Warranted

We have been sent to a young man who has called us from a public phonebox, he has told our calltaker that he has been cutting his wrists.

As a point of general safety the police are sent to this job as well as rather obviously he could well be armed with something sharp.

We meet with the police who are also searching for the patient – they have already been up and down the street and can't find him so they declare 'area searched, no trace' and disappear off to do something else (it's been a very busy night for the both of our services).

We decide to have a further scout around and, because of our experience of peering into the dark while driving slowly, manage to find the patient standing in a pool of his own blood in the phonebox.

The rather large blade that he has used to hack his arm to pieces rather thankfully is on the floor a little way away from him – I'd already approached him, but if we worried about people stabbing us all the time we'd never get any work done. I pick it up and throw it into out sharps bin where all our used needles go.

We bandage up his shredded arm and chat to him in the back of the ambulance. He's obviously emotionally shaken and keeps asking if the police are going to shoot him. It takes us some time to explain that the police have already gone on to their next job in the queue.

He tells us that he is in fear of the police because there is a warrant out for his arrest, I ask him what for and he answers, “you name it I've done it'.

So, my questions to you, the way I see it there are three ways to answer them – legally, ethically and practically.

  • Do we, as ambulance people tell the police that we have someone who is wanted for arrest, taking into account that we are supposed to be all about patient confidentiality?
  • If you decide not to tell the police, is there a certain level of crime that you would tell them – for example if the patient were a child murderer would you tell them as opposed to shoplifting?
  • In general, how far do you think we can we go against the patient's wishes when there are external pressures on us to do something (for example not reporting a domestic abuse case or not reporting a child abuse case)?

I'll tell you what we did, and why in a later post. Responses from police officers are especially welcome.

33 thoughts on “Warranted”

  1. It's a tough question with so many elements to it, after all does protocol apply or is it a question of morality or just a sense of doing the 'right thing'.On the whole I agree with the majority that you should not have said anything, after all he was confessing to having an outstanding warrant not to a particular crime. I do wonder though if you are leaving yourself open by not reporting it.

    I seem to remember something from my first year law course that if someone confesses to have committed a crime or that they are about to and they 'draw strength' from you and go on to commit a crime or further crime then you could be considered as aiding and abetting. Obviously, if I've remembered this right, then they would need to go on to commit a crime.

    I believe that in the first instance though, you are there to treat an individual without any discrimination and the responsibility of reporting anything to the police or what ever rests with those further up the food chain.

    Good post cheers.

    P

  2. Easy, not your job. If you don't get paid for it don't do it, no one can blame you for that.Let the pigs do their own work. Unless there is at least a little red coloured backhander in it for you of course, in which case take the money!

  3. OK, I guess what I meant was, if breaking the confidentiality would protect someone, it is acceptable, morally and legally to do so. The mere suspicion that it might, however, is not acceptable reason IMHO. I would not withold this information from other health care staff who would come into contact with him – they have a right to be aware of it, but as I and others have said, looking at the wider picture, more lives will be saved, and the ambulance personnel are safer, if there is still that element of trust – the patient knowing that they can tell me what I need to know to treat them appropriately without fear of reprisals.

  4. As part of my nurse training we were asked to write a reflection on this and I looked at it from each angle – HCP, Patient, and Public.I could not find any one way that I would chose.

    If you don't report it to the Police and they leave hospital and stab a granny less than 2ft out the doors, then I would be questioned as to why I didn't report it.

    If I did report it the patient could technically sue me for breach of their confidentiality and their human rights.

    It's catch 22.

  5. Surely this is a case where to cover your own back, you need to pass it to your 'superiors', who are paid to take this kind of decision.

  6. If an animal comes in that we suspect has been abused then we are allowed under rcvs guidelines to report the owners/case to RSPCA and police if the owners of the animal have children as there is a link between child abuse and animal abuse.

  7. You have no right to tell the police that your patient is WM. You can cover yourself by simply telling EOC that you have found your patient and ask them to pass that on to MPS. The police were attending as a matter regarding your safety, and not because they believed an offence had been committed, and they are unlikely to return to scene unless you request them.

  8. The Police are there to Police – the Ambulance Service are there to care and treat, and not judge, especially in the context that this pt is obviously not mentally stable.Therefore, focus on the pt, and stay out of the hearsay – different story if any alledged incident is witnessed ?

  9. I suggest that, unless you have independent reason to contact the police, you should do nothing. The patient could be lying, but is definitely less likely to call for help if they think they might be arrested.If you knew independently then off you go!

