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Discussion

talking to the cops about my patient

Hi all,

Today I was taking care of a patient who was brought in my the police for a SART exam after her family member called the police to report that she had been sexually assaulted. The patient's u-tox was positive for cocaine and she was admitted for hypertensive emergency and possible stroke. The police were unable to interview her in the ER because of altered mental status and she refused the SART exam. Today a police officer came to the unit to follow up on the case as they may arrest the man who assaulted her.

The officer asked if her condition was stable enough to speak to her and I said yes. He already knew about the high BP and I told him it was improving. He asked if her altered mental status could have been from the stroke and I said yes. He then asked if she had any drugs in her system. I told him not currently (the truth). I did not mention the cocaine from the u-tox in the ER but said she was tested for drugs in ER and those results are in her chart. I did not want to tell the officer anything he didn't already know from being with her in the ER in case it was a HIPPA violation and I definitely didn't want to tell him about the cocaine for fear that I would cause the patient to get arrested on drug charges. Does anyone know how we are supposed to handle questions from the police and what is considered a HIPPA violation and also if a patient could be arrested on drug charges if medical tests show positive for "illicit substances"? So complicated!

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    • Featured Replies

    • Admin

    Refer to your facility's policy, but typically a drug test can only be admissible in a court of law if there was a warrant/consent and the proper chain of custody is followed. Only those things that are required to be reported (GSW, child abuse, etc) are not protected by HIPAA.

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    Read your facility's policy for HIPAA and reporting to law enforcement.

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    Sounds like they are trying to get information for an investigation without going through the appropriate channels. If you give them ANY information, you could be called to recall information. If they want information from the patient, they should be asking the patient and not you. Has the patient consented to have you talk to the police? If they want further information, they can get a warrent and do things legally.

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    • Guides

    I mostly just smile and say "I can't really discuss that with you at this point". They need a warrant for the medical record.

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    As a former cop whose been in lots of hospitals I can state, your facility should have a written policy for this.

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    Formal answer: Consult your policies.

    General comment (not critique): Whenever we are in situations where we are being asked for information in real time and we don't know the policy or don't know whether we should be answering, the time to find out is right then. There's no harm in responding, "Let me find out how best to help you" or something similar that sounds pleasant without answering anything. Immediately contact your manager or supervisor on duty.

    Generally-speaking, they have two options: Speak with the patient, or get a warrant.

    Therefore, the best policy is to tell them absolutely nothing in that instant that they start asking questions.

    LibraNurse, I would let your manager know about this occurrence.

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    Once he asked if he could speak with her, that should have been the end of your conversation with him, and I'm sure he knows that. I can see how it's dicey as you want to respect law enforcement and not be considered to be withholding information; however, other than "she is stable and you may speak with her" there is nothing else that needs to be disclosed without a warrant.

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    Hmm this sounds like a discussion the police should Be having with the forensic nurse. I agree with the end of the conversation being "is she stable enough to

    Talk". I guess since she refused the exam that probably meant the SANE didn't get called in and the officer turned to you for details (instead of the forensic nurse).

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    Tbh, the information you provided already violated HIPPA (unless you had the pt's consent which you didn't mention). I second the advice that you should consult your facilities policy but unless you're making a report allowed by state law, police don't have a special right to a pt's medical information. Politely reminding them that you can't discuss a pt's private medical information without their consent will likely quash further inquiry. Police know what information they can legally request but will often push the boundaries and see what people will give them "for free." Simply reminding them that you know that you can't share information will tell them they're not going to get anything extra out of you and they will either go try someone else or do their job.

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    please remember the nurse in Utah.

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