An ethical question.

[workingforskies]

I work alongside this nurse in a 2 RN ER and to my eyes, she is one of the worst gossips I have ever met. I tolerate her because I have to if I want to continue working here. (And all in all, I really like where I am working so it is usually no big deal.) But a few days ago, I think she really crossed a line and it has stuck in my craw since then. I really want to call her out on it to the point that I want to report her to the state for violation of confidentiality.

A woman came to our ER via EMS who was the sole person in a one car MVA. She had bumps and bruises and a minor head lac. The attending MD ordered his routine labs, among them, an ETOH level. Her ETOH level came back at roughly twice the legal limit.

A police officer was in the ER doing the accident paperwork. As he was leaving, my 'partner' asked him about what he was going to do about her blood alcohol level. His reply was, "What do you mean?" She told him that her B.A.L. was 0.15. His reply was, "Well I guess I am going to have to arrest her for D.U.I. " Upon hearing that, I was absolutely flabbergasted.

I have always felt that as a nurse, my prime role is to be a patient advocate. In NO WAY do I see my role as an agent of the state. Unless I have objective evidence that a patient intends harm, or is a potential threat to themselves or others, any circumstance that brings them to my care is irrelevant and nobody's business save for those directly involved in their care. In that light, I just can't believe what that nurse did to her. I am so upset about this. That nurse could very well have ruined that woman's life from a legal perspective. At the very least, it will cost her about $5,000. How is that being a patient advocate?

Thoughts? Opinions?

[TazziRN, RN]

Varies from state to state. In CA we cannot release that info because it is a part of the pt's chart. Can't be released without the pt's signed permission. If she had come into my ER by private vehicle after an MVA, I would have been legally obligated to call and report the accident itself so that an officer could take a report, but I could not have said "And she's drunk," no matter what my feelings were about the situation. By the same token, if I have a pt who is obviously under the influence, or whose tox screen came back positive, I cannot call the police about it.

As for the pt mentioned by the OP, if she was that intoxicated the officer should have been able to smell the alcohol and should have followed his procedures to obtain a legal BA.

[mariedoreen]

I think it comes down to this: if you're mandated by state law to report the BAC then you should. If you're not, then you should not reveal this information without the patient's express permission... as this is part of their medical record and protected unless ordered revealed by a court of law.

This is a question that should be brought up with your supervisors for future reference. You're emergency room RNs, you will probably deal with this situation often, and you should know the proper way to handle it. You are correct that it should not be an arbitrary I think I'll do it this way this time... and a different way another time... type of thing. There should be a clear cut policy.

I think it's an 'ethical dilemma' easily solved by reviewing and comparing state statutes and HIPAA laws.

[control]

I believe the elements required to breech patient confidentiality are this: if the patient is an imminent danger to himself or others. This would preclude a past danger. I have to admit I'm quite surprised that many think it's appropriate to report this to law inforcement. We are not extensions of the police in the ER. That said, there are laws in place that we all know about - the requirement to report gun shot victims comes to mind. But an instance of an adult with a high BAL? I guess what I am getting at is if the law in my state required me to report this high BAL patient - I would without hesitation - it's the law. But if the law didn't require me to report it, I absolutely would not. It is not my job to rat out my patient to the police and I'm not doing it unless the law mandates it.

In total agreement with you. If it's not legally mandated, I'm pretty sure that was a HIPPAA violation at least.

[control]

The emotional side of me agrees whole-heartedly with the above statement. But the logical side of me says that I am the patient's nurse. I am the patient's advocate. It is stepping out of my role to advocate for the public at large. If the police investigating the accident wish to - they can subpeana the medical records and find out the BAL. That is their job.

This is just such a slippery slope. But just because this person was drunk driving this one time does not mean they will again. (Yes I have a hard time saying this, but it is true.) I just think it's too speculative to say that reporting is required to ensure future public safety, even though the danger really bothers me. I guess this issue does not meet the 'imminent danger' threshold in my thinking.

in total agreement again, especially that in bold.

