Drugs, Law, Nursing Role

mandasueRN · Jul 11, 2008

Toxicology screens we do in the ED are not admissible in a court of law. They are only done so that we know if the patient is under the influence of any substances that might interfere with the care we would give--also, many providers would argue that ethanol levels or UDS (urine drug screens) are not even needed. The trauma attendings at the teachning facillity I work at actually have told us that they do not want us to order tox screens on trauma patients because they are ultimately not going to change patient care and you cannot bill insurance for them (at least that is what I was told). So if we have an ETOH level above the legal limit on a MVC driver or a patient pops positive for crack we are not going to call law enforcement about it. However, if an officer suspects a patient involved in an MVC is under the influence and completes the proper paperwork , including in my state getting signed consent from the patient, blood ETOH levels will be drawn using a special kit that allows the chain of evidence to be complete--only then can it be used in court.

hope this helps.

freakjojo06 · Jul 11, 2008

In my own opinion as a student nurse also... well have to treat first the patient I guess before reporting it to the police... criminals, drug addicts are also human and they deserve to be treated the same as we treat those non-criminal individuals...

northshore08 · Jul 11, 2008

Being positive for any substances is not a reportable situation. Now getting shot or stabbed (altercations, not an attack of the bagel knife or frozen chicken) or bitten by an animal is reportable, as is anyone who comes to the ED for tx for MVC that has not been reported to law enforcement, if it occurred on public roadway.

Depending on the states, mandatory reporting includes domestic violence and abuse. (for those of you who think all domestic violence is mandatory reporting, not in Hawaii if the spouse does not want to press charges. Who knew?? In SC the officer will press the charges.)

If the law enforcement official wants to know about substances, they have to test separately (as said previously) so they can formally charge the person. :twocents:

Altra, BSN, RN · Jul 11, 2008

This varies considerably from state to state.

ETOH levels and tox screens are routinely ordered on most trauma patients where I work. It is relevant from a medical standpoint -- mental status, pain control, etc.

Law enforcement often sees evidence while they are at the scene that causes them to accompany/follow the patient to the hospital and go through the proper procedure to obtain blood and/or urine specimens. Alternatively, in my state they can later subpoena the medical record which will include those lab results. No, we do not call law enforcement as soon as we get a + ETOH result above the legal limit.

BrnEyedGirl, BSN, MSN, RN, APRN · Jul 11, 2008

I might also add,...not only do we not contact law enforcement about pos tox screens or high BAC's,...we can't,.it's against the law,.those lab results are part of the pt's medical record same as a CXR or CBC and are protected information!!! Just remember,.your are a nurse,.not a cop or an attorney,.let them do their jobs,..you are there to care for your pt!

needsmore$ · Jul 11, 2008

GREAT topic.

Here's a twist on it and I'd LOVE your input

Supposed pt arrives to ED under the influence -let's say alcohol- ETOH level- 280's

He's brought to the ED by friends/family who now have left. Pt now wants to leave. We know he is incapicitated- heavens he's falling down all over the place.

But he's REFUSING care. Where do we stand regarding this? Can we restrain him and provide csre even though he's cursing at us? Is he legally allowed to refuse care? Is he medically competent to make that decision?

This has been a very gray area for me-- what do you guys do and your rationale/ legal info to support your decisions would be great to know.

What I do-- tell the guy that 'Sure he could leave, but then the cops would be called, he'd be arrested for public drunkeness, and then he'd sleep it off in a drunk tank so why not stay here on our cozy stretcher, warm blankets, breakfast and THEN he can go home later'- it usually works - I've never called the cops but would I be covered if I did?

MassED, BSN, RN · Jul 11, 2008

Hello everyone! Please read this post and any/all responses are very much appreciated.
Let's say a patient comes into the ER that was just in a MVA. If the person tests positive for stimulants like cocaine... what is your next step as a nurse? I am a nursing student and I am confused on what the nurse's job would be in this situation. Do you contact the police only if the level of drugs in the blood stream is at a certain level? Or are you required to inform local law enforcement no matter the level? For example, I have seen patients in the hospital who tested positive for like cocaine... but what happens to the patients? Do they get in trouble.. Or does HIPPA not let us inform law enforcement? Is there any kind of special documentation that the patient was on drugs in case there is a lawsuit?
Thank you so very much for your time!!

let physician handle the issue of substances on board and notifying authorities. I have seen some docs notify the police if substances are involved, then others who do not want to make things complicated. Not saying it's wrong or right. That is not something you are required to notify to law enforcement - not really sure it's the docs obligation either, actually. If law enforcement suspects illegal substances, then they have their procedures.

MassED, BSN, RN · Jul 11, 2008

GREAT topic.
Here's a twist on it and I'd LOVE your input
Supposed pt arrives to ED under the influence -let's say alcohol- ETOH level- 280's
He's brought to the ED by friends/family who now have left. Pt now wants to leave. We know he is incapicitated- heavens he's falling down all over the place.
But he's REFUSING care. Where do we stand regarding this? Can we restrain him and provide csre even though he's cursing at us? Is he legally allowed to refuse care? Is he medically competent to make that decision?
This has been a very gray area for me-- what do you guys do and your rationale/ legal info to support your decisions would be great to know.
What I do-- tell the guy that 'Sure he could leave, but then the cops would be called, he'd be arrested for public drunkeness, and then he'd sleep it off in a drunk tank so why not stay here on our cozy stretcher, warm blankets, breakfast and THEN he can go home later'- it usually works - I've never called the cops but would I be covered if I did?

if he is knowingly discharged and may walk into the street and be killed by a passing motorist, the ER doc who wrote the d/c orders could be held liable for discharging an intoxicating individual that is not responsible for themselves at that point. If the person is intoxicated, that's not a crime, but if they are sent home with a responsible person to care for them, that is ok and is usually the route to go.

LilgirlRN, ADN, RN · Jul 12, 2008

Even though you are a nursing student, I know you've heard of HIPPA. Your information is supposed to be safe, so why would we call the cops and divulge the info? I work in triage and everyday ask people if the smoke, drink or use drugs, why would they tell me anything if their info wasn't safe with me? the answer is they wouldn't.

Someone asked about patients that arrive under the influence and leave under the influence. Inour ER if we give someone medication that impedes their driving and then they "esape", we call the cops and tell them that someone has just left our ER under the influence. While we do this to protect the public, I am not sure it's legal. I don't do it, as said, I'm in triage.

Many times the authorities bring in patients for ETOH levels, drug screens etc. All that has to have a legal chain, meaning that we have document and seal it in front of the patient and each time it's handled it has to be documented etc.

Just to throw something else into the fire here... I work in Alabama, the age of medical consent here is 14, meaning that if you seek medical treatment and you're 13 you can't get it without a parent's signature and if you're 14 or older you don't have to have it..... Mom and Dad bring in little Johnny who is 15, they want him to have a drug screen. Little Johnny can refuse the drug screen if informed of his rights, do you inform him?