Law on blood work

[Gracile]

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We were disussing a case in class last week and I would appreciate some help or directions to where I can get help.

In the case, a woman was brought th the ER and the physician had some blood work done on her to determine her blood alcohol concentration; a drug screen was also ordered. She was conscious the whole time. The question my teacher raised was: is it legal for the ER physician to conducts these tests without obtaining consent from the woman since she was fully awake and conscious?

Thanks a lot!

 

[Rendar5]

I'd actually think a lawyer would better be able to answer questions of legality as opposed to ethics.

 

[EctopicFetus]

Yes. Because the patient signs a consent to treatment and if the physician feels this is necessary and there is not physical risk to the patient then it is ok since this is not an invasive procedure.

On the other hand if the patient is not intoxicated (clinically) they can refuse a blood draw. if you are drunk you can not refuse this.

On the other hand we as physicians can not share this info with the police. The police blood draws have other issues.

 

[deleted65604]

It is easier to ask forgiveness than to ask permission. If you discuss every single test that you want to perform with every patient who is intoxicated, you are going to get a lot of unnecessary and unreasonable resistance. You may miss an important diagnosis- lithium toxicity, encephalitis, liver failure, brain tumor, delerium from sepsis, etc.

A couple of times a year you might get some complaints about tests that patients feel are unnecessary. Let administration worry about dealing with those complaints. Order what you think is necessary on patients and worry about the consequences later.

I had a patient a couple of months ago that swore that she couldn't possibly be pregnant. The ectopic pregnancy I found spoke otherwise. I'm glad I didn't believe her.

 

[USCDiver]

In addition to labs run in the ED not being turned over to police, they aren't admissible as evidence because there is no chain of custody.

 

[Go Time]

Regarding police reporting...

Don't some states have laws which mandate reporting MVA drivers to the police who test over the ETOH limit?

 

[docB]

Regarding police reporting...

Don't some states have laws which mandate reporting MVA drivers to the police who test over the ETOH limit?

I don't think so. Reporting your patient to the police for criminal activity you become aware of during the course of treatment is pretty clearly a breech of confidentiality and ethics.

The only exception I know of is the Tarasoff exclusion where if a patient tells you they're going to kill someone you have an obligation to tell that person.

The mandatory reporting statutes I know of involve reporting when you think a crime may have been committed against your patient (e.g. child abuse or elder abuse).

 

[wook]

I don't think so. Reporting your patient to the police for criminal activity you become aware of during the course of treatment is pretty clearly a breech of confidentiality and ethics.

The only exception I know of is the Tarasoff exclusion where if a patient tells you they're going to kill someone you have an obligation to tell that person.

The mandatory reporting statutes I know of involve reporting when you think a crime may have been committed against your patient (e.g. child abuse or elder abuse).

Actually, this may be state dependent. Massachusetts has a law concerning aiding and abetting a felon after the fact. It could be spun that by not reporting a murder, or shooting,....etc that you aided and abetted the perpetrator in the commision of the crime.

It would probably be best to talk to a criminal attorney or prosecutor to get the skinny on that.

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Chapter 274: Section 4. Accessories after fact; punishment; relationship as defence; cross-examination; impeachment


Section 4. Whoever, after the commission of a felony, harbors, conceals, maintains or assists the principal felon or accessory before the fact, or gives such offender any other aid, knowing that he has committed a felony or has been accessory thereto before the fact, with intent that he shall avoid or escape detention, arrest, trial or punishment, shall be an accessory after the fact, and, except as otherwise provided, be punished by imprisonment in the state prison for not more than seven years or in jail for not more than two and one half years or by a fine of not more than one thousand dollars. The fact that the defendant is the husband or wife, or by consanguinity, affinity or adoption, the parent or grandparent, child or grandchild, brother or sister of the offender, shall be a defence to a prosecution under this section. If such a defendant testifies solely as to the existence of such relationship, he shall not be subject to cross examination on any other subject matter, nor shall his criminal record, if any, except for perjury or subornation of perjury, be admissible to impeach his credibility
-----------------------------

Wook

 

[deleted109597]

I don't think so. Reporting your patient to the police for criminal activity you become aware of during the course of treatment is pretty clearly a breech of confidentiality and ethics.

The only exception I know of is the Tarasoff exclusion where if a patient tells you they're going to kill someone you have an obligation to tell that person.

The mandatory reporting statutes I know of involve reporting when you think a crime may have been committed against your patient (e.g. child abuse or elder abuse).

Not so. Any GSW/Knifing requires a call to the constabulary. Although other things (ie, positive drug tests, etc) do not. Local laws may differ.

 

[edgesofsanity]

While we're talking about these issues - if you look at your vehicle insurance policy, you'll see that they include language to deny insurance-related claims for driving while intoxicated. If they get a hold of the information via your blood draw of an EtOH above 80, conceivably they could use it to reject payment of the hospital care and force the patient to pay it themselves...

 

[docB]

Not so. Any GSW/Knifing requires a call to the constabulary. Although other things (ie, positive drug tests, etc) do not. Local laws may differ.

I was talking about instances where the patient was the one who perpetrated the criminal activity. Not where they show up with an injury sustained from a particular weapon or when they are children, elderly or mentally disabled. Those are mandatory reports.

Oddly the rule is to report when you become aware of a victim, not a perpetrator. Now what your obligations would be if a patient presented saying "I hurt my hand beating my aged mother." I have no idea.

While we're talking about these issues - if you look at your vehicle insurance policy, you'll see that they include language to deny insurance-related claims for driving while intoxicated. If they get a hold of the information via your blood draw of an EtOH above 80, conceivably they could use it to reject payment of the hospital care and force the patient to pay it themselves...

That's true and while I don't routinely order etoh or tox on everyone many trauma centers do and I do order them when there's some ALOC or any question as to the patient's ability to have a reliable spine exam. I don't lose sleep over the drunk driver getting screwed by their insurers even though it means I won't get paid either.

 

[Go Time]

FWIW, here's something I found regarding reporting MVA drivers who are intoxicated:

http://www.ncbi.nlm.nih.gov/pubmed/16141026

The publication states that reporting is to take place within 72hrs in Oregon. Other states listed include Hawaii, Illinois, Indiana, Pennsylvania, and Utah (as of 2005).