Over the past eight years, the process has been used at least 750 times on students. Some are as young as 5 years old.
The state law that allows for these removals, known as petitions for emergency evaluation, is meant to be limited to people with severe mental illness, who are endangering their own lives or safety or someone else's. It's the first step toward getting someone involuntarily committed to a psychiatric hospital.
But advocates say schools across the country are sending children to the emergency room for psychiatric evaluations in response to behaviors prompted by bullying or frustration over assignments. The ER trips, they say, often follow months, and sometimes years, of their needs not being met.
Black students are more frequently subjected to these removals than their peers, according to available data. Advocates point to students with disabilities also being removed at higher rates.
"Schools focus on keeping kids out rather than on keeping kids in," said Dan Stewart, managing attorney at the National Disability Rights Network. "I think that's the fundamental crux of things."
Schools in Wicomico County agreed not to misuse emergency petitions as part of a 2017 settlement with the U.S. Department of Justice. But while the number of suspensions and expulsions declined, mandated trips to the emergency room ticked up.
Last year, children were handcuffed and sent to the emergency room at least 117 times from Wicomico schools, about once per every 100 students, according to data obtained from public records requests to the Wicomico County Sheriff's Office.