When to call the police?

[RexKD]

Under what circumstances do doctors call the police on their patients?

I assume EM doctors are well versed with this subject because of the nature of their work.

If a patient was in a car accident and was drunk, would you notify the police?

If a patient was in a fistfight, would you call the police?

If a patient had drugs?

Gunshot victim?

Rape victim?

Etc.?

Would it matter whether or not the patient wanted you to call the police? Or would you call the police against the patient's wishes?

---

Members don't see this ad.

 

[Doczilla]

Assuming all of the following patients do not want you to call the police:
Victims of stabbings and GSWs usually require you to call the police as per state law. Sexual assaults may require a call as well as any assault or MVC that is a danger to life or limb. Simple assaults are another matter, and it would be difficult to call the cops on someone who got a little bloody nose in a drunken fight with a friend. Any assault on a minor requires a call. You have a duty to report suspected child or elder abuse or abuse of an incapacitated person.

If a person brings drugs or guns into your ER, you usually have to call as per hospital policy.

You have to call the police to report any patient who poses a threat to a specific person. You have a duty to warn that individual that they may be in danger, and the best way to do so is with law enforcement.

State laws may require notifying the police regardless of the patient's wishes as discussed above. Confidentiality laws prohibit you discussing the patient's condition or injuries with police without permission or a court order. Thus you cannot (or are not SUPPOSED to) say to the police officer "that patient is drunk". The exception is a minor patient coming for treatment without a guardian present (does not include older teens looking for birth control, STD treatment, or pregnancy services). You may treat the patient under "implied consent" but remember that the patient is a ward of the state at that point. The police officer, as an officer of the state, may take custody of the child on behalf of the state and consent to treatment (and you would therefore discuss the case with the PO as the guardian). This is more often used in the case of accidents or when you have a beligerant guardian who must be placed under arrest. A social services representative may also do this (this is the more common scenario).

You may call the police to restrain a violent, suicidal, or assaultive patient against their wishes pending a temporary detention order (72 hour hold).

Not sure about the one with the drunk from a car wreck who doesn't want you to call the police. My gut says to call anyway to report the accident. The PO will figure out that the patient is drunk.


'zilla

 

[beanbean]

Can't report drunks from car wrecks either due to the HIPPApotamus. EMTs on scene aren't even supposed to tell the police anything. This is often circumvented by asking the patient how much they have had to drink when the PD is in earshot, but even this is not supposed to happen. I definitely document everything in case the records are opened by court order.

However, what do you do if the patient is still drunk and wants to drive home? I vote for "danger to himself or others" and keep him until sober.

 

[FoughtFyr]

Can't report drunks from car wrecks either due to the HIPPApotamus. EMTs on scene aren't even supposed to tell the police anything. This is often circumvented by asking the patient how much they have had to drink when the PD is in earshot, but even this is not supposed to happen. I definitely document everything in case the records are opened by court order.

However, what do you do if the patient is still drunk and wants to drive home? I vote for "danger to himself or others" and keep him until sober.

There are subtle ways around the "on-scene" problem. For instance, if I, for the patient's safety, require additional resources from the PD, I can let them know why. E.g., "Officer, I think there is a reasonable chance this patient might become biligerant during the extrication. Could you please station an officer near the car?" seems to get the point across quite nicely.

BTW - In Minnesota a 72-hour hold can be placed for chemical dependence. The drunk who wants to drive home is holdable.

- H

 

[docB]

We have to report domestic violence even if the pt doesn't want us to. Once the police are called she can refuse to talk to them but we're obligated to call.

 

[RexKD]

We have to report domestic violence even if the pt doesn't want us to. Once the police are called she can refuse to talk to them but we're obligated to call.

But how can you identify domestic violence if the patient denies it?

For example: A woman comes into the ED with a broken nose and a series of bruises on her body. In which scenario would you call the police:

1. You ask her what happens, and she ignores you.

2. She says she fell down.

3. She claims she has been training martial arts

4. She says she got into an argument with her husband.

Obviously you would report the fourth scenario, but would you also report the others?

 

[FoughtFyr]

But how can you identify domestic violence if the patient denies it?

For example: A woman comes into the ED with a broken nose and a series of bruises on her body. In which scenario would you call the police:

1. You ask her what happens, and she ignores you.

2. She says she fell down.

3. She claims she has been training martial arts

4. She says she got into an argument with her husband.

Obviously you would report the fourth scenario, but would you also report the others?

We had the same protocol as Dr. B where I trained. It is not investigative work. If the patient states that she was assaulted, you call. If not, you don't. If the story "doesn't fit" you try and get the patient to tell you the truth. If they still insist no assault, then you do not call.

- H

 

[Doczilla]

But how can you identify domestic violence if the patient denies it?

For example: A woman comes into the ED with a broken nose and a series of bruises on her body. In which scenario would you call the police:

1. You ask her what happens, and she ignores you.

2. She says she fell down.

3. She claims she has been training martial arts

4. She says she got into an argument with her husband.

Obviously you would report the fourth scenario, but would you also report the others?

The same way that you identify victims of child abuse.
- Injuries inconsistent with the stated mechanism of injury or witness accounts
- The patient's (or complaintant) story keeps changing
- Identifiable marks of abuse, such as handprints, coat hanger marks, whipping marks (like from an electrical cord), cigarette burns, glove or stocking immersion burns, stove element burns, or curling iron burns
- Severe injuries to well-protected areas of the body. For example, bruises are common on bony prominences or on the extremities. They are uncommon on the abdomen (which is soft and doesn't bruise easily, even in karate class) or rib cage under the arm
- Poor hygeine, malnutrition, poor dental health, untreated medical problems (obviously in certain populations)
- Interview clues, such as avoidance of eye contact, reluctance to speak in front of the abuser or looking to the abuser for answers, reluctance to talk about the injury, or emotional responses to the injury which seem inappropriate in context. Signs of PTSD are also a clue such as hypervigilance, constantly looking over one's shoulder, being easy to startle, and sudden emotional outbursts.

You can always make a report in good faith. If later on it turns out you were wrong, you are insulated from liability for reporting what you thought might be abuse. For child abuse, reporting is mandatory. For spousal/domestic partner abuse, it may vary from place to place.


'zilla

 

[docB]

We had the same protocol as Dr. B where I trained. It is not investigative work. If the patient states that she was assaulted, you call. If not, you don't. If the story "doesn't fit" you try and get the patient to tell you the truth. If they still insist no assault, then you do not call.

- H

Exactly. The way it usually happens is that the woman reports the abuse to us but doesn't want to tell the cops.

 

[Katee80]

I'm not suprised the women don't want you to call the police for abuse or even rape in some instances. The crap the lawyers do to them on the stand when trying to get justice served is cruel and heartless. Now the fact that many women will put up with spousal abuse is a mystery to me. It must drive you nuts I know it'll drive me nuts. You'd have to hold me back from shaking some sense into them. I know its a vicious cylce and all and the element of self esteem and defeat is a factor but wow..come on.... It's so frustrating.....and this is speaking from experience w/ friends in the same boat.



hey...I took part in a thread that has nothing to do with demerol


Katee

 

[Sessamoid]

I'm not suprised the women don't want you to call the police for abuse or even rape in some instances.

s/some/most

Otherwise, I completely agree. Most cases of domestic abuse and rape go unreported. I've known (personally, not professionally) three women who were raped. None reported it to the authorities. Only one ever sought professional help that I know of, and one of the others needed it badly.