Vic,

i don't think that you are right in thinking that the police, once involved, will force this lady into the witness box. I seem to remember that 8 out of 10 cases of rape reported to the police do not result in a prosecution - usually due to the dynamics of the relationship between the victim and her/his assailant.

The whole police handing of sexual assault has been revolutionised in many areas of the UK - we in the ED have a duty to know our local system. Speaking to a police officer specialising in sexual assault is part of the process of clarifying the options for this patient.

It is not up to the victim to decide whether or not to "press charges" (I think this comes from american dramas)- in the UK this is a function of the CPS. However if the victim is unwilling to co-operate with the investigation there is almost no chance of building any sort of case to rpesent o the CPS, so the police will not waste their time taking it any further.

I think that the fact that she has come to the ED and disclosed the information (full marks to the SHO for creating the right atmosphere in the consultantion) probably means that she wants to resolve the situation. However our role should be to support her in her decision making and enpower her rather than to take it out of her hands. There is little urgency to the situation, and this complex situation may not be delt with in one ED visit, so involving primary care (with the patient's consent) may be important.

Tim. Coats.

-----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

-----Original Message-----
From: Accident and Emergency Academic List
[mailto:[log in to unmask]]On Behalf Of Peter Cutting
Sent: 17 June 2005 08:43
To: [log in to unmask]
Subject: Re: Rape & confidentiality & ED vs GP


Jel,
That fence must catch you in a very sensitive area from time to time though?
Peter

>>> [log in to unmask] 08:36:12 17/06/2005 >>>
Peter Cutting wrote:
> Thanks for all your thoughts.. I was particularly impressed by the GP vs
ED side spat.. always good for a giggle..

See me, my insurance category is GP with Emerg - because I work as both
an emerg doc and a GP - so I can choose to stand on whatever side of
whichever argument whenever I choose :) :)

(fortunately, no longer in the UK though)

Jel

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