Ethical Dilemma

  1. I recently took care of a pt for several months who was a known drug dealer and pimp. It is suspected that this patient was conducting " business" from his hospital bed, making arrangements via visitors and telephone calls. However, none of the staff had any real proof. The pt has since passed away but for future reference, I want to know: What is the nurse's responsibility when a pt is suspected of conducting criminal activity while an inpatient? Do we advocate for the pt as a nurse or do we advocate for ourselves as private citizens?
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  2. 11 Comments

  3. by   e-nurse
    Get the social worker involved.
  4. by   NurseJacqui
    Since the criminal activity is only a suspicion...are there any legal ramifications for the nurse reporting it, if her suspicions turn out to be unfounded? I know that a nurse by law is required to report suspected elder or child abuse but I am unclear about anything else. This patient would have several visitors who were also known prostitutes and drug dealers/addicts. The patient would often close the door when his visitors were present and refuse any interruption by medical staff while these visitors were present. Later the medical staff would have to be at his beck and call when he decided he wanted his meds, resp. tx, bloodwork,etc. Where do the patient's rights end and the rights of the medical staff as private citizens begin?
  5. by   Agnus
    IMHO only, I believe that as Citizens we have an obligation to report suspected criminal activity to the police.

    I do not believe that we as citizens nor nurses are required to investigate nor provide proof before reporting this. That is what the police and District Attorney are for, I thought.

    I do not see how there can be any legal ramifications for reporting our suspicions and observations. I believe that sometimes we might be asked to assist in an investigation after reporting something, but I don't think we are obligated to assist especially it our part in the investigation will put us at risk.

    A hospital is either private property or (if government owned) state, county or federal property (depending on which gov entity owns it.
    We have a right to not have criminal activity being committed on our property or on (our) gov. property. The hospital may not belong to me personally but I represent the hospital and there foe the as a rep of the hospital I have a right and responsiblity to protect it.

    If I thought some criminal activity was taking place on MY private property or on my private business property you can bet I would report it to law enforcement. I am entitled to reasonable protection and freedom from criminal activity.

    I do not understand where advocating for the patient comes into the picture here. What is it you want to advocate for?

    Second when a patient is admitted to a hospital it is implied that he will comply with the rules of the institution and that he understands that this is not the Hilton, and the focus is on medical treatment not luxuary hotel service. Natuarally we try to accomodate all patients as much as possible however it needs to be understood that does not go to the point that it disrupts work or care of other patients.

    I believe this issure harms more than just the nurse as a private citizen, it harms the hospital as well. Imagine if it got out that there was this sort of thing going on at XYZ Hospital. The hospital's reputation would be harmed. The hospital would be up for investigation for allowing it to go on without reporting it. The hospital could be implicated in supporting this activity. It also makes the hospital vulnerable to more criminal activity takeing place there. It becomes an easy mark. Even if no crime took place, because it is now understood that the hospital does not report it's susupicions.

    Sounds to me like someone really slipped on on this one. It sounds like folks were intimidated by this patient. To the point that they were blinded by the fact that the hospital had power in this situation. The power of the hospital was turned over to this patient.

    I know if a cop or DA comes and demands information without following proper procedures or without a warrent that we as nurses cant just give it to them. This is not that situation. THis is a situation where we are reporting a suspected crime.

    If there were a guest in my home I would try to protect their privavcy. If I suspect they were commiting a crime in my home I think my rights as a home owner then take presidence.

    If this were an employee I bet no one would hesitate to report thier suspicions to the police. This is no different.

    He was allowed to get away with what he did because folks did not understand thier rights, the rights of the hospital, the law, nor that the hospital and nurses had the right to expect the visitors andpatient to abide by the rules and proceedures of the institution
    Last edit by Agnus on May 31, '03
  6. by   gwenith
    Hmmmm I personally would have called crimestoppers or even just dropped into my local police station and had a quiet word with a cop - not an officail complaint - just a quiet word and asked him/her what tehy thought your responsibilities might be. Remember that cops are also people and he/she might very well tell you that there is nothing you can or could do. Police TV shows aside I doubt that they would push you to do more than dsicuss the matter with them.

    The best thing to do would be to diary everything - includign visitors and descriptions and later hand THAT over to police. It is not "solid" evidence but you never know where it might fit in a chain of incrimination. After that it becomes NMP - not my problem - your conscience is salved - the only problem would be invasion of privacy by letting the polce know the person was on your ward and without reading your privacy laws I cannot judge that.

    Possibly I am being too radical but I sincerely and honestly HATE HATE HATE drug pushers and drug dealers.
  7. by   Agnus
    I understand what you mean about revealing the patient identity. This is not necessary initally. Again IMHO. you could say this is what you have seen and this is what you have observed and that you believe or know (if the case) this person is a known dealer/pimp. Witout giving identifying info

    Have we forgotten that every hospital has a legal department that should be consulted so that the method of reporting does not violate anyone's rights?

    In all this I am expressing only my opinion. Maybe I am way off on all this but it just seems reasonable to me that the employees are entitled to a safe crime free work enviorment and the hospital has a right to protect it self from criminal activity takeing place on its property.
  8. by   Agnus
    When it come to a violation of law I do not see a delima.

    If you suspected your neghbor was engaging in this activity would you be concerned about his rights to privacy as a citizen?

    My understanding of an ethical delima is where there are only two choice and both are equally harmful.
  9. by   jadednurse
    Some excellent points made here already. I would also add: Could you be jeopardizing the welfare of other patients, staff and visitors by NOT reporting this alleged activity?
  10. by   nowplayingEDRN
    I think, and this is just MHO, that the ethical dilema proposed in this post was giving a tip to the law enforcement with out revealing the identity of the patient....a protection of privacy act type of dilema. And I would first speak with my Nurse Manager and then go to the hospital's legal department and discuss my concerns with them. Terra, ty for an excellent and thought provoking post.

    Christie
  11. by   nursenatalie
    OK, this is my opinion, and just the way I feel. Unless you had hardcore evidence that this person was doing something illegal from his hospital room, you dont say anything. Your suspicion could be somewhat bias. If you had evidence enough to tell the police more than, "I think he is doing something illegal because I saw or heard this..." then by all means do so. This is my opinion related to reporting ONLY this type of illegal offense so please dont start telling me that I am saying I should wait for hardcore evidence of abuse etc...my opinion applies only to the aforementioned scenario! Definately one to send to the ethics committee at the hospital, perhaps see if other staff see the same things you do...
  12. by   oramar
    Sorry, I would just tell the manager about my suspicions and let it go at that. It would be up to them to do something. It would be different if I saw something for sure. I know people who are a little paranoid and strange and act just like this person but are not involved in drugs. That business about keeping records about comings and going sounds like invasion of privacy to me.
  13. by   traumaRUs
    I work in the ER, not on the floors. However, when we have criminal activity occurring (definitely occurring, not just something that we think is happening), the cops are just a phone call away. In Illinois it is a felony to hit, spit, kick or otherwise assault any healthcare worker, in hospital or pre-hospital. 100% of the time, we prosecute. We also call the cops when we find knives (not pocket knives of course), guns, drugs, drug paraphanalia, etc.. We do have the right to a crime-free work place.

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