State v. Patrick McLeod Nissley, 387 P.3d 1256

Patrick Nissley drove erratically, caused a crash that injured four and killed a pedestrian; he was delirious, combative, and had head injuries when paramedics arrived.
Paramedics restrained and transported Nissley to the hospital; medical staff sedated him and drew blood for treatment despite his protests.
A police officer requested and received a portion of the medically drawn blood without a warrant; testing showed methamphetamine and an active heroin metabolite.
Nissley was indicted on multiple charges; he moved to suppress the blood-test results arguing the medical blood-draw exception did not apply because treatment was against his will.
Trial court denied suppression; a jury convicted Nissley; the court of appeals affirmed in a split decision.
The Arizona Supreme Court granted review to clarify when the medical blood-draw exception (§ 28-1388(E)) applies if medical treatment was against the patient’s will.

Issue	Plaintiff's Argument	Defendant's Argument	Held
Does § 28-1388(E) allow warrantless law-enforcement access to blood drawn during medical treatment when the patient refused treatment?	State: statute permits turnover of a portion of any medically drawn sample when officer has probable cause and exigency; no additional consent standard required.	Nissley: exception does not apply if medical treatment was rendered against the patient’s will; state must prove consent.	The state must prove probable cause, exigency, medically motivated draw, and that providing treatment did not violate the patient’s right to direct care. If patient was capable, state must show free and voluntary consent (express or implied). If incapable (e.g., unconscious/delirious), treatment and sample may be lawful.

State v. Cocio, 147 Ariz. 277 (court recognized medical-blood-draw exception when blood is drawn for medical reasons and exigency exists)
Missouri v. McNeely, 569 U.S. 141 (2013) (no per se exigency from alcohol dissipation; exigency must be determined case-by-case)
Schmerber v. California, 384 U.S. 757 (warrantless blood draw may be reasonable under exigent circumstances; case-specific analysis)
Cruzan v. Director, Mo. Dept. of Health, 497 U.S. 261 (competent persons have a liberty interest to refuse unwanted medical treatment)
Skinner v. Ry. Labor Execs.' Ass'n, 489 U.S. 602 (private actors compelled by law to collect samples are performing state action for Fourth Amendment purposes)
State v. Spencer, 235 Ariz. 496 (appellate decision requiring voluntariness for medical treatment when invoking § 28-1388(E))
State v. Estrada, 209 Ariz. 287 (appellate decision stating exception does not apply when treatment is received against the patient’s will)
State v. Valenzuela, 239 Ariz. 299 (procedural standards for reviewing suppression rulings)