Do you know which cases you’re required to report?
A child with a suspicious fracture. An elderly woman who says she hasn’t been eating regularly. A drunk driver involved in a fatal motor vehicle accident. Do you know which of these cases you are required to report to agencies or law enforcement?
"An alarming number of ED nurses are unaware of reporting laws," says Mary Ann Shea, JD, RN, a St. Louis-based nurse and attorney.
To increase your knowledge of requirements, consider the following items:
• Drug testing results.
You may need to obtain blood alcohol levels or urine toxicology screens to provide appropriate patient care, but the results of drug testing is privileged information and should be released only with the patient’s consent, warns Kathie Eberhart, RN, CEN, a Santa Rosa, CA-based legal nurse consultant and ED nurse at Santa Rosa Memorial Hospital.
"I do not know of any exceptions to the privacy rule, short of a court order for release of medical records and drug testing," she says.
You must be aware of your state’s reporting requirements, Eberhart adds. "In the state of California, test results are never released to the police unless a legal blood alcohol level is drawn with the police in attendance, providing the equipment and witnessing the blood draw," she explains.
There is a difference between therapeutic levels done to determine appropriate care and testing done for legal purposes, notes Shea. Different rules apply to the ordering and obtaining of specimens for testing for legal purposes, which is not used for treatment decisions but for prosecution in the criminal justice system, she notes.
In this case, you have a duty to inform the patient of the purpose of the test, and in most states, the patient has a right to refuse, says Shea. "Regardless if the patient consents or refuses, be sure to document this incident in detail in the medical record," she says.
Unless the patient is in police custody or there is a court order for treatment, the police officer has no legal authority to dictate treatment, and you cannot provide any information unless the patient consents, says Shea. Although state laws vary, generally a police officer does not have legal authority to override a patient’s refusal, and only a court order can do so, she adds.
• Abuse or neglect of children or elders.
ED nurses are mandated reporters, which means there are penalties for not reporting which vary by state, says Shea.
The intent behind child and elder reporting laws is to ensure that these vulnerable patients are given protection from further harm, she adds. "The ED nurse does not need concrete proof that abuse and/or neglect are occurring," she says. "A reasonable suspicion is sufficient to invoke the reporting obligation."
ED nurses who make a report in good faith, based on reasonable suspicions, have immunity from legal recourse from the individual reported, she adds. "So even if the nurse is incorrect, as long as there were adequate grounds for suspicion of abuse or neglect, the nurse will be protected by the statute," says Shea.
Because the penalties for failure to report can be severe, always err on the side of caution and report whenever you suspect abuse or neglect is occurring, recommends Shea.
• Domestic violence.
Your ED may have policies and procedures that require specific interventions for these victims, says Shea. "For instance, you might automatically call in a social worker to talk to the patient," she says.
A policy may require that suspected abuse is reported to the appropriate law enforcement agency even if the abused person refuses care or refuses to acknowledge the possible situation, adds Eberhart. "The agency must then investigate, even if it entails interviewing in the ED setting in order to maintain patient privacy and keep the suspected abuser out of the initial interview process," she says.
Your EDs should have policies and procedures to direct you on what to report and where to report it, but these cannot be detailed enough to cover all the scenarios you may encounter, says Shea.
"Consequently, you must your professional judgment to decide if the type of injury and the history given come under the category of suspicious," she says. "I often tell nurses that nursing is a visceral’ profession — that if your gut is trying to tell you something, you should listen," she says.
In any case, policies may not adequately address the situation at hand, says Shea. "Rather than just guessing when unsure of what to do, the nurse should rely on the advice of supervisors," she says.
For example, if there is no policy on how to handle a police officer’s demand for action, and you aren’t sure what to do, get your ED director or risk manager involved, Shea advises. "If a nurse is handed a court order, but is unsure what to do with it, the nurse should get the supervisor involved," she adds.
Document the name of the person you consult with and what was said, advises Eberhart. "Three years down the road, you can pull a record and note who you spoke with and what the contents of the conversation were," she says.
Sources
For more information on reporting requirements in the ED, contact:
- Kathryn Eberhart, RN, CEN, 2777 Yulupa Ave., No. 342, Santa Rosa, CA 95405. Telephone: (707) 538-7056. E-mail: [email protected].
- Mary Ann Shea, JD, RN, Attorney at Law/Registered Nurse, P.O. Box 220013, St. Louis, MO 63122. Telephone: (314) 822-8220. Fax:(314) 966-0722. E-mail: [email protected].
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