Social EM Teaching Modules

ICEP Social EM Committee

Social EM Teaching Modules

Case-based teaching resources for emergency physicians exploring the social determinants of health and equitable patient care.

Guide for Faculty

For On-Shift Teaching (10–15 min): Read the case aloud. Use the discussion questions to prompt brief conversation, then use the teaching points to summarize key takeaways. Review practical questions to confirm learners know how the case applies at your institution.

For Small Group Teaching (30–45 min): Distribute the paired reading in advance. Open the session with the case and discussion questions, then move through teaching points and institutional practice questions.

For Motivated Learners: Direct them to the additional readings and encourage engagement with the module authors or ACEP/SAEM Social EM sections.

Teaching Modules

MODULE 01

Incarceration Rush University Medical Center · Weber, Gore, Ansari et al.

Authors Attending: William Weber, MD, MPH | Katarzyna Gore, MD FACEP | Sobia Ansari, MD, MPH (Rush University Medical Center)
Medical Students: Chizelum Ikedi MS3 | Tayler Rodriguez MS3 | Tarin Tanji MS3 (Rush Medical College)

✉ williamweber@medicaljusticealliance.org

1-Minute ED Checklist: Caring for Patients in Custody

1
Humanize your patient. Use person-first language (“person in custody,” not “inmate”). Avoid documenting carceral status unless clinically relevant. Do not speculate about criminal behavior.
2
Protect privacy immediately. Ask officers to step out of earshot when discussing medical history. Explain to the patient what information will remain confidential. Only share health information with officers if it directly impacts safety or transport.
3
Address shackles thoughtfully. Request removal or repositioning of restraints if they limit an exam or procedure.
4
Confirm autonomy and consent. Assess capacity — patients in custody can refuse care (unless legal exceptions apply). Officers are not surrogate decision-makers.
5
Practice trauma-informed care. Acknowledge the stressful environment. Maintain eye contact and speak directly to the patient. Avoid practices that may retraumatize (unnecessary skin exposure, unnecessary security presence).
6
Plan discharge carefully. Review instructions verbally and clearly — patients cannot keep paperwork. Consider formulary limitations in correctional facilities. Write prescriptions for over-the-counter medications to improve access. Assess for substance use disorder and overdose risk, especially if release is near.
7
Check yourself for bias. Would I be making the same clinical decisions if this patient were not in custody? Am I minimizing pain, delaying care, or documenting differently?

Learning Objectives

Promote the use of respectful and person-centered language to describe patients in custody.
Describe special concerns and considerations when interacting with law enforcement.
Describe ways to advocate for the rights of patients in custody.

Case Presentation

A 43-year-old male with a past medical history of HIV presents to the emergency department from prison with redness, swelling, and pain of his left forearm that has been worsening over the last two weeks. Medical staff at the facility tried oral antibiotics without improvement. You notice track-marks on his arms and are concerned that he has an abscess that may have been influenced by intravenous drug use. When you ask the patient about substance use, he keeps looking at the officers and tells you he does not want to talk about it. The patient’s arm is shackled to the bed and it is difficult for you to examine his left arm.

Discussion Questions

Is the patient allowed privacy from the officers? What steps can you take to ensure patient privacy and autonomy?
When is it appropriate to remove shackles for exams or procedures? How do you promote safety for the patient and medical staff?
Are incarcerated patients allowed to refuse care?
What information, if any, must be shared with prison system staff? What unique considerations must be made when documenting this patient encounter?

Privacy

All patients, incarcerated or not, are entitled to privacy of their health information under HIPAA.
Correctional officers are not medical staff and should only learn privileged health information if it directly impacts them or their transport (e.g., a tuberculosis diagnosis).
If officers learn that a patient uses drugs or alcohol behind bars, there can be legal consequences for the patient.
Officers generally must maintain “line-of-sight” with a patient in custody but can step outside of the room or out of earshot.

Forensic Restraints / Shackles

Forensic restraints are placed by officers to lower escape/harm risk — distinct from medical restraints ordered by physicians.
Restraints should not limit medical care; physicians can ask officers to move or remove restraints when needed.
Patients in custody are generally low-risk; if concerned about safety, consider moving shackles to another extremity rather than removing entirely.
The American Public Health Association recommends policies to limit shackling of patients receiving medical care.
Most states, including Illinois, have laws limiting or prohibiting shackles for pregnant patients outside of clear extenuating circumstances.

Right to Care

Individuals who are incarcerated have a right to medical care under the 8th Amendment — leaving someone to suffer from untreated medical conditions is considered cruel and unusual punishment.

Consent

Patients generally retain the right to consent or refuse treatment; officers are not allowed to be surrogate decision-makers.
You can often speak with family or emergency contacts, coordinated through officers to establish a secure line and avoid providing a care location for security purposes.

Documentation

If noting a patient’s carceral status, use person-first and respectful language (e.g., “man in custody” not “inmate” or “convict”) in alignment with National Commission on Correctional Health Care guidance.
Only document information that is necessary for medical care.

Discharge Planning

Facilities often have a restricted number of medications on formulary — consider calling the facility to verify availability.
Writing a prescription for OTC medications allows patients to receive them for free from the medical unit.
Patients are not allowed to keep discharge instructions — explain instructions and return precautions verbally in detail.
Provide clear follow-up care recommendations to support continuity of care at the facility.
Consider writing discharge instructions and sealing them in an envelope for delivery to medical personnel at the facility to prevent accidental disclosure to correctional officers.
Patients have an increased risk of death in the first few weeks following release — drug overdoses contribute; referral to treatment programs should be considered if they have a history of substance use disorder.

Health Disparities

People experiencing incarceration face higher rates of communicable diseases such as HIV, Hepatitis C, tuberculosis, and certain STIs — consider medical screening if appropriate.
Studies suggest that hospitalized patients in custody may receive less care than other patients; addressing biases may help ensure more equitable care.

Patient-Centered / Trauma-Informed Care

Recognize and address the impact of trauma in carceral settings.
Seek to avoid practices that may cause retraumatization.
Provide trauma-informed care by fostering safety, trustworthiness, collaboration, and empowerment.