Surgery on Public Enemy #1

Abstract

Community general surgeons, particularly those working in urban areas, may occasionally be called upon to provide surgical care to prisoners or patients suspected of committing crimes. Most of these patients do not pose threats to hospital personnel or themselves; nevertheless, the hospital should follow standard security protocols to prevent their escape or an unpredictable attempt to injure hospital personnel or other patients. Rarely, a patient involved in more dramatic events (mass shootings, terrorist bombings) may require surgical care. The surgeon’s role in the care of such a “public enemy” patient remains the same as for all other patients: the surgeon is the patient’s primary care giver and advocate. The care of such patients may challenge hospitals and providers logistically and ethically in unexpected ways. Care for such patients has many parallels with the care obligated to prisoners of war; hence, the 1949 Geneva Conventions serves as an appropriate document to guide care for such patients. Documentation of any injuries, the informed consent process for invasive or surgical procedures, and care delivered must be meticulous. The surgeon sets the tone and environment of care for the entire team.