Imagine you and your partner are evaluating a patient who was the driver involved in a motor vehicle collision. The patient (for whatever reason) informs you that she has recently used recreational drugs, are you allowed to report this to the police? What if they ask you if the Pt appears to be under the influence? What if you smelled ETOH on the Pt's breath, and the police ask if you noticed it? Is this a HIPPA violation, or are the police entitled to this information since this is a legal matter, and they were also responders to this incident?
Legality of informing police about intoxication
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Shishkabob
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Technically, no, you can't tell them as it is up to their own investigative work to find out what they need to, as we aren't in the law enforcement aspect, they are. It's not our job to worry beyond what it takes to treat out patient.
Morally? I've yet to meet a provider who HASN'T atleast hinted at something being off atleast once, even if never outright going "They're drunk" though it is truly a fine line and it's best not to do.
Morally? I've yet to meet a provider who HASN'T atleast hinted at something being off atleast once, even if never outright going "They're drunk" though it is truly a fine line and it's best not to do.
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Unless there is a law specifically requiring mandatory reporting, law enforcement are entitled to nothing, and in best practice, should be informed of nothing by healthcare providers.
Whether or not it is a hipAA violation or not is irrelavent. If a provider needs a law to hold in confidence what a patient tells them, they have no place in medicine or healthcare of anykind.
My friends in law enforcement have never asked me for such information and tell me that improper disclosure can actually make their job harder. They know what the proper procedures to obtain information they need are and they should never require information from EMS or other healthcare providers outside of mandatory reporting.
Aidey
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The cops usually know, or suspect without us ever having to say anything. They will ask if the pt said anything relevant, so no just about drugs/alcohol, but about what happened. If the answer is yes, they will take our info. I think it makes it easier for them when they know our info ahead of time, rather than waiting to get the report. Even if they have to get the report to find out the exact info we know.
EMT11KDL
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when I have been asked. I tell the officer that they should draw labs when the patient gets to the hospital, this way it gives them the information they need and ur not giving any information out. It is also in there protocols to do these lab draws. Another thing to do is ask the patient if he or she has been drinking or doing drugs while the officer is next to you or where they can hear it.
JPINFV
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Oh, yea, that's great for patient confidentiality. Should the police always stand next to you just in case someone answers the recreational drug question with a "yes"? You have a legitimate medical reason to know if the patient has been using anything, both long term and in the immediate past, and are looking to give them every reason to lie about it.
Silver_Star
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In my experience the cops are the first to know when someone is drunk, most specifically during an mva.
jjesusfreak01
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This is the best answer that will be given on the thread. If the patient was driving, the officers have the right to at least get a BAC, and possibly a full drug screen, depending on local ordinances. No reason for you to endanger your career by doing something that doesn't help your patient.
firetender
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What are you???
One aspect not mentioned is this:
As paramedics, we need to be able to move fluidly through all social strata and have continuing access to EVERYONE. If any segment of the population has to be concerned that, under anything less than the most horrendous of circumstances, you as a medic are an arm of the Law, then that may mean someone will hesitate to call for help. Why put yourself out of business?
Let's face it, the lower strata of society are the most vulnerable to this sort of thing. If you pull this on the Mayor, YOU'RE the one at risk!
Even Junkies deserve a chance without you CHOOSING to drop a dime on him/her. Unless you do that with everyone, you should do that with no one.
That's the job, Folks! Doling out chances indiscriminately. You do, however have a duty to report anything within the medical realm regarding the circumstances of the incident; that could include psychological trauma resulting from illegal activity. Just be very, very specific without revealing anything but the essentials for the hospital staff. From there on, it's in their court.
And on a more practical note; once you document or pull a cop into things other than good patient care, you can count on spending a certain chunk of your future being part of the CASE as well as the CALL! It's your choice.
One aspect not mentioned is this:
As paramedics, we need to be able to move fluidly through all social strata and have continuing access to EVERYONE. If any segment of the population has to be concerned that, under anything less than the most horrendous of circumstances, you as a medic are an arm of the Law, then that may mean someone will hesitate to call for help. Why put yourself out of business?
Let's face it, the lower strata of society are the most vulnerable to this sort of thing. If you pull this on the Mayor, YOU'RE the one at risk!
Even Junkies deserve a chance without you CHOOSING to drop a dime on him/her. Unless you do that with everyone, you should do that with no one.
That's the job, Folks! Doling out chances indiscriminately. You do, however have a duty to report anything within the medical realm regarding the circumstances of the incident; that could include psychological trauma resulting from illegal activity. Just be very, very specific without revealing anything but the essentials for the hospital staff. From there on, it's in their court.
