Releasing ETOH levels to police in the ER

Discussion in 'Emergency Medicine' started by waterski232002, Dec 15, 2008.

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Do you give the police your patient's ETOH level?

  1. Yes, and if I didn't order an ETOH level I willl add it on

    15.6%
  2. Yes, but only if I ordered it as part of my work-up

    21.9%
  3. No, that is a breach of physician-patient confidentiality

    59.4%
  4. Sometimes I do, Sometimes I don't

    3.1%
  1. waterski232002

    waterski232002 Senior Member
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    What do you guys do when the Police ask you for the ETOH level on a patient they are investigating for a DUI?
     
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  2. TXchick

    TXchick Member
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    The nurses at my hospital handle it. The police generally have a kit including the specimen tube, the nurses draw the blood (if the patient is under arrest), then hand it over to the police who process it in their lab. The results from our lab have a disclaimer that they are not valid in a court of law.
    If the patient is not under arrest they have to consent to have the blood drawn.
     
  3. southerndoc

    southerndoc life is good
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    If they ask, I usually tell them. The state has its own blood collection kit. Nurses, techs, EMT's, physicians, etc. are required by law to draw it when the police ask for it. A patient can refuse, but it pretty much means they are pleading guilty in the eyes of a judge. Our alcohol levels are not forensic levels, so they cannot be used for that purpose.
     
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  4. BADMD

    Physician 10+ Year Member

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    Want blood? Ask patient. Refuses? Show warrant.

    Want lab result? Ask patient. Refuse? Show warrant to medical records.

    Want me to add one on? No.
     
  5. spyderdoc

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    As a former cop, I am more than happy to help bring down an intoxicated driver. Don't want this drunk guy to take out some innocent family someday....
     
  6. docB

    docB Chronically painful
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    I'm inclined to try to help the police as well but I also know that the police will say lots of things about what they think they're allowed to do and demand and they are sometimes wrong and that sometimes the rules that apply to them don't apply (or indemnify) us.

    For example when I was in residency in CA we were sort of out of the loop on this because the Ca Nurse's Assn had a policy that a nurse who is not an "agent of the state" could not draw blood for evidence against a patient's wishes even if the patient was under arrest. Their position was that the nurse in the ED had a caregiver relationship with the patient and if they started doing invasive procedures without consent it was assault even if the officers wanted it. They held that the law enforcement agency involved needed to have their phlebotomist come to do the draw and that the phlebotomist, employed by the agency was an "agent of the state."

    In NV my current understanding is that the officers are allowed to demand that our RNs draw their evidence labs and I see it happen frequently. I've never had anyone ask me for the results here.
     
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  7. DrMom

    DrMom Official Mom of SDN
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    Here our nurses draw the blood and the police officers take the blood & their own lab runs it.
     
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  8. roja

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    Pretty much the same here.

    I am all for bringing down drunk drivers; however, as one DA friend of mine told me, a second year law student can rip to shred a case (and many have been) by MD's releasing this information. Chain of command, admissibility, etc etc etc all come into play. Any experienced cop and/or DA knows this.

    Get a warrant for the blood. Get a warrant for the record. You might think you are helping but often times, you are making it easier for one of these DUI'ers to get away.
     
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  9. waterski232002

    waterski232002 Senior Member
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    I recently had a discussion with a colleague of mine who said that under Illinois law we required to draw blood and release the ETOH level on drunk patients in the ER when police request it. And furthermore, we are protected under this same illinois law for breaching physician-patient confidentiality (which we would obviously be doing) by disclosing the patient's ETOH level without their consent.

    My thoughts are that if the police want the information, they can get a court order to obtain the medical record.
     
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  10. waterski232002

    waterski232002 Senior Member
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    Does it really make any difference if the patient is under arrest??? It's still a matter of physician-patient confidentiality.
     
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  11. waterski232002

    waterski232002 Senior Member
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  12. BADMD

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    The Hospital General Counsel made it clear to us that if the police present us with a body search warrant, we are require to draw the patient's blood, even if the patient refuses. It is, however, not up to us to make the patient comply. It is up to the police to restrain or do what ever they think they can do to allow us to draw that blood.
     
  13. MrBling

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    At some places that I've rotated, I was told that ETOH wasn't ordered in all MVAs because some insurance companies didn't reimburse for MVAs sustained while under the influence. (or something like that)

    Anyone else hear of this? Or was I fed some BS (or maybe I just misheard)
     
  14. Hallm_7

    Hallm_7 Senior Member
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    My main concern isn't the patient confidentiality because the welfare of the general public is improved by getting these people off the road. Confidentiality is clearly not mandated by ethics when the well-being of the public is at stake. My concern stems from belief that this is heavy-handed government slowly chipping away at our Bill of Rights. The 5th Amendment clearly says that citizens can refuse self-incrimination. I realize that the judicial system has ruled mandatory blood draws constitutional, but SCOTUS has ruled a lot of things Constitutional or Unconstitutional that I disagree with. I see no difference between being forced to comply with verbal interrogations and being forced to comply with blood draws, DNA, or fingerprints prior to conviction.
     
  15. Dr.McNinja

    Dr.McNinja Nobel War Prize Winner
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    Wait, you're extending the 5th amendment to fingerprints? I don't see that one holding up at the courthouse. It might gain you the time it takes for them to get a warrant I suppose, but seriously.
     
  16. Febrifuge

    Febrifuge Grizzled Old Newcomer
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    The difference is a doctrine called "Evanescence of Evidence." The information the state would get from interrogating you presumably isn't different information depending on when they ask, or whether your lawyer is there, so your lawyer should be there. Your fingerprint will be the same fingerprint 12 hours from now; the crucial difference is the BAC will not. Therefore, the blood gets drawn now. Otherwise, there's no way to prove you were above the legally-defined BAC at the time of your alleged offense.

    Also, the 5th Amendment applies to testimony and court appearances (the actual text says that no one may "...be compelled in any criminal case to be a witness against himself..."). DNA and fingerprints fall under the 4th Amendment (search & seizure) more than the 5th.

    I agree with you in principle about the Bill of Rights, and the importance of protecting the citizenry against overzealous governance, which is cool because the Founders felt the same way. I learned this in Constitutional Law classes; I studied Criminology as one of my college majors. Therefore, I'm pretty sure you don't get to arbitrarily second-guess the Supreme Court, at least not when it comes to explaining your rationale to the DA when the time comes.

    As to the issue, I'm with Roja. I want the drunk off the road, so I want a good case against him. Even if I'm caring for the patient, I drew the blood myself, and I'm holding our ER lab report in my hand, it's still hearsay. Officer, I'm happy to help any way I can, so go get the legal blood-draw kit from the trunk of your car and we'll be right here waiting.
     
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  17. The White Coat Investor

    The White Coat Investor Practicing Doc and Blogger
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    Ditto. Much as I like busting drunk drivers, it's called assault.
     
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  18. docB

    docB Chronically painful
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    Interesting article about this in this month's Annals.

    Let me say that this jackass DA in Houston, Warren Diepraam, is being ridiculous if he thinks that his stance that a medical person who does forcibly and against a patient's wishes draw blood for the police is in fact committing a crime or at least a civilly actionable act but we shouldn't worry about it because he's never heard of anyone getting sued for it. Lawyers:rolleyes:.
     
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  19. docB

    docB Chronically painful
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  20. wook

    wook Just a hairy situation
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    Minor point, subpeona for medical records needed...not warrant.
     
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