State v. Nissley (Arizona Supreme Court Case No. CR-15-0393-PR, filed Feb. 1, 2017)

Under Arizona law, medical personnel are required to provide to a law enforcement officer (upon request) a portion of any blood sample taken from a patient when the officer has probable cause to believe the patient was driving under the influence of alcohol or other drugs. See A.R.S. § 28-1388(E). This law is an exception to the general rule that a law enforcement officer must first obtain a search warrant before taking an involuntary blood sample from a suspect. In State v. Nissley, the Arizona Supreme Court clarified the state may only use a sample obtained under this exception as evidence in a criminal prosecution if the state proves:

  1. Probable cause existed to believe the suspect was driving under the influence;
  2. Exigent circumstances made it impractical for law enforcement to obtain a warrant;
  3. The blood was drawn by medical personnel for a medical reason; and
  4. The provision of medical services did not violate the suspect’s constitutional right to direct his or her own medical treatment.

The defendant, Patrick Nissley, crashed into another car while driving erratically at a high speed, injuring four people and killing a pedestrian. When emergency personnel arrived on the scene, they found Nissley delirious, flailing his arms, and screaming incoherently. Nissley had suffered a head wound and was covered in blood from numerous cuts. He did not cooperate with paramedics and demanded they leave him alone. The paramedics ignored his demands, concluding Nissley could not make coherent decisions for his own care. They restrained him and loaded him into an ambulance. He fought them throughout the ride to the hospital, where medical personnel eventually sedated him for treatment and took a blood sample for medical purposes. A police officer later requested and received a portion of that blood sample without first procuring a warrant. Subsequent testing of the blood revealed the presence of methamphetamine and an active metabolite of heroin.

The state indicted Nissley on charges of second degree murder, endangerment, and possession or use of narcotic drugs. Nissley moved to suppress the results of his blood test for lack of a warrant or a valid exception to the warrant requirement. He argued that because he was treated against his will, the medical blood draw exception to the warrant requirement did not apply. The trial court denied the motion, and a jury subsequently found Nissley guilty of reckless manslaughter (a lesser-included offense of second degree murder) and the remaining charges. The Arizona Court of Appeals affirmed his conviction and sentence, over the dissent of one of the three judges who heard the appeal.

Addressing the issue of whether and under what circumstances the medical blood draw exception to the warrant requirement can constitutionally apply when a suspect contends the medical personnel who drew the blood rendered treatment against the suspect’s will, the Arizona Supreme Court analyzed how the exception affects a suspect’s Fourth Amendment right to be free from unreasonable searches and seizures, and a suspect’s due process right to direct his or her own course of medical treatment. The court held, consistent with its prior precedent, that a warrantless seizure of a medical blood draw is only permissible under the Fourth Amendment if probable cause existed to believe the suspect was driving under the influence, exigent circumstances were present, and the blood was drawn by medical personnel for a medical reason (as opposed to being drawn principally for law enforcement investigative purposes). Disavowing language from one of its prior decisions, however, the court held the natural dissipation of alcohol in the bloodstream does not itself establish a per se exigency that authorizes a warrantless seizure of a medical blood draw.

Turning to a suspect’s due process right to direct his or her own course of medical treatment, the supreme court also held the state must show that either the suspect freely and voluntarily consented to the medical treatment that led to the blood draw, or medical personnel provided the treatment when the suspect was incapable of providing consent. Consent may be express or implied, and a court should examine the totality of circumstances in deciding whether the state has met its burden of proving consent in situations where the suspect was capable of providing consent. Those circumstances may include whether the suspect communicated an unwillingness to be treated. If, however, the suspect cannot provide consent because he is either unconscious or delirious, the state’s interest in preserving life, safeguarding the integrity of the medical profession, preventing suicides, and protecting third parties overrides the suspect’s right to direct his or her own course of medical treatment.

Because the record in Nissley did not conclusively establish whether Nissley was able or competent to direct his own medical treatment and whether medical personnel acted against that right, the supreme court remanded the case to the trial court to apply the standard it established in its opinion and to determine, in the first instance, whether law enforcement lawfully obtained the blood sample.

To read the supreme court’s full opinion, click here.