Policing Providers: Collaboration and Contestation Among Enforcement Agents Who Target Healthcare Workers

• In Event: 30254 - Professionall Legal Practices

Abstract

Today’s physicians are dancing on a shifting legal carpet. Practices that are legal one day may be illegal the next and there is significant legal variation across states. For physicians who work in reproductive health, immigrant health, gender-affirming care, and other stigmatized specialties, the threat of legal action has fostered significant uncertainty about what kind of care to provide and how. Healthcare providers envision a treacherous legal environment filled with enforcement agents poised to investigate and prosecute them which has resulted in a chilling effect on care. But how closely do providers’ imaginaries map onto enforcement practices? Little sociological research examines the enforcement environment surrounding healthcare practice and many of the laws restricting physicians’ behavior are so new that their outcomes are not yet known.

This study uses the case of opioid enforcement to examine how enforcement workers pursue cases against physicians. Given the shift from medicalization to criminalization of opioids over the last twenty years, the opioid case offers insights into the micro-level dynamics of enforcement in administrative law and criminal law arenas. Drawing on 94 interviews with enforcement agents gathered from 2009-2019, I ask: How do enforcement workers identify, investigate, and discipline physicians? To what extent do they collaborate and to what extent do they compete? These questions are critical because they illuminate an understudied aspect of legal mechanisms that shape professional work. I address these questions by: 1) mapping the enforcement environment and identifying key sources of variation across enforcement organizations; 2) offering preliminary findings about collaboration and competition based on pilot research; and 3) identifying next steps. Findings provide a window into dynamics of political and legal control of healthcare work and contribute to broader understandings of frontline work and inter-organizational processes in enforcement fields.

Author

• Elizabeth Chiarello, Washington University in St. Louis