that really downplays what may already be in our implicit biases and practitioners for certain groups to like, not take seriously their medical concerns is compounded. It's compounded and it's complicated alright we're going to get to some of these questions. So, first question from someone that I know alright Dr. Plevin sorry, if he understands it correctly is it. It is allowable for police to lie to suspects, but are there limitations on them lying making up rules and conditions to medical personnel, or the general public who aren't suspects really great question. That's such a fascinating. That's a great question. That's a lot of you articles. Yeah. So, yes, yes, it is allowable for police to like though there are places that are trying to legislate around that, especially around youth interrogations. Only just from the limitations that I see are only if medical personnel, perhaps if they rely on something that the police officer said, and then expose them to some liability and then they're wanting to blame or rely on, or go after the police officer that lied that they rely on that line then acted I could see but that is like a ex post kind of limit which is not. Just be lying to nurses and doctors right there that's just simply not something that is lawful and I know it and I can't so and I want to take there's the lie but there's also like, not really the lie, right so like a couple examples that I give to people are like people who police will say are just like witnesses or victims, especially like gunshot wounds, and they'll be like their victims or it was we're just we're just investigating we want to see how he got shot or something. And then those people can then get charged with felon and possession of a firearm and end up in federal court and then their DNA gets put in. And then so there's all sorts of ways in which it's not even like a lie and a truth, right, but it's also the the gloss of or kind of like, right. And are you aware of any kind of handbook that helps physicians and medical personnel to sort through all right so that's another project okay. Can you speak to the limits of HIPAA, regarding these law enforcement requests. So first of all HIPAA disclosure HIPAA has a disclosure section, it's discretionary. So, know that that it's discretionary first, but there's they actually have much more tighter provisions when a person is supposed to is categorized as a victim, right if they're categorized as a victim. There are certain steps and there's like maybe four, four to six steps that a provider has to go through before they release it, or to justify why they didn't ask permission from the victim first and also with the caveat that this information is not to be used against the patient. Now there's also another separate HIPAA disclosure exception, which relates to state laws. And this is where a lot of stuff comes in because of state mandatory reporting obligations. And I went back and looked at like it's 1927 JAMA editorial written by a doctor when the first mandatory reporting for a gunshot wound. Bob got passed in New York, and he wrote this editorial why us, why us. There's a bunch of other people before it gets to us, who can report on this gunshot wound. This is going to impact my ability to provide care and for patients to want to come to me. I think that in some ways I think the mandatory reporting obligations seems like a lost battle or not anything live but I think it's, especially for physicians, it becomes a big, a big hole that allows law enforcement request and stuff to come in. All right, I'm going to go to another question. I think there was another part of Phil's question too, which also related to HIPAA and law enforcement taking pictures of patients or overhearing healthcare conversations. Maybe I'll let's add to that because there are, you know, there are limitations in terms of what is private and what can be shielded from later disclosure and what isn't, right, such as if something is being heard by a third party in a public venue. Can you unpack that a bit? Yeah, so I'll start by saying this. So I was talking to a former HIPAA privacy or someone who worked in the HIPAA privacy government office and a HIPAA privacy officer. She, when I described these things to her, she's like HIPAA is not designed for these like dynamic interactions that, you know, HIPAA was designed for like, a celebrity came into the hospital and the hospital staff disclosed, or there's a big pile of hospital records that nobody shredded, right. And so, in that sense, it's a little bit like a, like a mismatch there, but just looking at HIPAA itself, patient health information of for overhearing like that is a HIPAA violation. So when I talk to hospital privacy officers, or people who are in the privacy unit, I'm like, you, you should care about police presence in the ED, not just because of how it affects that person who's under law enforcement custody, but because you're opening the door to every single other person's PHI who's here. So taking pictures per, I think that that so often times they might say, oh, this is for evidence collection. And that is one. I don't see why you wouldn't ask permission right if the person was taking pictures when you're outside the hospital right the police were taking pictures let's say you were the victim of a burglary and they come in. I mean, unfortunately, you know, my family has had to do that and they come and they ask, they ask you want to press charges they ask if you can take pictures, they ask you things. Yet, because you're in the space that