Thank you for your comments and support.  My letter is being published in
the Telegraph tomorow but only with my name on it because the Telegraph are
too mean to use space to list everybodys name to it.

Paul

-----Original Message-----
From: Stephen Hughes [mailto:[log in to unmask]]
Sent: Thursday, October 03, 2002 19:34
To: [log in to unmask]
Subject: Re: An insult to A&E


In message <[log in to unmask]
nhs.uk>, Howarth, Paul - RCHT <[log in to unmask]> writes
>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
>
As I understand it, the test requires consent. This is with due regard
to the fact that failure to provide consent is equivalent to failure to
provide a sample.

I see no harm in taking blood from an incompetent patient. It is the
testing that requires consent. What I object to is sending that sample
to anywhere other than the hospital's own laboratory. The police should
apply to the lab for the sample, with the necessary consent from the
(hopefully recovered) patient.

A sample is normlly taken for blood glucose and that is the one that
alcohol is tested from. Let the police apply for that separately from
any A/E involvement.

--
Stephen Hughes SpR 'Arlow
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