Can a pregnant female who is intoxicated and arrested refuse to be sent to the emergency room (ER) in a correctional setting due to her impaired state?

Medical-Legal Considerations for Intoxicated Pregnant Inmates

A pregnant female who is intoxicated and arrested cannot legally refuse emergency medical evaluation when correctional staff determine it is medically necessary, as her impaired state compromises her capacity to make informed medical decisions and creates significant risks to both maternal and fetal health.

Understanding the Legal and Medical Framework

When dealing with a pregnant inmate who is intoxicated, several critical considerations come into play:

Capacity for Medical Decision-Making

• Intoxication significantly impairs a person's capacity to make informed medical decisions
• Alcohol intoxication during pregnancy represents a medical emergency for two patients (mother and fetus)
• Correctional facilities have a legal duty to provide necessary medical care to inmates

Medical Risks of Alcohol Intoxication During Pregnancy

• Acute alcohol intoxication can lead to maternal complications including:

  • Respiratory depression
  • Aspiration risk
  • Hemodynamic instability
  • Potential for cardiac arrest

• Fetal risks include:

  • Acute fetal distress
  • Potential for fetal cardiac arrest as documented in case reports 1
  • Placental insufficiency

Legal Framework for Medical Care in Correctional Settings

Correctional facilities have a constitutional obligation to provide adequate medical care to inmates. This includes:

1. Duty to provide emergency medical care: Facilities must ensure inmates receive necessary emergency medical treatment

2. Special considerations for pregnant inmates: Pregnant women require specialized care, particularly when substance use is involved 2

3. Informed consent limitations: While inmates generally retain the right to refuse treatment, this right is limited when:

   • The inmate lacks capacity to make informed decisions (as with intoxication)
   • There is an immediate threat to the inmate's health or life
   • There are risks to a viable fetus

Management Algorithm for Intoxicated Pregnant Inmates

Initial Assessment

1. Assess level of intoxication and vital signs
2. Determine gestational age (if known)
3. Evaluate for signs of maternal or fetal distress

Decision Points

• If severely intoxicated OR showing signs of maternal/fetal distress: Emergency medical evaluation is mandatory
• If moderately intoxicated: Medical evaluation is still indicated due to risks to pregnancy
• If mildly intoxicated but stable: Close monitoring within the facility may be appropriate with medical consultation

Transport Considerations

• For pregnant women with a viable fetus (≥23 weeks), transfer to a maternity facility is recommended when injuries are not life-threatening 3
• For emergent situations or when gestational age is <23 weeks, transport to emergency department is appropriate 3

Documentation Requirements

Thorough documentation is essential in these cases:

• Level of intoxication and assessment findings
• Explanation provided to the inmate
• Reasons for mandating medical evaluation
• All interventions performed

Ethical Considerations

While substance use during pregnancy raises complex ethical issues 4, the primary focus must remain on:

• Providing necessary medical care
• Protecting maternal and fetal health
• Balancing autonomy with safety when capacity is impaired

Special Considerations for Substance Use Disorders

For pregnant inmates with substance use disorders:

• Medication-assisted treatment is the standard of care 2
• A non-judgmental, supportive approach improves outcomes 5
• Treatment rather than punishment should be emphasized 4

The correctional facility has both a legal and ethical obligation to ensure that pregnant inmates who are intoxicated receive appropriate medical evaluation and care, even when the inmate attempts to refuse such care while in an impaired state.