And on a more practical note; once you document or pull a cop into things other than good patient care, you can count on spending a certain chunk of your future being part of the CASE as well as the CALL! It's your choice.
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reaper
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One aspect not mentioned is this:
As paramedics, we need to be able to move fluidly through all social strata and have continuing access to EVERYONE. If any segment of the population has to be concerned that, under anything less than the most horrendous of circumstances, you as a medic are an arm of the Law, then that may mean someone will hesitate to call for help. Why put yourself out of business?
Let's face it, the lower strata of society are the most vulnerable to this sort of thing. If you pull this on the Mayor, YOU'RE the one at risk!
Even Junkies deserve a chance without you CHOOSING to drop a dime on him/her. Unless you do that with everyone, you should do that with no one.
That's the job, Folks! Doling out chances indiscriminately. You do, however have a duty to report anything within the medical realm regarding the circumstances of the incident; that could include psychological trauma resulting from illegal activity. Just be very, very specific without revealing anything but the essentials for the hospital staff. From there on, it's in their court.
And on a more practical note; once you document or pull a cop into things other than good patient care, you can count on spending a certain chunk of your future being part of the CASE as well as the CALL! It's your choice.
+10
You are not there to be johnny lawman. You are there to treat a pt. Let the word get out that you are turning over info and your Pts will stop talking to you.
You have your job to do and LEO has their job.
Agreed. I make it my duty when I have an ETOH or altered via drugs PT in the rig to inform them that I NEED to know what they've taken to inform the RNs at the hospital, but what they tell me is between the PT and myself, and that's all.
Makes for a good rapport builder also.
One aspect not mentioned is this:
As paramedics, we need to be able to move fluidly through all social strata and have continuing access to EVERYONE. If any segment of the population has to be concerned that, under anything less than the most horrendous of circumstances, you as a medic are an arm of the Law, then that may mean someone will hesitate to call for help. Why put yourself out of business?
Let's face it, the lower strata of society are the most vulnerable to this sort of thing. If you pull this on the Mayor, YOU'RE the one at risk!
Even Junkies deserve a chance without you CHOOSING to drop a dime on him/her. Unless you do that with everyone, you should do that with no one.
That's the job, Folks! Doling out chances indiscriminately. You do, however have a duty to report anything within the medical realm regarding the circumstances of the incident; that could include psychological trauma resulting from illegal activity. Just be very, very specific without revealing anything but the essentials for the hospital staff. From there on, it's in their court.
And on a more practical note; once you document or pull a cop into things other than good patient care, you can count on spending a certain chunk of your future being part of the CASE as well as the CALL! It's your choice.
As always awesome post, but I would just like to expand one thing about what you and reaper said.
Patients not talking to you or not calling you is not a good thing, but even worse is when they start seeing you as the one who always rats them out to the cops they may decide you are responsible for thier jail time or that of a loved one, or the confiscation of the drug money they need to pay their supplier, and then they may come looking for you.
As well, it puts every other medic on the streets at risk, because they identify the uniform, not the overzealousness of individual providers.
From the legal perspective maybe EMSlaw could chime in, but if I gave you medical information in confidentiality and you "hinted" to the cops or didn't ensure my reasonable confidentiality. I would sue the crap out of you for real damages and the attorney fees to defend myself, and any other losses I incurred, like loss of time at work, job, etc.
You would certainly not find many providers to testify on your behalf in court they do the same thing.
We are here to help patients, not enforce laws.
"Officer Krupke, what gave you the idea the defendant was a drug user?"
"The EMS worker hinted I should perform some tests."
"So prior to the breach of internationally accepted medical confidentiality over hundreds of years, you had no reasonable suspicion to use your powers of search or to obtain a warrent from a judge?
You see where that goes horribly wrong in a suppression of evidence sort of way?
I almost forgot, before you started questioning them on their medical history, did you inform them of their right to remain silent among other miranda rights?
There are more laws and rights people have than just what is seen on the street.
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brentoli
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4th Amendment - It guides the police in evidence gathering
Of course there are thousands of pages of case law that examines every letter, comma, and period of this paragraph.
I can tell you though, no case law is established that allows medical information, of the type we are discussing, to be given to an officer with out a warrant. An officer worth his weight in brass will be able to establish the appropriate PC needed to request an intoxalizer/blood draw from a person.
Of course there are thousands of pages of case law that examines every letter, comma, and period of this paragraph.