you know the courts kind of think is public and police officers think is public when it's actually very private, like your body, somehow, they can't just ask. This is very interesting because again, when we think about the Constitution, we, you know, their rules about, you know, even your house, right, let alone your body right and very strong rules right that you can't even enter the kind of physical structure around someone, let alone their bodies. I turn to another question from our audience thank you so much you have so populated our q amp a and the chat, which relates to are there benefits can police offers offer something of benefit in terms of information that might help in treating a patient. I think that is probably better answered by someone who's on the medical side to be able to say, Oh, there's certain kinds of information that I need in order to better treat this person. I think though that if there is some kind of benefit it's, you know, one hospital that I'm working with it's it's a matter of figuring out how to formalize that channel of communication right so that can't you have that communication without giving a carte blanche to police to the ED completely right there's a triage nurse that that sits there at the trauma bay and most Edie's I've been to you. And so, like, give that information put it in the hospital notes. Does that also mean that the police follows the patient into the trauma bay and then into the CT scanning room that I think is the question for me. But that doesn't foreclose that they might give information now I think the flip side of and this is what I was also hearing both in my research and recently is that well what if it's a police use of force right and the person comes in. There is some incentive from the police to perhaps not give you as much information as the patient might need. And then that ends up affecting and impacting patient care to another question. And I've seen this and you may have to in in your work which is with individuals who are undocumented may be afraid to stay at a hospital even go to a hospital because they're concerned about ice policing hospitals. I mean, has that come up for you. Yes, your work. So, and I think part of it so Alice Goffman wrote a book years ago. And one of the controversies of her book was that police were running warrants and you know some people couldn't believe that police would run warrants or run names. That was also in our research a common thing that physicians noticed right that they didn't know why but that they would see people taking names, or does that mean so run warrants. So when they take your name, they can run it through the system to see if you have a warrant, right and the whole thing about Ferguson. I mean, I think the idea that Ferguson, Missouri, right, is was the idea that that whole town had so many people who had just like very low level warrants, but that gives the police officer an excuse to arrest you right. And they have these low level warrants right to also further explain right so they've got these low level warrants because they are being more police in the community across the way right like so they're being police just by standing on literally crossing the street but not in the crosswalk. Yes, and they're getting a ticket and this is happening one community over which happens to be predominantly white and people do it and they don't pay attention to it and they don't. Right, and this is part of what the Department of Justice investigation found right like two different cities one that's more brown and one that's more white, doing the same things but it's over here in the brown community where people are being ticketed for J walk on the court like all of these petty tickets but these tickets add up, if you can't afford to pay them, you're 18 years old 16 years of 1890, you know, you're 50 and you can't afford to pay the J walking ticket, and it's in the system long enough, then hence the warrant but not because you were some dangerous person brandishing a weapon and trying to rob some place right and then you know turning to the undocumented side is that, you know, in California there is a, and in certain other hospitals that are especially close to the border that ice agents would come in, and they would, you know, do raids of such to pick up people who are undocumented. California did pass a California bios values act to make places like hospitals like sanctuary spaces when it comes to immigration. But yes, that is, and I think that undocumented leads also into other people who may have fears of being placed or may not want to just be around them for whatever reason, and then also not seeking care or walking away because she opened a Yale law journal piece that I wrote a few years ago with a case involving a woman Mrs. Borrego who sought medical care and and and integration enforcement was called on her as she was using a I think license it was, but this was her regular medical provider but she went to a different office, you know, so the medical provider to offices. And she went for a treatment of her condition but not to the main office and the people at the other office called ice on her so it is a it is a real concern and she was arrested in front of her nine or 10 year old daughter. And, and then subject to deportation and then, you know, there were efforts to try to help or she had been living in the United States for a while her children were documented she was not. Her husband was documented she was not and she actually had like, she had medical insurance through her