Police in the ED
For more detailed guidelines please click here
There are many occasions that the police and A&E doctors come into contact. Please remember both you and they have jobs to do, but the welfare and confidentiality of your patient comes first. There are occasions when the police may ask about the clinical condition of a patient. It is important that you respect the patients privacy, and you are not allowed to divulge this information. However, many of the police are genuinely interested in the patients welfare, and they may have been involved in their rescue. The easiest thing to do is ask the patient if it is OK for you to speak to the police, and if they are happy then you can tell them. If you tell a police officer details which they have no legal right to know, the patient can take you to the GMC for breach of confidentiality.
There are exceptions to this rule:
1. If there is a gunshot victim, the police must be informed as there is a real threat to the department from individuals returning to 'finish the job' or reprisals. Armed police are then needed to guard the patient and the department. The welfare of the patient, other patients and staff supercede the individuals right to confidentiality. Discuss with the Duty Consultant before doing this.
2. Patients involved in RTAs, may have their personal details (ONLY-not clinical information) given to the police (Road Traffic Act)
3. Patients who pose a threat to society and have committed a serious arrestable offense, may have their details released to the police, ONLY after an Inspector or above, has filled a specific form, and then the Consultant will release pertinent information. Any queries of this sort must be directed to the Duty Consultant.
4. Patients who act in a violent, racial or aggressive way (unless due to medical illness such as hypoglycaemia, head injury, hypoxia etc) forfit any right to treatment or confidentiality and the police should be informed.
Any attempts to get clinical information by police officers outside these guidelines must be discussed with the Duty Consultant, don't be tempted to be too helpful: Be polite and calm and explain that you have a duty of confidentiality to the patient, then ask the patient permission, or speak to the Duty Consultant.
The police are allowed, and obliged, to collect evidence after serious crimes, so when you remove clothing the police may place it in a bag. This fine.
The presence of police is generally discouraged during a consultation, however if a patient is violent, then the police are very useful helpers, don't put yourself at risk from assault.
Specimen collection for forensic purposes (eg blood alcohol levels in an RTA) is only done AFTER documented permission has been obtained from the doctor caring for the patient. This is to ensure that care is not compromised during this process. Occasionally you may be asked to take the blood. Under no circumstances are you to do this. It has to be done by a Forensic (Police) Surgeon and there is chain of evidence forms, special ways of taking it (no Alcowipes) etc. Any sample obtained in breach of the Police and Criminal Evidence Act 1984 will not be admissible in court.
If a patient absconds from the department, and you are worried about them (eg self harm patient), inform security and if they cannot find the patient, inform the police and they can try and bring the patient back. Bear in mind the police have no direct powers to bring a patient in to hospital if they are in their own home and don't want to come in. If the patient is being a public nuisance and appears to mentally disturbed they can bring them on a Section 136 (Mental Health Act), which has to be assessed directly by the psychiatrist. You may be asked to help them assess these patients from a medical point of view, and this is reasonable provided it is clear that they retain responsibility for the patient and is not dumped on A&E to 'work up'. The police cannot take someone off a 136, only the psychiatrist can do this.
You will all be called on to produce statements for the police & courts from your notes, often weeks or months later, so make them legible and comprehensive especially in assault cases - remember you may have to produce the original in court! Be careful about how you label wounds; lacerations (blunt injury), incised wounds (sharp injury) or stab wounds (wound smaller than its depth). Wherever possible, document lengths, and anything else that may be forensically useful.
a) Prior to giving a statement you should be provided with the patients consent in writing.
b) Never dictate a statement to the police officer - always write or type it in your own time for them to collect later, you can then make sure that you have said what you meant to!
c) Remember to fill in the claim form for your fee.
d) Statements should consist of facts. Get your first few statements checked by a senior doctor. Statements should be in a standard form i.e.