I can tell you though, no case law is established that allows medical information, of the type we are discussing, to be given to an officer with out a warrant. An officer worth his weight in brass will be able to establish the appropriate PC needed to request an intoxalizer/blood draw from a person.
Shishkabob
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Just as an FYI--- unreasonable search and seizure only pertains to law enforcement, not to civilians.
Okay, I get it that we're bound to HIPPA, and that suggesting anything to LE can create a loophole that gets the charges dismissed.
I see drunk driving like I see speeding. How many times do you speed before getting caught? I suspect it's the same for driving under the influence. I've had two relatives killed by drunk drivers, I know a good many more through friends and acquaintences that have been permanently injured. I've seen more than my share of MVC fatalities on the job where alcohol is was a contributing factor. Our pt confidentiality mandate is protecting the pt from the law and enabling that behavior, when you think about it. I know we can't hint that the pt might be drunk, but I don't see anything wrong with informing the LEO that we can't divulge pt information, but that a blood draw at the hospital would give them defintive proof of intox, or perhaps to clear them. That way, you're not suggesting guilt, merely that the test will either clear them or help to convict them.
I see drunk driving like I see speeding. How many times do you speed before getting caught? I suspect it's the same for driving under the influence. I've had two relatives killed by drunk drivers, I know a good many more through friends and acquaintences that have been permanently injured. I've seen more than my share of MVC fatalities on the job where alcohol is was a contributing factor. Our pt confidentiality mandate is protecting the pt from the law and enabling that behavior, when you think about it. I know we can't hint that the pt might be drunk, but I don't see anything wrong with informing the LEO that we can't divulge pt information, but that a blood draw at the hospital would give them defintive proof of intox, or perhaps to clear them. That way, you're not suggesting guilt, merely that the test will either clear them or help to convict them.
Not at all trying to be inflammatory, but are you really advocating subversion of the protections afforded by law because of a personal agenda based on emotion?
Devil's advocate:
The "protections of law" are already relaxed in some cases where there is a compelling public interest in physician/provider disclosure of otherwise confidential information. In the US required disclosures may differ state to states, but most states at least require notification of law enforcement of gunshot or knife wounds, some infectious diseases, etc.
Legal exemptions to confidentially are really based on an ethical weighing of the interests of one (the patient) against the interests of society at large. Medical providers in general buy into that sort of ethical balancing act, as evidenced by obedience with laws requiring disclosure.
If medical ethics truly forbade any and all disclosure without regard to impacts on society at large, it would be unethical to disclose even "mandated reporting" information and physicians would be obligated to refuse to comply with such laws. Instead it seems like commonly accepted medical ethics embraces a balancing between individual and societal interests.
Given the acceptance of a balancing act, it seems a lot less radical to suggest that society's interest in keeping a dangerous driver off the road might outweigh the patients ability to unencumbered communication and care, especially when they are seeking care for injuries sustained as a result of their choice to be a drunken fool and get behind the wheel.
The proximity of the threat to others is certianly a part of the balancing act, and I think it is a key part of the equation here. There seems to be little dispute over the duty to report presumed anthrax exposure, on the presumption that there is a current, severe, and active threat to society. By contrast, I think few would argue that it is acceptable to disclose that Mr. executive with chest pain is under a lot of stress because he cheats on his taxes and feels guilty. Perhaps this issue of a drunk driver is more of a gray zone?
As a side note, it is interesting that while medical ethics would be expected to remain constant regardless of location, providers are perfectly willing to adapt their ethics to local laws. Laws requiring breach of confidentially differ state by state (Hawaii, for instance, apparently has unique reporting laws that have a greatly expanded list of required disclosures including things like injuries caused by MVA's). Providers seem to have no problem bending their ethical obligations to match with legal obligations, and thus avoid personal unpleasantness. Fighting the law is not fun, and it seems that many providers are perfectly willing to compromise their (supposedly inviolable) ethics to avoid such a conflict. Where is the line drawn?
The "protections of law" are already relaxed in some cases where there is a compelling public interest in physician/provider disclosure of otherwise confidential information. In the US required disclosures may differ state to states, but most states at least require notification of law enforcement of gunshot or knife wounds, some infectious diseases, etc.
Legal exemptions to confidentially are really based on an ethical weighing of the interests of one (the patient) against the interests of society at large. Medical providers in general buy into that sort of ethical balancing act, as evidenced by obedience with laws requiring disclosure.
