Refusal for Blood Draw

[MikeyBSN]

We had a pt come in about a week ago who had been involved in an MVC. The pt was awake and oriented. The cops told us to draw blood for their kit but the pt refused to have their blood drawn. The cops told us if we didn't draw it they would charge use with obstruction of justice. Does anyone know how to approach this situation or what the correct couse of action would be? Thanks.

[Noryn]

Why don't they just take a urine sample? That would eliminate the wait for someone to draw the blood.

I dont know if a urine drug screen would hold up in court. There are too many variables involved along with false positives but when you are dealing with alcohol most laws specify a blood alcohol level as a sign of intoxication so it pretty much has to be blood drawn.

[clee1]

In some cases if the draw is done more than 3 hours after an incident it is inadmissable as evidence.

We all see the devastating effects of alcohol and driving. As nurses we should be willing to assist law enforcement to curb this problem. ER managers and law enforcement should work together to educate ER staff in their role.

Northernlights

Sorry, friend.

I went to school to be a nurse, the ethics of which require that I advocate for my patient.

It is NOT my job to gather evidence for the government; I don't work for them. If ever presented with a court order and the pt still refuses the draw, somebody else will have to obtain the specimen.

[hogan4736, BSN, RN]

...If a person is caught driving appearing obviously impaired, then they should be able to be tested for ETOH & drugs. If they haven't broken the law, then they have nothing to hide. If they have broken the law, then they need to get caught. Especially if they were involved in an accident.

If they turn out to be 'clean' and impaired, then the ER is where they need to be because something is definitely wrong with them.

tested by the POLICE dept that wants it...let them get a court order to draw against someone's will (be careful what you wish for when big brother is involved!)

determining impairment (field sobriety testing) is subjective...

innocent until proven guilty should be on everyones' minds...

bottom line, even if the pt appears drunk to me, if he refuses a blood draw, I will not draw it...

arrest me...

1) the DA will throw it out

2) I'll get paid for my remaining time in my shift

3) I'll be released after being cited

4) I will get to go home, likely before my shift ends

5) one less drunk to deal with at work :)

[Huscarl73]

All this legal stuff hindering nurses & cops is just nonsense. It's a urine spec. or a little needle stick - get over it!

If a person is caught driving appearing obviously impaired, then they should be able to be tested for ETOH & drugs. If they haven't broken the law, then they have nothing to hide. If they have broken the law, then they need to get caught. Especially if they were involved in an accident.

If they turn out to be 'clean' and impaired, then the ER is where they need to be because something is definitely wrong with them.

The standard is unreasonable search and seizure. We have a court system that decides if a search is reasonable based upon specific evidence. We should not ignore this based upon expediancy.

I've never been a fan of this 'nothing to hide' approach to law enforcement. We have the right to not answer any questions, not submit to having vehicles searched etc. Refusing to do so is not hiding anything, it is holding the police departments to the standards that the law says they have to follow. When we get to the point that this is no longer true I would personally hope that you are one of the first to be held in that little room in the basement of the police station having a confession beaten out of you.

[911RN]

Illinois also has an implied consent law when you are issued the dl. ISP brought a drunk, MVC in and I had the audacity to question the officer about consent for the legal BA. Our Md's will draw a BA if they deem it medically necessary, but the PD has to get a warrant for the results. We can give them the results verbally, which they usually know when someone has been drinking.

[KyPinkRN]

The standard is unreasonable search and seizure. We have a court system that decides if a search is reasonable based upon specific evidence. We should not ignore this based upon expediancy.

I've never been a fan of this 'nothing to hide' approach to law enforcement. We have the right to not answer any questions, not submit to having vehicles searched etc. Refusing to do so is not hiding anything, it is holding the police departments to the standards that the law says they have to follow. When we get to the point that this is no longer true I would personally hope that you are one of the first to be held in that little room in the basement of the police station having a confession beaten out of you.

It is not unreasonable to think that someone who crashed their car may have been impaired... the cops do not just dream up these things. Remember their is a whole chain of events that happens outside of the ER before people wind up there. Cops don't just pluck up everyone who is involved in an MVC and bring them to you for a blood draw. I think you are forgeting that they have a job to do too... keeping us safe from criminals. If that means I may have to submit to a search or a little needle stick once in a while I am o.k. with it because I know that they are trying to do their job. Why wouldn't you want to comply if you knew you had not been drinking. Like it or not if you don't comply, people do perceive it as having something to hide. I have been an EMT for 8 years and I have seen people who choose to go to the ER because they think it will get them out of going to jail. Should we let these people get away with that? I for one will do everything within the law to help these officers to do their job... because in the end it is keeping my family safe. As far as advocating for my patient goes... are they not in far more danger if they get off and continue to drive drunk?