  10. I would keep it to myself. In order to be able to do your job, you need to be able to tell casualties that anything they tell you will be confidential.If you break this confidentiality, you can no longer truthfully do this, and you have broken an important trust that you need in order to do your job properly.

    Unless it is going to endanger you/your crewmate/hospital staff/patients, you should keep it confidential – for the sake of all future casualties. As I understand it, legally, you are only entitled to break this confidentiality in order to protect your own, or other people's safety, and for no other reason.

  11. Even priests are told that if they get a confession that someone is planning a murder, or has committed a murder – or other dangerous/harmful act against another – that the “seal of the confessional” does not apply.I disagree with the majority here – if you are aware that you have a wanted criminal in your “custody” – then I believe it is your duty as a citizen of the country – not to mention a professional – to alert the police to this.

    Child abusers and child abuse cases are REQUIRED BY LAW to be reported by medical professionals to police in this country. I know when my daughter broke her arm, I was subjected to the 3rd degree – as was she – by the doctors and nurses. And I didn't mind in the least, because I knew there was no abuse, and because if there HAD been – I'd have wanted them to report it.

    “Patient Confidentiality” regards their medical condition, IMHO – not whether they are wanted by the police.

  12. If I really thought I'd identified a murderer then I'd likely go for an anonymous tip-off. An adult victim of abuse can report it or walk, generally speaking. If a child was involved there are set protocols for reporting which supercede the patient's right to confidentiality – ditto vulnerable adults. If they were just wanted by the bobbies for being an anti-social toe-rag – so what? If I reported all of those I came across I'd be at it several times a week.

  13. This is a very hard question. I am working in Austria and I have to admit that I was never in such a situation.Never the less, I would put it that way. I would do what ever would be best for my safety. That means, if there is a threat to my safety i call dispatch to get the cops. I think with a murderer that would be the case. If the patient is running away… I am not going to hold them back or chase them. Thats not my job and it is to dangerous for me.

    Another question is: What are you doing when your patient does not want to go to hospital? In Austria he choose if the patient is fully aware of what he/she is doing. If we think that this is not the case, we call the cops, they call the public health officer and he decides weather the patient goes to hospital or not.

  14. The thing is, human nature dictates we assume the worst, but a warrant for your arrest can be issued for simply not responding to an Application to attach your earnings!He alludes to something more serious by saying 'you name it I've done it' but and I mean this with the up most respect for the patient, he has just slashed his wrists and may not be the most reliable source I guess.

    I suppose each situation is potentially unique and requires a judgment call at the time!

    Interestingly I had a similar conversation with a student midwife about a fictional patient who was continuing to have unprotected sex despite finding out she had a STD. The discussion revolving round patient confidentiality, patient duty of care and a duty of care to a wider community and in this case her partner.

    Most of the arguments for and against discussing it with/ alerting others were very similar.

  15. What I don't understand is: why is it up to you to make that decision? Surely there are policies and procedures in place for situations such as these?(My personal opinion is that the police should be notified. I know there has been the victim / criminal issue discussed on this forum before, but I have little sympathy for law-breakers (especially when the criminal act leaves a victim scared). I believe that we are all faced with choices and should know that our decisions have consequences – you make bad choices and bad decisions then expect bad consequences. But then I'm a bit harsh!)

  16. 1: ??? why was call box not identified by its call number with location of street address so that people in trouble could be found in time, especially when loss of conscious be in the offering.2: patient needs stabilizing, which you did.

    3: patient needs mental evaluation, because his ramblings be “hear say”, but a warning of instability, none the less.

    4: warn your organization of the potential problem , so that it can calmly be evaluated for the true situation, with the person under a watchful eye, until a conclusion can be resolved.

    5:One does not mouth off, if you do not want the world know your problem so this appears to be case of asking for help, a wee bit on the dramatic, One does owe it to ones fellow man to be protected from the evils and dangers of an unstable mind.

  17. In my opinion, you should tell the police. There are situations in which you could justify breaching confidentiality and I think this is one of them i.e. to protect the wider public.

  18. Assisting an offender – section 4(1) Criminal Law Act 1967Well worth a read, particularly if you believe than that the person has committed an offence.

    You would have to rely on the “reasonable excuse” defence – might be difficult as it could be argued that you could convey the patient to hospital and then summon the police.