husband's employment, but she was not documented. All right, there is a question which may have been more rhetorical about why on earth that the hospital call the police on Ms Dawson. It's a good question right it's it's a question that we can all spend time with and I think that the work that you know explains implicit and explicit biases say a lot and I think also the explanation that you offer when you know a hospital say okay we've stabilized we're required to stabilize we've stabilized and we don't want to do anything more. She's dying from a blood clot in her lung or, you know, but so long as we don't do the work to discover it, we've done enough to just say she's stable. Okay, having heard many of the ways in which the presence of law enforcement and medical spaces raises significant ethical concerns. Can you speak to some of the ways in which the presence of law enforcement can be supportive and or consider the contours of a legitimate role for police and medical spaces, given what you found in your research. So in sexual assault instances right like, and there are, I think in many EDs there might be, I'll use the term start but sexual assault response team unit, and in at least one ED I saw that there was a room for it right so law enforcement had a key for it that was a safe space for sexual assault victims to go. And so, and there's obvious value for something like that you need evidence collection. There's all sorts of forensic things that help make that woman be her victimization, then be vindicated later. Now, I think the that as long as it doesn't spill over right to other ways when the problem is that you could have legitimate and necessary roles for police and hospitals and emergency rooms, and for victims of crime for victims of injuries. There's all sorts of reasons why we turn to the police that are legitimate, but it's this like diffuse kind of like bleeding over into other ways and these kinds of informal things that aren't documented and are virtually then unseen. And then if you think about people who are don't know what's going on, right, because they're like, sick, or, you know, sedated or whatever patients, but then things are happening to them that they can't control, and then you have the eyes of the state, literally the, the, the, the arm of the state that can use force upon. And then within law there are, you know, part of the reasons why the protections that we've talked about are in the Bill of Rights, and is because we understand just how it affects our democracy and rule of law for the state to act in tyrannical ways right so in law we're really concerned, not just about it by the action itself but also the perception of the action as well. And we're deeply concerned about the constraining of people's civil liberties and civil rights by the potential threat by the threat itself, even if not actualized in certain spaces. And it's a really good question because I do think about the follow through with individuals who have been sexually assaulted, which can be women can be folks who are LGBTQ sex workers and whatnot. And what we know is that there are so many unprocessed rape kits right so like in the one area where one would say that yes there is that you could see a kind of need aligned. And I think that's helpful to the person who has survived the attack. We're building this kind of healthy relationship with medical personnel may be good in terms of helping to facilitate. We see that they go on process, 10s of thousands in the United States today. And I think that there's so much more to be said about the vulnerability of women and these in these intersectional spaces and LGBTQ folks as well that really is just even beginning to be unpacked. And that connects to the question of, you know, what does a positive partnership look like. All right, we've got a question here from Dr. Bob Trug. Okay, what should doctors and nurses do when patients arrive directly from a crime scene and evidence needs to be collected. In some cases for the benefit of the victims. How should clinicians know whether to allow police to be present and the extent to which they should cooperate. So Bob we need to do a conference on this. This is that's the 2022 2023 goals. So here, I'm going to go back to the sexual assault so in the sexual assault arena, because so I'm talking about in the 90s right so when there was like a push that sexual assault assault was not being treated by police, not by prosecutors. And so then it was a lot of reform that was put in place right to help make sure that these things happen so in the sexual assault arena you have a ton of protocols about forensic evidence collection. This is forensic evidence collection. Right, I don't know how many emergency doctors and nurses are actually trained to be forensic pathologists or forensic. There is some, I think a lot of training on custody, a chain of custody. But to me, this is about lanes staying in lanes, because you can be a forensic help, medically to the police officer but can you do that and also be a patient care provider without coming into conflict with any certain kind of ethics. What if it's a sexual assault victim who is confiding you but does not want at that time to do anything about it. Then do you say, oh it doesn't matter, I still think that you still need to be safe right which could be a human reaction and then say well you need to just have the police come in and do the rape kit anyway and get photographed. I think that that would infringe on the patient's autonomy right and like it or not like whether we