Well we are not obliged to say who has been shot just that we have someone
who has been. They must still give consent. However we can break
confidentiality if we believe it to be in the public interest (which it is
likely to be), as is reporting the case of someone being stabbed. This is a
little long, but is the GMC FAQ
Reporting Gun Shot Wounds Guidance for Doctors in Accident and Emergency
Departments
September 2003
This guidance has been developed with the Association of Chief Police
Officers and is supported by the British Association of Accident and
Emergency Medicine.
Q1 Should all gun shot wounds be reported?
Yes, gun shot wounds are the result of a serious incident. The police should
be told whenever a person has arrived at a hospital with a gun shot wound.
At this stage identifying details, such as the patient's name and address,
should not usually be disclosed.
Q2 When should the police be informed?
As soon as possible. Quick reporting may help prevent further incidents or
harm to others. But the interests of the patient must always come first.
Q3 Who should contact the police?
The doctor with responsibility for the patient should ensure the police are
contacted. The doctor may delegate this task to any member of the A&E staff.
Q4 Why should the gun shot wounds be reported to the police?
The police are responsible for assessing the risk posed by members of the
public who are armed. They will want to consider:
. The risk of a further attack on the patient;
. Risks to staff, patients and visitors in the A&E Department or
hospital;
. Risk of further shooting near to, or at, the site of the original
incident.
Q5 What happens when the police arrive at the hospital?
The police will usually ask to see the patient.
The treatment and care of the patient is a doctor's first concern. Doctors
should not allow police access to the patient if this will delay or hamper
treatment or compromise the patient's recovery.
If patients' treatment and condition allow them to speak to the police, a
member of the health care team should ask patients whether they are willing
to do so, and if not explain what the consequences, if any, may be. The
health care team and the police must abide by the patient's decision.
Q6 What happens if the patient refuses to talk to the police, or the patient
is unconscious?
Patients have a right to expect that information about them will be held in
confidence by their doctors. This is an important element of a relationship
of trust between doctors and patients.
However, if the patient cannot give consent, or says 'no', information can
still be disclosed if there are grounds for believing that this is the
public interest or disclosure is required by law .
Disclosures in the public interest are justified where:
. A failure to disclose information would put the patient, or someone
else, at risk of death or serious harm.
. A disclosure may assist in the prevention, detection or prosecution
of a serious crime.
If there is any doubt about whether disclosure is justified, the decision to
disclose information without consent should be made by, or with the
agreement of, the consultant in charge, or the Trust's Caldicott Guardian.
Wherever practicable patients should be told that a disclosure will be or
has been made.
The reasons for disclosure should be recorded in the patient's notes.
Further guidance on disclosures in the public interest is available in our
booklet Confidentiality: Protecting and Providing Information.
What happens if there is no public interest justification for disclosure?
If there is no immediate public interest reason for disclosure, no further
information should be given to the police. The police may seek an order from
a judge for the disclosure of confidential documents, under the Police and
Criminal Evidence Act 1984 (Schedule 1). They can also use powers in S19 of
this Act to seize evidence, such as clothing, which may help in detecting or
prosecuting a crime.
Andy Webster
SPR in Emergency Medicine
Northern General Hospital
+447989587971
-----Original Message-----
From: Accident and Emergency Academic List
[mailto:[log in to unmask]] On Behalf Of Rowley Cottingham
Sent: 17 October 2004 21:30
To: [log in to unmask]
Subject: Re: Stabbings
The GMC notification in GSW is not something we can argue - we must
report all GSWs and will be in breach of the GMC regulations if we do
not. There is NO requirement formally to report any other assault or
injury except in the circumstances that were agreed between BAEM and
ACPO which I trust all emergency units abide by. These include breaking
patient confidentiality either by reporting an incident or giving
medical details against the patient's wishes in the greater public good,
and I would advise any doctor contemplating this to talk to their
medical director, Caldicott guardian and defence society before wilfully
doing so. Requests made under the Data Protection Act will not be
honoured - the officer must provide evidence that the information sought
is in the investigation of a serious arrestable offence.
The Consultant involved may make that disclosure after due
consideration.
It can thus be seen that the medical director of your Trust has
incorrectly interpreted the guidance, and you can perhaps assist in
redrafting it correctly.
Best wishes
Rowley.
-----Original Message-----
From: Accident and Emergency Academic List
[mailto:[log in to unmask]] On Behalf Of Rocky
Sent: 17 October 2004 13:42
To: [log in to unmask]
Subject: Re: Stabbings
I'm afraid I disagree here. If someone has been shot , it is almost
inevitably a deliberate act by someone else, or a self-inflicted suicide
attampt, pretty well invariably successful. Thus, there has been a
serious crime committed because virtually all GSWs are potentially life
or limb-threatening. In addition, handguns are illegal (apart from
under the most stringent conditions) so another crime has probably been
committed, by posession of the gun. Furthermore, shootings often happen
in the course of a robbery or another crime so there may be three
different crimes involved. I do not think there are any circumstances
when it is right to withold information from the police about GSWs. I
do not know of one single occasion in Belfast in the last thirty years
or so when the police were not involved and, in practice, they usually
know anyway. As far as stabbings go, I thnk a deliberate stabbing by
another person falls into the same category as GSWs. Again, in
practice, the police often know from someone else. I believe, if a
serious crime has been involved, the police have a right to know and we
have a duty to tell them. Stabbings are usually serious crimes. If the
wound is self-inflicted, I do not think we need to inform the police at
all unless the patient explicitly asks us to do this. So I do not think
there is any real difficulty here and I do not think there is any chance
that a court would find against a doctor who told the police about
either a GSW or a stabbing because they believed there had been a
criinal offence. Sorry for being long-winded. Cheers, Rocky.
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----- Original Message -----
From: "JONES Lewis, Locum Consultant - A&E"
<[log in to unmask]>
To: "Laurence Rocke" <[log in to unmask]>
Sent: Friday, October 15, 2004 3:22 PM
Subject: Re: Stabbings
I'm of the same opinion as Steve here if it is a murder / attempted
murder inquiry then the police will be involved as consent is not an
issue. If the "victim" is still able to give consent i.e. not dead or on
a ventilator then they have every right to withold their medical
information form the police. Lewis
-----Original Message-----
From: Accident and Emergency Academic List
[mailto:[log in to unmask]]On Behalf Of Steve Moore
Sent: 15 October 2004 15:14
To: [log in to unmask]
Subject: Re: Stabbings
Duty of a doctor is to maintain patient confidentiality isn't it? This
might be affected if you think the patient has committed a serious
arrestable offence, but sounds like this directive concerns the victim.
I guess the powers that be think this might help develop clues regarding
perpetrators and we all have sympathy with that but the principle
remains.
Would you tell the police about victims of domestic violence without
their consent? I would play this one with a straight bat.
--
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