" I am Joe Bloggs, GMC number 123456. My qualifications are MB ChB. I am employed as an SHO in the A&E department at North Manchester General Hospital. In the course of my duties on 29/2/1880 at 00:00 hours I saw and examined Jane Doe, date of birth 12/3/45. She attended the A&E department at 1200 hrs.
According to the patient she had been ............................
On examination ....................................
X-ray findings were...................................
Treatment given was............................."
Record any medical details such as anatomy etc followed by bracketed explanation in simple English, and where possible use everyday terms eg collar bone, rather than clavicle.
You may include a brief history of the events as given to you by the patient - it is privileged information not hearsay and may or may not be supported by the injuries you have found which is obviously of relevance to the case.
Always record the size of wounds, number of sutures etc.
If you want to type out your own Police Statement: here is a template
To download and electronically complete the Witness Claim Form: click here (don't forget to sign it!)
Please return ALL statements and copies of notes to the secretary, even if you type them yourselves. This is to ensure that copies are kept for future reference, prior to sending. There is a tradition of providing 10% of the fees to the secretary for the typing/photocopying etc.
Procedure for Dealing with Unauthorised Drugs or other Unidentified
- Where a patient is found in possession of an unidentified substance, the member of staff should immediately inform the nurse in managerial charge of the ward or department.
- The patient found in possession of an unidentified substance should be requested to identify the nature of the substance.
- Where a patient confirms that the substance is illegal, or the member of staff suspects it to be, the patient should be advised that possession of an illegal substance is unlawful and be asked to hand over the substance voluntarily for destruction, this should be witnessed by two members of staff. The person concerned cannot be searched.
- If the patient refuses they should be asked to make immediate arrangements for the substance to be removed from the hospital premises.
- If the patient agrees to hand over the unidentified substance, the ward or departmental nurse manager should place the substance in a sealed envelope which is signed across the seal by two members of staff. The source (patient’s initials and hospital number) and a brief description of the contents should be written on the envelope. The envelope must then be placed in the controlled drugs cupboard and recorded at the back of the Controlled Drug record book.
- The nurse in charge should contact the consultant in charge of the patient, their manager (or on- call manager) and the Head of Pharmacy or their deputy (or on-call pharmacist) to notify them of the incident.
- Where it is agreed by the nurse in charge and the patient’s consultant that the quantity of the substance is consistent with personal use, then the substance should be destroyed on the ward as soon as practicable (i.e. as soon as a pharmacist is available). The pharmacist will advise on the method of destruction.
- If it cannot be destroyed at ward level, it should be taken back to pharmacy by the pharmacist for appropriate destruction, in the same way as patient’s own prescribed controlled drugs are and an entry is made in the Controlled Drugs record book that this action has been taken. This must be signed by the nurse and pharmacist
- During the working week the hospital pharmacist and the nurse in charge must destroy the substance(s) on the ward and a record made in the back of the ward’s controlled drugs record book with the date and signatures of the pharmacist and nurse. Out of hours this can be left to the next working day.
- If the nurse in charge and consultant in charge of the patient consider the quantity of the substance is greater than is consistent with the patient’s own personal use, the Divisional Nurse Manager / service manager / on-call manager, following discussion with the Head of Pharmacy or their deputy, should telephone the police on 0161 872 5050. Reference should be made to the Trust policy on disclosure of personal information to the police.
- A police officer will be expected to attend the ward or department. In this instance, they must
provide a Section 29 (3) form which has been signed by a Police Inspector. Only minimal information, e.g. name, address and date of birth, should be supplied. Clinical information should not be provided.
- The police officer, following their enquiries, will remove the unidentified substance from the ward. The police officer will enter a description of the substance in his / her pocket notebook in the presence of the person handing over the substance and ask them to sign the entry. The officer will sign in the Controlled Drugs record book as evidence of the substance being handed over to the police. This will be witnessed by an authorised member of nursing staff.
Under no circumstances can a non-prescribed Schedule 1 controlled drug be returned to a patient on discharge, as the person doing so could be guilty of unlawful supply of a controlled drug.