make judgments about that or not that is her choice. And so, I think that when I what I want to see in this question is like, how does the patient do it first before we think about whether a police should be allowed to be present into what extent we could cooperate and the police should have their own forensic evidence team if they want to do it or have established protocols with your hospital so people know. Well, these questions are so rich. Great. I mean it just really shows the importance of doing more work at these intersections. We have another question that relates to police seeking preferential treatment and whether any of your research exposes some of that. Well, there's so I Armando Lara Marlon is a sociologist at Berkeley and he's done it just came out with a book about a hospital in Los Angeles about this precise issue that police were being prioritized in this hospital, both because they were both in the trauma bay and also in the waiting room that police in the waiting room would be sometimes deployed to whittle down the list by kind of just showing their force so people who on one, one people, one side could characterize as people with not serious issues to people could be like the flip side could be a person who does not feel comfortable being in a hospital where there's police roaming around the hallways, but that ended up affecting wait times and the triaging of care. And so I would point to that research. I think the extent to which it. Okay. In the Q&A also is is more of a comment and it is really worth noting which is that they're explicit and implicit biases and that and that's a reality and there have been so many studies that document that over 20 years ago the Institute of medicine study on unequal treatment, the medical studies showing that across hundreds of areas there's an unequal treatment and the one area where black people could be guaranteed to get as much or more care than white people was with an amputation. And so, you know the question that's raised about healthcare workers viewing black people as malingers or drug seekers is something that has been well documented or this concern that black people are just seeking stronger medications for pain or on the flip side of black people don't really have pain and therefore when they're asking for pain relief it's actually something that's more nefarious than something that is aligned with treating them. And I'm sure you all are aware of that. It's an important university of Virginia medical school study of medical school students first year, second year, third year, fourth year and residents that revealed shocking perceptions about how those students viewed black patients versus white patients. Thinking that black patients didn't feel pain as white patients did the black patients blood doesn't coagulate as white patients blood do that black people have thicker skin density and this is not a study from the 1930s, 40s, 50s, 60s. This is a study from just a few years ago and so these are concerns that remain and that must be addressed and that training really is important and even I think being able to get at it through sessions such as this being able to address these issues in ways that are not now let's all sit down and talk about implicit and explicit bias and those are important, but even to be able to unpack it in this way. Alright, our last couple questions. Okay. What about the concern that some are raising with regard to the vulnerability of medical professionals vis-a-vis their patients. How is that addressed and also was there racialized lens to that at all do you think. Yeah, and I just also see the note in the chat about proponents negative characterizations in black patients charts like aggression and things like that and one, one way to for that I've looked at is that yes so there's a lot there is a lot and growing of research on workplace violence in healthcare settings, but the question that I that then comes to mind is that in medical providers, people who deal with have have their own set of ways of confronting those issues right so I've been pouring over about medical restraints right and that are highly specific right and I'm talking to this one doctor and he's like yeah so apparently our risk management says it's okay if I'm standing there and the patient maybe acting out a little bit that he can just punch the patient a couple times and it's because it is his use of force protocol. And so that's the thing right medical side, how you might respond to someone who's acting out right and who might require and I'm not this is before I unpack what acting out means. Have a different way versus like when you bring a police officer in it's like when someone told me like don't go to your surgeon for your back problems because they're just going to tell you to get surgery right if you go to a police officer to deal with the use of force, they're going to go with what they think is it's like what we're seeing now with all the calls to reform mental health response right, the police have a certain way of responding to acute situations, and that is with violence. So, is that something that want you want to be perpetuate in the healthcare setting, or, for example in San Francisco they've now invested in its research is I mean it's question still out there how effective this behavioral emergency response teams, where you have some security, but you also have some people who are trained and de escalation, and also trained and de escalating in the medical sense right, or like the hospital way. So, and this is not to