Dear All
I know that this is not an acaedemic issue so forgive me if you think I am
out of order in posting this to you.
There was an editorial in yesterday's Telegraph which I believe undermines
the integrity of all who work in A&E including paramedics who work so hard
in the field to bring patients to us. My secretary has kindly typed the
editorial out in full so that those of you who missed yesterday's paper may
have an opportunity of seeing it in full:
Vampire powers
The state sucking your blood is normally a metaphor applied to excessive tax
regimes. Now it's for real. As of yesterday, under the new Police Reform
Act, doctors can take blood from incapacitated drivers without their consent
if asked to do so by the police. Doctors attending the scene of a car crash
may now be more interested in convicting you for drink-driving than trying
to save your life.
Even the doctors are worried. All that is needed to force blood from
someone's veins is the untrained opinion of a policeman that a suspected
drink-driver is either unconscious or incapable of fully understanding a
request to take blood. The BMA is extremely concerned that the police have
received no guidance or training in how to assess capacity. It is perfectly
possible that an injured or shocked patient will express clear opposition to
having blood taken, albeit in an agitated way, and a policeman can use that
agitation to justify sticking a needle in his arm.
There are some supposed safeguards. The blood sample can be tested only at
a later date, when the patient has given his consent. And the medical
guidance for the procedure demands that collection of the blood samples must
not prejudice the proper care and treatment of the patient. But who can
ever be sure that the seconds spent taking blood might not be better spent
looking after a patient than trying to work out how much he's had to drink
that evening? There can be no guarantee that there will never be a conflict
between the officious policeman, desperate for his phial of blood, and the
ambulance driver who wants to get the patient to hospital.
A doctor has, quite understandably, always been able to take a blood sample
without a patient's consent in order to do some good to him - say, to work
out his blood group before a transfusion. It is putting doctors into a
difficult position - and ptients into a possibly dangerous one - to allow a
procedure that could not only bring a criminal conviction, but also hinder
medical attention. Hippocrates would not have been pleased.
PAUL'S RESPONSE
I am intending to send a letter of reply to the Editor for publication a
copy of which is laid out below:
If any of you feel the same way about this and wish to add your name to my
letter please respond with your full name, position and any qualifications
you may wish me to include.
Sir,
The suggestion that doctors attending the scene of a car crash may now be
more interested in convicting you for drink-driving than trying to save your
life (editorial Oct.2) gravely underminds the integrity of doctors, nurses
and paramedics in the front line specialties caring for victims of road
traffic accidents. It has never been the case that the collection of
forensic evidence of any description has taken precedence over the care of
an injured person. The Police Reform Act now allows for a blood sample to
be taken from a patient who is incapable of giving consent. Thereby closing
a loophole in the law which has in the past allowed drivers who have caused
accidents whilst under the influence of alcohol to escape conviction. It is
important that the collection of the blood sample is taken by a police
surgeon in exactly the same way as it would from a person capable of giving
consent. This is essential in order that the Courts can rely on the sample
and to avoid any potential conflict of interest between the patient and the
emergency services caring for them. Doctors still have the right to refuse
the police surgeon access to the patient if they do indeed believe that the
circumstances would prejudice care and the public must understand that this
right will be exercised if the circumstances are appropriate. The emergency
services have always treated accident victims without discrimination and to
suggest that this might change prejudices the confidence that the public
have in those who take great care in looking after them.
Mr P A W Howarth MBBS FRCS FFAEM PGCE
Consultant in Accident & Emergency Medicine
Royal Cornwall Hospital, Truro
Mr JP Wyatt MB ChB, B Med Sci, FRCS, FFAEM, MD
Consultant in Accident & Emergency Medicine
Royal Cornwall Hospital, Truro
Obviously, if you disagree with me I would be happy to hear from you.
Paul
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