How Emergency Physicians Obtain a Medical Emergency Custody Order (ECO) in Virginia
Ensuring access to care for those who need it — even if they refuse or are incapable of getting to an ED on their own
In Virginia medicine, a medical emergency custody order (ECO) is for adults who are incapable of making an informed decision as a result of physical injury or illness. A legal maneuver available to licensed physicians, Virginia’s ECO process ensures people who need medical care but refuse or are incapable of making the decision to seek it get the attention they require.
If a physician believes that a person cannot make an informed decision and need medical care or testing, the doctor may file a form to petition the local magistrate, who can issue an ECO. Once issued, a law enforcement officer will take the person into custody and transport them to a hospital emergency department for testing, observation, or treatment. Once the individual reaches the ER, the emergency physician evaluates them to determine whether they meet the requirements for a temporary detention order (TDO) in the ED; if not, the person is released.
Virginia has a form (DC-491), available online, for physicians to quickly fill out and initiate the ECO process.
There are some considerations before a medical ECO is issued.
Magistrates must ensure there is no legally authorized person available to give consent for treatment of the adult.
The magistrate also must ensure the person is incapable of making a decision, has refused transport or intends to resist transport, and is unlikely to become capable of making such a decision.
Before filing for an ECO, physicians must communicate with on-scene EMS and attempt to do the same with the adult in question.
Want to read the full statute? It’s here.
More questions? Contact Sarah Marshall, VACEP Executive Director, and we’ll route your inquiry to a VACEP member who can respond to you.