discount the kind of security that hospital staff may need, may need in order to accomplish their Yeah, and you know and it strikes me to that these are spaces where, you know, I was doing a keynote presentation for Johns Hopkins a few years ago, and someone raised a question about What about angry black parents and the NICU's person was saying that they work in the NICU and use angry black parents. You know probably lots of angry parents, it's not just the black parents that are there. We're talking about the NICU. Right, so how much of this is the kind of framing of, yeah, I'm really concerned when this group of people are loud. Like everybody gets loud right like there's, you know, I mean it's not like, you know, I mean it is that but we're also sometimes conditioned and triggered by certain communities and people who might act loudly or even aggressively because there's their kids and they're, you know, really worried about whether their child will survive. And it seems to me that those things we, you know, are worth us unpacking as well. Yeah, we have another question which is what's your recommendation for protecting the rights of other patients in the ED, when allowing police in a clinical area to address another matter or accompany another patient. So there's some research that's ongoing about design right like, or like the actual physical design of EDs right there's emerging conversations on how to make EDs actually much more private right for patients how do we deal with workflow so we don't have overcrowding. I think that question is very much tied in with that because it's, it's a space issue right I've for a while I was doing observational visits to EDs before COVID put a shut down on it but you know, in a lot of these places, it's like just tree flowing so you can't help with the actual meaning police officer who's coming in just to talk to that person is going to see patient charts here patient information see all sorts of stuff on their way out. And so I think that this again goes back to hospitals about how is it then like in one hospital they said well we have a room that police have to go to and check in and tell us which patient they're there for, because in other hospitals they don't know why they're there and the doctors are like well I'm not sure why they're here I think it's this patient but it might be something else. And so it's like this kind of managing the space because ultimately this kind of. I was on this other was one night I was in the ED and then suddenly this like women came in through the trauma they everybody was like freaked out that she came into the trauma they without like talking to anybody first she was there for a gunshot wound. And then I looked around and then suddenly there was like more police officers in this trauma they then there were medical personnel and nobody seemed to comment on that. I think there's like kind of like this normalization that happens about police care for some valid reasons and some maybe not valid and just accepted that I think can be rectified by thinking about how do we deal with patient flow and how do we deal with like just at the outset, without being aggressive like without being rude about it being like, why are you here. This is our place right this is our castle, but can you tell us and you're here to help but who are you here for. Well, you know, as we wrap up and it's been such a robust chat and robust q amp a and I want to just close with regard to the questions that have been put or the comments in the chat with about the growing policing of the reproductive space, what this may mean for people who are going to manage reproduction at their home manage abortion at home which for many people may spare them from harassment at clinics but at the same time we know that the constitutional rights that were articulated in Roe v Wade and Planned Parenthood v Casey are very vulnerable right now. We see in Texas the SB eight law which provides for a bounty to be placed on people who aid and a bet in the termination of a pregnancy. We see other states with copycat laws, no exceptions for cases of rape or incest. We're in a pandemic and during this time we've seen the increased use of medication for terminating a pregnancy but their deep concerns about what that's going to mean. If states begin criminalizing in that space and some already have and we see that in the chat. And so, as we wrap up, you know, I just want to acknowledge those concerns that are in the chat they serve as part of something that I was seeing more than a decade ago in writing of policing the womb I think it was a book that I thought would take me two years and it took 10 because the more that I researched the more that I saw the time I spent in Alabama the time that I spent in Arizona, leading a task force with Amnesty International doing work with the ACLU, all of that is the more that I saw the more across states, these efforts that bring us till now. And I think what was so disheartening is that so many didn't see it. I was articulating and writing about it, where people really thought this isn't going to happen in the United States we've got Roe v. Wait, this is now we're not going to see that day take place in the United States but on the ground I was already beginning to see it. And so I want to close off with you Professor song and just see you know whether any of your work in the future may take a look into some of that area that kind of intersection of policing and reproduction at all. Well, well, your book policing the womb was really one of