Hi to All,
First time I make a comment in this list. First I work in Venezuela and
always  been interested on how other colleagues resolve their "medical
situations in A&E".
Mainly the reason of my "interference" is about your rape policy/police
comments.
1. Is a very logical statement to keep silence on behalf the patient privacy
& religious believes/culture
2. Is a very logical statement to call the police because the rapper is a
peril to the community/family.

Just last week I read a email from a 23 years old Argentinean woman that
kill her babygirl just after the birth. The background was that the
stepfather did rape her several times. Now she faces  20 to 30 years of
imprisonment. A low family income, functional illiteracy, dropout of school,
etc. All are ¿excuses? pardon, reasons for light up her sentences. Why or
how the problem got that far? Very difficult to explain,,,

But going back to your young victim. Is she (or any) in her right mind would
let a perpetrator on the lose?
Was she raise in the UK or is she a new comer? and Does she not live in the
UK, in both cases. Even if she comes from a rigid alien culture for western
standards she must comply to UK laws and ways of life. What would you do if
the person is raped again? I believe she is asking for help and she is very
scare.
Don´t let the perpetrator lose confidentiality will only let him free.
Confidentiality is not for public crimes.
Best regards and forgive my english sintax
Manuel Sotelo




Sorry Jeremy, I'm not saying that the Police should not be informed but that
you must do everything in your power to encourage the woman to consent to
this, and you do not inform them until she does. Use the arguments you have
for me on her, but she must agree. I did this with the GP's wife and she did
agree to see a Police woman at a neutral location and gave a statement. She
did nothing for a couple of weeks and then decided to take it to Court. The
OOH service records were kept separately in a sealed envelope in the Medical
Directors safe - and even he didn't know the identity of the GP until the
records were properly requested by her Solicitor.

Now the question of the person who kills their terminally ill relative is
much the same, only it is your patient who is the perpetrator. I have taken
a patient up to the Police Station and been beside them whilst they have
confessed to a crime. Handing yourself in has a powerful effect on the
sentence and your patient should be given every opportunity to avail
themselves of that. The difference is that the patient cannot be left
unaware that you will report the crime if they do not.

Surely the duty of the doctor is always primarily to the patient, and we
should enable them, not force them. As the International Conference of
Islamic Doctors stated "The doctor is an instrument of God's Mercy and not
of his Justice"

Vic Calland

-----Original Message-----
From: Accident and Emergency Academic List
[mailto:[log in to unmask]] On Behalf Of Jeremy Mayhew
Sent: 19 June 2005 20:30
To: [log in to unmask]
Subject: Re: Rape & confidentiality & ED vs GP

I disagree with you Vic, your intentions are correct but informing the
Police protects the public from the perpetrator (alleged) which is arguably
more significant than the woman from the inconvenience of Police interviews.

Informing the Police in no way commits a person to court and cross
examination. If she refuses to support the prosecution, it will be unlikely
to reach court. As you know I do a lot of forensic work, and would argue
that by contacting the Police you will be giving this lady access to
specialist forensic medical teams which may include forensic gynaecologists
but more frequently forensic physicians, and depending on locality
counselling/ victim support and an appointment for STDs, screening and post
coital contraception plus consideration of PEP.

In fact if she doesn't need PEP, it may be more satisfactory to refer to
Police (with consent) immediately and make no attempt to examine her for
fear of contamination and weakening forensic evidence.

What you are dealing with is handling disclosure of a vulnerable adult and
she may never try to disclose again if we screw up!! Remember rape is
punishable by life imprisonment for a reason, it's the same sentence as
murder - would you hesitate reporting a distressed daughter who confides
that she has just smothered her elderly aunt at home, whom you knew to be
living in pain from terminal cancer...

Don't let another Ian Huntley loose on our society. Imagine if this victim
was just the tip of the iceberg, the police could be alerted to a
psychopath, even if on this occasion they were unable to prosecute. Don't
assume the police will handle it very badly and the whole thing will be
awful and do talk to your MDO!!

Best wishes

Jeremy

-----Original Message-----
From: Accident and Emergency Academic List
[mailto:[log in to unmask]] On Behalf Of Vic
Sent: 19 June 2005 20:00
To: [log in to unmask]
Subject: Re: Rape & confidentiality & ED vs GP

You think Nitroprusside will work!

I'm sorry but I disagree with informing the Police without her consent. The
woman has just had her privacy and autonomy violated by one man and you have
the arrogance and audacity to think you have the right to do it a second
time?

You MUST let her decide whether she wants to face humiliation of a cross
examination in Court, and you have NO right to initiate the pressures that
will be applied by the Police if she does not want to press charges.

She has to make the right decision and she needs the handling that persuades
people to make painful decisions all professional people have to use. That
she will need time to make that decision, we are all, thank God, in
agreement over

Vic Calland

(I would have preferred an oral beta blocker to a Nitroprusside infusion..)

-----Original Message-----
From: Accident and Emergency Academic List
[mailto:[log in to unmask]] On Behalf Of Simon Odum
Sent: 19 June 2005 09:22
To: [log in to unmask]
Subject: Re: Rape & confidentiality & ED vs GP

You're a very sensible doc, Jel!

Seriously though - if we leave Vic on the Nitroprusside infusion for a few
days - as I understand the GMC guidelines we have a duty to report violent
crime if we feel there is a risk to the public.

Just after yesterday's posts I was talking to a barrister about this, and
her reply was very interesting. Apparently a senior judge has recently
incensed the Bar by stating that rape is not a violent crime. Maybe an
altered guideline is in the offing to specifically cover such offences.
However the "cry for help" theme is what my barrister friend seized on. The
Asian communuity see us as responsible professionals (if only they could see
this list sometimes!) and this lady could easily have been asking us to call
the police for her, even if she didn't say so in so many words. Having had
my conversation with my friend, I have to backtrack now and say that I very
likely WOULD call the police in future if this kind of case arises. Maybe
that is because I now feel on firmer legal ground, but I will still be
cautious.

Still entails spending 2-3 hours with the patient though. Don't have a
problem with that. Just the state of the ED when I get back out on the shop
floor, as Peter was saying earlier.

Simon