by Dr. Daniel H. Low, Dr. Amish J. Dave, and Dr. Rajneet S. Lamba
In the aftermath of George Floyd’s death, a broad array of activists and public figures have called for defunding the police in towns and cities across the nation. For many Americans, police officers are often the first responders to small and large crises. While surveys suggest much of the public wants police reform, there is concern that defunding efforts could erode the safety of our communities. Other voices argue that mere police reform is insufficient. Research has shown that measures such as implicit bias training, body cam usage, and firing problem officers with a history of misconduct have not led to meaningful change. In the interest of public safety, we are all vested in understanding how acute crises would be addressed if we were to defund police departments.
As physicians working in the hospital and clinics in Seattle, we manage crises every day and recognize that delays in care and overlooking details can lead to adverse outcomes including death. With a global pandemic and protests highlighting an urgent need for social justice, we are managing more crises than ever before. Our patients arrive with mental health emergencies, from acute suicidality to mania. Patients present to the emergency room with respiratory distress as we aim to diagnose a new COVID-19 infection or another cause for their breathlessness. Other patients present with chest pain and need urgent cardiac interventions. As physicians, we learn what we know and what we do not know within the bounds of our specialty. We reach out to our colleagues in other specialties — be it psychiatry, pulmonology, nephrology, or radiology — when we need guidance on key questions related to the health and care of our patients. We build collaborative relationships with our colleagues that are respectful and collegial ahead of time so that, when crises arise, we have the ability to bring together a team that patients can trust.
This delegation of responsibility and specialization makes sense to medical professionals and the public when it comes to healthcare. Yet, when the public and our media consider public safety beyond the clinic or hospital, they forget about the importance of having expertise, training, and skill sets honed for the specific problems at hand. American police departments have been tasked with managing a wide and unwieldy portfolio of social behaviors including, but certainly not limited to, traffic safety, mental health crises, housing insecurity, homicides, drug use, and theft. Such a discordant range of responsibilities is impossible for any single police officer (despite training or longevity in uniform) to execute. As Dallas Police Chief David Brown exclaimed, “We’re asking cops to do too much in this country … every societal failure, we put it off on the cops to solve.”
The King County Medical Society would like to see professionals who respond to crises be the people who are best equipped to deal with those events. If our patients or loved ones needed cardiovascular surgery, we would want the most qualified practitioner to operate. We should similarly want housing experts to address our concerns with homelessness, not police officers. We should have drug use experts treat people with addiction rather than patrolmen and women. Public safety can be enhanced by allocating a large portion of funding previously designated to police departments instead to community and social organizations that are more expert in areas that the police have been inappropriately asked to address.
Such a re-allocation of funding has precedence and does not need to be contentious. In Eugene, Oregon, the police-fire-ambulance communications center collaborates with the Crisis Assistance Helping Out On The Streets (CAHOOTS) team. When there is a mental health crisis, the CAHOOTS team is dispatched rather than police officers. Previously, interactions with an individual with schizophrenia experiencing a psychotic episode might have carried a high-risk for violence and death. The new CAHOOTS team would deploy a nurse or medic and a crisis worker to focus on de-escalation, supportive therapy, and resources to prevent the next emergency. Negative police interactions with members of society in Eugene have become rare. This model has been warmly accepted by both the police department and the community, leading to improved outcomes and reduced costs. While implementation will be challenging for many, similar models are possible for many of the social challenges that police officers are currently tasked to address.
The protests across America are forcing the question, “where do we go from here?” Police violence is a public health issue and King County has declared racism a public health crisis. The criminal justice system disproportionately exposes certain communities to life-altering experiences including extended pretrial incarceration for those unable to post bail, disruption of family, housing, and employment relationships, and associated trauma and stigma. Violent crime makes up only 1% of police calls in Seattle and is far outranked by medical emergencies, vehicular accidents, and mental health crises. First response of choice in these situations should not necessitate an armed agent of the state with the potential to criminalize a call for help. We need to work with communities to re-evaluate our response to these situations and appropriate funds in a way that can better serve the public. It is imperative that we find a prescription of policies and programs that respond to the issues at hand and first do no harm.
Dr. Daniel H. Low is a family medicine physician in Seattle, WA and a board member of the King County Medical Society.
Dr. Amish J. Dave is a rheumatologist in Seattle, WA and chair, Public Health Committee, King County Medical Society.
Dr. Rajneet S. Lamba is an internal medicine hospitalist and President of the Board, King County Medical Society.
Featured image: photo Courtesy of U.S. Army Africa.