the first things I read and kind of gave me even a framework and a lens to articulate the problems that I was saying, and it's something I routinely come back to because Ferguson versus city of Charleston which is like an an important Supreme Court case actually the only one that said that this the way that the medical personnel have cooperated with police here is wrong. Right. This is a law enforcement purpose and you shouldn't be doing it and then you see, and nothing else being very protective since, but then when I so part of this like this mandatory with the reporting on each other and reporting of patients, especially because of what when abortion was banned I was doing a lot of reading of that but I you know when I first started on this project, I could I read your book and I could also see like we're on the horizon where we might be heading, but I didn't quite know we would be where we are now. And so, even just in the last few months it's really changed the lens in which I'm thinking about it where this idea. So one of the reasons why I focus not just a kind of more generally is because, you know, it's it's it's I'm trying to say it's a general problem, but how can I not, at this moment think much more about the ramifications especially as we see criminalization on the horizon that res seems so repetitive of things we saw past and that we thought we were past but we aren't in an area that may make medical professionals vulnerable who want to care for their women and LGBTQ patients that need reproductive health care services so there's more, more to come in this in this space. I'd like to close with thinking about a silver lining right it's there. You know, is there either a silver lining in the space of this or something that you might recommend for medical providers who want to be on both sort of right side of the law on the right side of their patients, and who want to make sure that they are not the cog in the wheel that that somehow makes people civil liberties and civil rights more vulnerable in the space because I think that that's part of that gray zone right yeah if the medical professionals will do it, then it's all good. But you know what advice do you give what silver lining. Well, so I have a silver lining and then I have advice so the advice is I tell people that there's a couple things like one you can there's like right now what's so amazing is that there's like cops out of care there's all sorts of like organizing going on but to you could have there's there's ways I think of it very simply as like okay think about what about this care that you're providing right now is different than if law enforcement was not here right so establish that boundary then make the request. Make the request of the officer so that you can go back to how you would otherwise treated this patient and then document that and then turn to your patient and explain why you did it because I think that there is a powerful statement to your patient to show that you have delineated this situation you have done the best you can and and perhaps because perhaps the officer has not listened to you, but that you respect their autonomy and and they're informed consent as well as a law enforcement comes in and says we want you to do this. Yes, no I mean there is seeking informed consent from that individual and that's not something that law enforcement can just wave at all right that is empowerment right for nurse doctor I need to get informed consent if the patient does not consent to this, then I'm not doing it. Right and I think that's the other thing is to both in your notes because I know that you know physicians are some note heavy, but also with your higher ups your administrative, but how is this law enforcement impacting my ability to give adequate care, right. And so and I think that this often falls by the wayside and then I'm going to end with the silver lining which is that I think that the reason why this gives me hope is that you we you could there could have been an alternate universe right where you could have you could see if you take the medical profession at its most altruistic right as the healers of our world, right, and you had the healers of our world intersecting with people who you can conceptualize as being like the avatars of violence in our society, right. There shouldn't have been an alternative way in which this could have come out where we could have infused this mass incarceration state with more thoughts of like dignity and autonomy and saving life, right, rather than diminishing life. And I still think that there is that possibility and so that's like what I'm working for it both my research and my policy prescriptions and then these conversations that I have with all of you so thank you so much for having me thank you Michelle this is been a dream so to just be in conversation with you Well, it's been my pleasure and I want to thank our audience for joining us today for the third in our three part series. As we are examining contemporary concepts in medical ethics and we've done so across spaces of the ER room reproductive health rights and justice and professionalism as well. So I want to thank you all I want to thank Ashley Trotman, because these things don't happen without people behind the scenes who helped to pull it all together. And I'd like to thank my colleagues at Harvard Medical School and our Center for Medical Ethics, and for you all for tuning in for our program. We look forward to seeing you when we do this again in our next academic year. All right. Bye everybody.