If medical ethics truly forbade any and all disclosure without regard to impacts on society at large, it would be unethical to disclose even "mandated reporting" information and physicians would be obligated to refuse to comply with such laws. Instead it seems like commonly accepted medical ethics embraces a balancing between individual and societal interests.
Given the acceptance of a balancing act, it seems a lot less radical to suggest that society's interest in keeping a dangerous driver off the road might outweigh the patients ability to unencumbered communication and care, especially when they are seeking care for injuries sustained as a result of their choice to be a drunken fool and get behind the wheel.
The proximity of the threat to others is certianly a part of the balancing act, and I think it is a key part of the equation here. There seems to be little dispute over the duty to report presumed anthrax exposure, on the presumption that there is a current, severe, and active threat to society. By contrast, I think few would argue that it is acceptable to disclose that Mr. executive with chest pain is under a lot of stress because he cheats on his taxes and feels guilty. Perhaps this issue of a drunk driver is more of a gray zone?
As a side note, it is interesting that while medical ethics would be expected to remain constant regardless of location, providers are perfectly willing to adapt their ethics to local laws. Laws requiring breach of confidentially differ state by state (Hawaii, for instance, apparently has unique reporting laws that have a greatly expanded list of required disclosures including things like injuries caused by MVA's). Providers seem to have no problem bending their ethical obligations to match with legal obligations, and thus avoid personal unpleasantness. Fighting the law is not fun, and it seems that many providers are perfectly willing to compromise their (supposedly inviolable) ethics to avoid such a conflict. Where is the line drawn?
AnthonyM83
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In general, law enforcement responds to accidents with injuries. This is usually a non-issue. They'll often know before you do that the patient is drunk.
Legal in what sense? Do you mean in the context of the criminal law, and whether the information will be usable in court? Do you mean "will I lose my license if I do this?" Those questions may or may not yield different answers, and may also yield a different answer than the question, "Is it ethical for me to do this?"
The answer to the first two questions will be widely variable as a matter of state law. For example, it depends on whether the state in question has a physician-patient privilege, or something wider (a "medical practitioner" privilege), and what the exceptions to that privilege are. I would say as a general rule that as an EMT, you could be compelled to testify, either in court or at deposition, about what you observed and were told (Incidentally, for those keeping score at home, statements made for the purposes of medical treatment are not hearsay. Fed. R. Evid. 803). If you were called to testify, I'd suggest you discuss the matter with your employer's attorney, who will probably know or easily find out your state's law on the matter.
Your state might also have a statute or regulation regarding medical information. Again, you'd have to find out what your law is. That impacts the "lose your license" question, though I think under the circumstances you've described, that's unlikely.
Now, the "should you" ethical question is, I think, the easier one. In my opinion, you absolutely should not discuss this information in the usual course. Going back as far as Hippocrates it has been the practice of the medical profession not to discuss what is learned from patients. If you are compelled to, then of course, you should do what the law requires, but I certainly wouldn't rush out to volunteer the information.
However, I would record the information on the run sheet or PCR, because it is highly relevant to the patient's condition. And it is likely that if they really want it, the police, prosecutor, attorneys, and soforth will be able to obtain that report. In essence, this is a reason NOT to go off 'tattling' - the authorities have plenty of ways to get the information without the need for you to tell them.
The answer to the first two questions will be widely variable as a matter of state law. For example, it depends on whether the state in question has a physician-patient privilege, or something wider (a "medical practitioner" privilege), and what the exceptions to that privilege are. I would say as a general rule that as an EMT, you could be compelled to testify, either in court or at deposition, about what you observed and were told (Incidentally, for those keeping score at home, statements made for the purposes of medical treatment are not hearsay. Fed. R. Evid. 803). If you were called to testify, I'd suggest you discuss the matter with your employer's attorney, who will probably know or easily find out your state's law on the matter.
Your state might also have a statute or regulation regarding medical information. Again, you'd have to find out what your law is. That impacts the "lose your license" question, though I think under the circumstances you've described, that's unlikely.
Now, the "should you" ethical question is, I think, the easier one. In my opinion, you absolutely should not discuss this information in the usual course. Going back as far as Hippocrates it has been the practice of the medical profession not to discuss what is learned from patients. If you are compelled to, then of course, you should do what the law requires, but I certainly wouldn't rush out to volunteer the information.
However, I would record the information on the run sheet or PCR, because it is highly relevant to the patient's condition. And it is likely that if they really want it, the police, prosecutor, attorneys, and soforth will be able to obtain that report. In essence, this is a reason NOT to go off 'tattling' - the authorities have plenty of ways to get the information without the need for you to tell them.