[htrn]

Kind of along the same lines - where do the HIPPA laws stand on notifying law enforcement. We occ. get requests from law enforcement to let them know if s0 and so shows up for treatment because they just found their car in a ditch with blood all over it, or there was a hit and run, so if someone comes in with injuries possibly from an MVA, please call.

I know there are certain things such as GSW or child abuse that we have to report, but what about these other requests? Where does HIPPA trump law enforcement and vica versa?

We just had them call last night and I told them that "federal law prohibits me from releasing the name of any patient without a patient's permission". They came out anyway and lo and behold, but guess who they found?

[Toquay]

In the state of Florida driving is priviledge not a right. It even says on the front of our DL "Operation of a motor vehicle constitutes consent to any sobriety test required by law". I am pretty sure refusing a bal test, which any person has a right to do, means you lose the right to drive since this was the agreement you signed to even have this priviledge.

Usually in cases that are alcohol related and brought in for medical clearance, the ER MD will order a medical bal which we will get in that person's best interest to medically clear them. This is not the same as the legal bal that the state needs and we don't obtain that unless the patient consents for it. I am pretty sure the state can get a court order for the medical bal and use it and that along with the patient refusing to comply probably hurts them worse than just doing the test.

Toq

[ZippyGBR, BSN, RN]

it depends on the law etc etc etc

does Us legislation not have a specific crime (for the alledged perp) of refusing to give a sample ... which is assumed to be becasue the sample would be over the limit therefore the prosecution goes ahead anyway...

[Altra, BSN, RN]

it depends on the law etc etc etc

does Us legislation not have a specific crime (for the alledged perp) of refusing to give a sample ... which is assumed to be becasue the sample would be over the limit therefore the prosecution goes ahead anyway...

Yes, some US states have this law as other posters have described.

[bigsyis]

It depends upon your State Law. One New Year's Eve, I had a similar situation. The Secretary for the State Prosecutor in our county was brought in after the car she was driving plowed into 6 brandnew cars at a car lot and stopped against a tree. You could smell the ETOH, big time (and yes, I know it is the metabolized components of liquor, wine, beer). There were three State Troopers harrassing the pt, who continued to refuse to allow me to draw the blood. I got along great with all of them, but I finally told the one that was in charge that they were going to have to get a court order for me to draw the blood, or else quit harassing my pt. They quit, after 5 attempts to get her to agree. I just documented out the Wazoo, and wtih good reason. One of the things that she refused to allow were xrays of anything but her C-spine. When it was cleared, she wanted off that backboard (after several attempts to contact her boss, the Prosecutor, by phone-he wouldn't take her calls) to use the restroom. She stood up and crumped! I was right beside her, and got her back up on the stretcher. Long story short, sh ehad a ruptured bladder. Longer story short-several months later I was called to a deposition with an Asst. Prosecutor for an adjoining county regarding this pt. They wanted me to describe what I meant by odor of ETOH, and to answer various other questions about the events of that evening. I did, and a few weeks later they informed me that this woman had been sentenced to 6 months of "community control" (wearing an ankle bracelet), had to pay a fine plus restitution to the car lot, and had lost her job. They said this was all based on my notes of the night of the accident, my deposition, and what law enforcement reported. Don't ever think that your notes won't count!

[58flyer]

In the state of Florida driving is priviledge not a right. It even says on the front of our DL "Operation of a motor vehicle constitutes consent to any sobriety test required by law". I am pretty sure refusing a bal test, which any person has a right to do, means you lose the right to drive since this was the agreement you signed to even have this priviledge.

Usually in cases that are alcohol related and brought in for medical clearance, the ER MD will order a medical bal which we will get in that person's best interest to medically clear them. This is not the same as the legal bal that the state needs and we don't obtain that unless the patient consents for it. I am pretty sure the state can get a court order for the medical bal and use it and that along with the patient refusing to comply probably hurts them worse than just doing the test.

Toq

Also in Florida law enforcement can forcibly take blood in cases where there is an accident involving death or serious bodily injury to anyone other than the driver. We usually have EMS paramedics draw the blood at the scene before the subject is transported if possible, otherwise we just have EMS take the blood at the hospital without asking the nursing staff to do it. We would never ask hospital staff to do a blood draw on a refusing subject. And there is not enough time to get a court order since the BAL is time sensitive.

BALs for medical purposes are generally not admissible in court. That's why police take blood samples to the crime lab separately. This has to do with rules of criminal procedure and custody and security of evidence. The BAL is evidence.

In my present assignment I have not done traffic crash investigation in the last 5 years so there is the possibility that there may have been some procedural changes I am not aware of.

flyer