[PANurseRN1]

If you're legally obligated to report, then you should report. If not, you could be violating HIPAA.

[tencat]

Was she a treat and release? It sounds like she was. If she was, and she was drunk, how was she going to get home? Drive? (provided her car was in driveable shape) If I'm being her advocate as a nurse, am I really helping her by letting her get home by herself in a drunken state? Just a thought.

[FroggysMom]

I would say that driving at twice the legal BAC is a potential threat to others, no?

So it's going to cost her money. Big boo-hoo. Maybe there's someone out there who won't be killed or crippled from her drunken driving.

No burn intended Hunter, but it was ironic to read your reply to this post and then look at your signature line.

Now, in response to the question at hand, I think much will depend on the laws in your state. This is, like for for many others, one that rubs me both ways. It would be interesting if this case gets to court - say should a lawyer question as to how the police came about getting the evidence of her BAL in the first place. There will be quite a few very uncomfortable people over that one, until a judge resolves it. Her charges could be thrown out of court, or if not, the hospital (and your co-worker) could be sued should her attorney find out how the evidence came to be discovered.

Whether we think something is right, not right, fair or not, the law works in pretty weird ways and not always predictable, especially where juries are concerned.

[ZASHAGALKA, RN]

No burn intended Hunter, but it was ironic to read your reply to this post and then look at your signature line.

Now, in response to the question at hand, I think much will depend on the laws in your state. This is, like for for many others, one that rubs me both ways. It would be interesting if this case gets to court - say should a lawyer question as to how the police came about getting the evidence of her BAL in the first place. There will be quite a few very uncomfortable people over that one, until a judge resolves it. Her charges could be thrown out of court, or if not, the hospital (and your co-worker) could be sued should her attorney find out how the evidence came to be discovered.

Whether we think something is right, not right, fair or not, the law works in pretty weird ways and not always predictable, especially where juries are concerned.

Regarding your quote S'quatch, I don't think they DID always work for Hunter Thompson, at least not at the end. . .

Regarding this thread: I worked in an ED and the officers there usually were well aware of which BALs to subpoena. I disagree with the above scenario: the officer would state that he had suspicions and obtained the record as a result - end of story.

I'm sorry, I'm not a lawyer - it's simply not my job to put the community's ethics aside in favor of a drunk; a potential killer. I think a drunk driver - one that just almost killed themselves in that fashion - IS an immediate threat to themselves or others. I quess we can just quibble about the meaning of "imminent".

I would define it as somebody whose course of conduct, without immediate intervention, could reasonably be expected to cause potential harm to self or others. And I would say that this fits the bill. In fact, I have said as much, more than once. And would again.

~faith,

Timothy.

[Jolie, BSN]

Pehaps it might help to think about it this way...

Why not be an advocate for the innocent people who may get permanently injurred, killed or lose loved ones should this woman not learn her lesson and get away with this because she has not been penalized.

I don't mean to sound overly harsh or uncaring, but my answer is this: Because those people are not my patients. This woman is.

If a police officer were to make a formal request for patient information as part of an official accident investigation, then by all means, provide it within the scope of the law. But to tap the cop on the shoulder and say, "Hey, look at this!" is completely inappropriate, and probably a HIPAA violation.

[SuesquatchRN, BSN, RN]

No burn intended Hunter, but it was ironic to read your reply to this post and then look at your signature line.

Heh. I believe that adults shold be able to put whatever they want into their bodies - but not then get into a lethal weapon and drive it around. My liberties end where your rights are endangered. One of those rights is to live unmolested by my decisions.

:)

[FroggysMom]

Interesting case in Illinois - in favor of reporting. http://www.state.il.us/court/Opinions/AppellateCourt/2000/2ndDistrict/February/HTML/2981489.htm

[PANurseRN1]

I don't recall reading anyone saying they'd let the pt. get back into her car and drive home while still intoxicated. We routinely held pts. in the ED until they sobered up; if they tried to leave AMA, we did indeed call the police. But we did not call the police every time someone came in under the influence.