The Ministry of the Interior is currently considering a bill to amend the Law Enforcement Act that concerns how the state determines whether a person is intoxicated, for example when someone is suspected of driving under the influence of drugs. The aim is a good one: to speed up proceedings and reduce the burden on doctors. But the proposed solution is nevertheless odd because it places the task entirely on shoulders that are already buckling under the strain — those of hospital emergency departments.

It is 3 a.m. The emergency department waiting room is packed. One patient is clutching their chest and struggling to breathe. Another has fallen and screams when moved; their hip may be broken. In the corner sits a mother whose child is coughing so badly that they struggle to breathe. A nurse rushes from one bed to another because staffing is thin at night and there is too much work for everyone.

Then a man is brought in whom the police have picked up off the street. He is not ill; he does not need treatment, surgery or pain relief. What is needed is a description of him — his gait, speech, pupils and behavior — so there is evidence on paper that can later be presented in court.

You can imagine for yourself what medical staff already drowning in work think in such situations and what the sick patients waiting their turn think.

Scenes like these are already part of everyday life — and nights — in Estonia's emergency departments. A law is now being drafted that would make them even more common.

Why the ER is not the place for intoxication checks

First, it is worth recalling a simple truth that the bill has strangely overlooked: determining whether someone is intoxicated is not medical treatment. It is not a healthcare service, as the bill's own explanatory memorandum acknowledges. But if that is the case, why should such a person be taken to a hospital at all, let alone an emergency department?

An emergency department exists for one reason: to save the lives of people whose health is at risk and to do so quickly. Every nurse and doctor on duty there at night, every hospital bed and every medicine cabinet is dedicated to that task.

If the state adds a duty that has nothing whatsoever to do with treatment — assessing whether someone is sober and drawing up a report about it — no additional staff will magically appear to perform that extra work. That time will be taken away from someone else: the patient waiting for help with chest pain or the child who cannot stop coughing. This additional burden will not diminish; it will grow.

As the bill's explanatory memorandum notes, police already have to turn to emergency departments now that the Tartu University Hospital's Psychiatry Clinic has stopped providing the relevant rapid-response service and waiting times have grown as a result. The ambulance reform due to take effect in the coming years will, in turn, bring even more patients to emergency departments.

So at precisely the time when the burden on emergency departments is already growing, there are plans to give them an additional task that, in principle, should have nothing whatsoever to do with emergency medicine.

Treatment and drawing up expert assessments not the same thing

But there is another, even more important issue of principle here. A healthcare professional, whether a doctor or a nurse, is there to help a sick person get better. Their skills, training and professional ethics are all built around that purpose. Describing a person's state of intoxication for use in criminal proceedings is an entirely different activity: it is an expert assessment intended to produce evidence that can be used in court. These two roles must not be conflated.

When a doctor provides treatment, they are on the patient's side and their concern is the person's health. When they prepare evidence for the police, they instead become an instrument of the state in legal proceedings. That entails an entirely different responsibility, different expertise and a different relationship with the person in front of them. The bill seeks to blur that line by assigning the task not only to doctors but also to nurses, without establishing who will train them to do it or how, who will be responsible if the assessment proves incorrect or what happens if complications arise — because complications can indeed occur.

The bill states that, when necessary, part of the procedure may involve collecting a urine sample using a catheter. This procedure carries a genuine risk of bleeding or injury. Because such a procedure is not legally considered a healthcare service, it remains unclear whose liability insurance, if any, would apply in such a case. This is a gap that the bill leaves unresolved at the expense of both patients and healthcare professionals.

What should be done instead?

I am not arguing that the rapid and reliable determination of intoxication is unimportant. It is important, both in traffic enforcement and elsewhere. But the solution is not to bring yet another task into hospitals and place it on nurses' shoulders in the hope that they will somehow manage.

If the state wants to make this work faster and more flexible, it should be organized in the most logical places: police facilities, sobering-up centers or forensic institutions.

And if the state nevertheless considers it necessary to assign this task to someone other than a doctor, it must first carefully consider what training is required, who bears responsibility and what level of compensation would cover the actual costs. The fees currently proposed in the bill for collecting a sample are ridiculously low — just a few euros — while the work carries enormous responsibility.

Hospitals and organizations representing healthcare professionals have already raised these concerns once and they have largely been disregarded. I hope that before the law is adopted, these arguments will be properly discussed rather than addressed as a mere formality because emergency departments are, after all, there for people who are sick.

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