San Francisco, Calif. — Fair and Just Prosecution, a prosecutorial reform advocacy group that works with elected local prosecutors, is calling on prosecutors nationwide to take a more active role in supporting hospital-based violence intervention programs, arguing that these initiatives are a proven public health strategy for reducing repeat violent injury and retaliatory violence.
In a December 2025 issue brief titled Hospital-Based Violence Intervention Programs: The Role of Prosecutors, the organization outlines how HVIPs operate, summarizes evidence of their effectiveness, and urges prosecutors to adopt policies that protect patients’ rights and limit law enforcement practices that can undermine trauma-informed care. The brief was authored by Kyle Barry and Dawn Milam.
The report describes HVIPs as programs that engage victims of violent injury at a critical moment, often while they are receiving emergency medical care, and connect them with long-term support services. According to the brief, HVIPs “provide services designed to improve the long-term physical, mental, and economic wellbeing of victims and their families, thereby also reducing retaliatory violence and promoting better health outcomes in the community.”
Fair and Just Prosecution argues that while law enforcement has legitimate investigative responsibilities, an unchecked police presence in hospitals can disrupt medical care and erode trust between patients and providers.
The brief states that HVIPs “can be needlessly undermined by the pervasive presence of law enforcement in hospitals where victims of violence…are treated,” particularly when police use aggressive investigative tactics that conflict with trauma-informed practices.
The report highlights research showing that victims of violence face high risks of reinjury if they do not receive comprehensive support. It notes that young victims can experience reinjury rates “as high as 45% within five years of discharge” and are at increased risk of becoming involved in future violence themselves. To counter these risks, HVIPs provide wraparound services that can include counseling, mentoring, safety planning, and assistance with education and employment.
As an example, the brief recounts the experience of Project Ujima, a hospital-based program at Children’s Hospital Wisconsin that has operated since the mid-1990s. According to the report, participants in Project Ujima have had a recidivism rate of less than 1% since 2004. One participant quoted in the brief said, “I know one thing, I wouldn’t be here. Without that support, I don’t know what life would’ve turned out to be.”
The brief also cites multiple studies demonstrating the impact of HVIPs. An analysis of Oakland-based Youth Alive!’s Caught in the Crossfire program found that participants were “70% less likely to be arrested and 60% less likely to have any criminal involvement,” and that 98% were not rehospitalized for violence-related injuries. In San Francisco, a study of the Wraparound Project found a 75% decrease in injury recidivism, from 16% to 4%, in the six years after implementation.
Fair and Just Prosecution also points to data from Baltimore showing that HVIP participants were “six times less likely to be hospitalized for another violent injury two years post–program completion” compared to nonparticipants. The organization argues that these reductions in reinjury not only save lives but also generate significant health care cost savings.
A central focus of the brief is the role prosecutors can play in regulating police activity in hospitals. The report warns that emergency departments are often treated by courts as public spaces, giving patients limited constitutional protections and allowing police to question or observe trauma victims during vulnerable moments. According to the brief, “police investigatory practices may conflict with the protocols of emergency health care and can threaten patients’ privacy and due process rights.”
The organization urges prosecutors to work with hospitals and police departments to establish clear protocols governing police access to patients, protection of private health information, and handling of personal property. The brief notes that without such policies, hospitals may engage in “ad hoc negotiations for when, where, and how law enforcement activities take place in health care institutions,” which can lead to improper or illegal disclosures of patient information.
Fair and Just Prosecution emphasizes that federal law, including the Health Insurance Portability and Accountability Act, strictly limits when protected health information may be shared with law enforcement. The brief cautions that hospitals that fail to curtail improper disclosures could face enforcement actions, financial penalties, or civil litigation.
The report also raises concerns about law enforcement seizing patients’ personal property, such as cell phones, clothing, or cash, practices it says can destabilize trauma victims and undermine participation in HVIPs. Citing a federal lawsuit against the Baltimore Police Department, the brief notes allegations that police engaged in a “practice or custom of at least arguably unconstitutional searches and seizures.”
Beyond policy guidance, the brief calls on prosecutors to advocate publicly for HVIPs and help secure funding and institutional support. It points to Travis County, Texas, where District Attorney José Garza has supported a countywide gun violence reduction strategy that includes a trauma center-based HVIP. According to the brief, the program served more than 350 people in its first six months.
Fair and Just Prosecution Executive Director Aramis Ayala said prosecutors have a responsibility to ensure that public safety strategies do not harm victims at moments of crisis.
In the brief’s conclusion, Ayala wrote, “Violence intervention programs save lives, strengthen community trust, and offer people a path toward healing… prosecutors have a vital role to play in helping these programs succeed by ensuring that policing inside hospitals respects patients’ rights and supports the trauma-informed services essential to breaking cycles of violence.”
The organization argues that as HVIPs continue to expand nationwide, prosecutors are uniquely positioned to bridge public health and public safety approaches, ensuring that efforts to investigate crime do not undermine the care and services designed to prevent future violence.
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