Guide & Script: How to Secure a Medical TDO in Virginia

Emergency physicians regularly care for patients who, because of a mental or physical condition — including delirium, intoxication, acute psychiatric illness, or other medical impairment — are unable to make or communicate informed decisions about their care.

When those patients require urgent medical evaluation or treatment to prevent serious harm, clinicians must balance patient autonomy with their obligation to provide stabilizing care. In Virginia, a medical Temporary Detention Order (TDO) under § 37.2-1104 can provide the legal authority to continue necessary testing, observation, and treatment when decision-making capacity is impaired.

Confusion often arises between medical and psychiatric TDOs, as well as about the specific legal findings a magistrate must make before issuing an order. VACEP’s quick-reference guide was developed by emergency physicians to clarify the statutory standard, outline the clinical factors that support a request, and provide practical language for communicating effectively with magistrates.

It is intended as a concise, real-world resource for emergency department teams navigating high-risk situations where capacity and urgent medical necessity intersect.