  19. I attended a pt a few weeks ago who had “dropped a glass in a pub and tried to catch it” (euphamism for ” i got glassed but will sort it out myself”). When i asked about previous medical history he told me that he'd nazzed his knee a couple of years before. I asked if he worked and after he'd stopped laughing he told me he was “on the sick” because of his bad knee.Before we arrived at hospital he asked if there was a bloke with a broken leg in, I said I have no idea, why? Turned out he'd broken it playing football earlier that afternoon.

    I now know that despite having a crocked knee and claiming money from the state to support him (fraudulently) that he's well enough to play football on the crocked knee.

    So, do I disregard this information or do I contact the DSS and point out his fraudulent activity?

  20. Hmmm, that reads REALLY badly.The pt had broken the other bloke's leg playing football that afternoon. He wasn't at all bothered about it, just more concerned that the bloke's mates would be there and probably give him a kickeing

  21. hmmm… I've had that a few times as you could imagine the number of times we work with the LAS. As far as I am aware patient confidentiality only extends as far as their medical circumstances. Just as we (the Police) aren't supposed to be told that the person we are dealing with has a blood-borne disease for example (although we usually are out of courtesy) as it shouldn't change how we deal with them, the fact that the person may or may not be wanted isn't the concern of the medical professionals and shouldn't come into the way in which they/you deal with them.If the person has an injury then that always takes precedence over a criminal matter anyway, as it rightly should.

    I have never heard of a medical professional being criticised by the BMA or anyone else for informing the Police that a person they have in situ or in hospital is wanted or is of interest. The flipside is someone (the CPS) could possibly go down the lines of assisting an offender but as you surely know, some people talk a lot of bollocks and unless you know for a fact that the person has committed, is suspected or wanted in connection with committing an offence then you will never be dealt with from a legal point of view.

    Practically, I think that most criminals we deal with know or believe that at some point if they are wanted and they go 'into the system' either through NHS or criminal justice then they are going to be found out. I've no doubt you've had people who have refused to give you personal details for one reason or another when they have had an injury, most of the time it's because they think we (the Police) are going to get involved and if that impedes their treatment, then more fool them.

    A W/M (wanted/missing) marker could be for anything from an information report to a circulation for rape/murder, if you believe that the Police should be informed then I personally don't think there is any harm ethically, legally or otherwise in passing the information. The most that will happen is they are dealt with after medical treatment anyway, and we do get lots of people who believe they are wanted for anything and everything and simply aren't, in which case we don't care if they big themselves up.

  22. I agree with all dungbeetle has said here. The extent of the self harm indicates a need for a mental health assessment. Also, being a mental health professional in a forensic setting myself, I would raise the possibility of false confession which is more common than may be imagined. The patient gave no specific details, only a vague and 'dramatic' statement. If I had been there I would have handed over the full story to those doing the psychiatric assessment. You had no evidence to suggest he had done anything other than harm himself. Had he been quite specific I may have reported it to the police but I would inform him (Pt) that I intended to do so.

  23. My 2c as a civillian are: if I was so out of my head to cut myself and say that stuff, in such a tone of bravado… well, I wouldn't be in a right state of mind. I wouldn't want people running to the authorities; it would help nobody. I would want to receive prompt help for my injuries, and psychological issues.On the other hand, if potentially dangerous people get better care, you could be doing me a favour by reporting me.

    As for people I suspect of murder, child abuse, or voting for politicians, whether I'd report would depend on my level of certainty, weighed against risk (to public, to my job, to an innocent man's freedom).

    About every choice we ever make is a value judgement, but I do not envy the ambulancemen their choices.

  24. my tuppenny worth.Assess, get him to the hospital for treatment, i'd question his mental health status too and inform whoever you're handing over too of what was said. It's still confidential, but the patient needs assessing and treating and if he's any sort of risk u have to pass that on as part of the record, then its up to the hospital what they do, its not your job to inform the police its your job to get him to hospital and inform them of the patients status.If you took him to cas here, there's a cop station in there.

  25. That is a difficult one. Id hand it over to my supervisors to take that decision.I was in a similar situation in my voluntary work. I had a young person on the phone confessing to quite a horrific crime. I didnt believe him, but I wasnt prepared to take the chance. So, I passed it onto my supervisor who consulted their supervisor.

  26. Similar quandary in France at the moment as a volunteer social care worker took it upon herself to report an illegal immigrant staying with the family she was 'helping' to the police. Bearing the war-time history of denouncing people to the authorities in mind, her actions have gone down like a ton of bricks.My instinct would be to keep schtum, unless you're certain that you're patient is a serious danger to the public, then report via your chain of command/management. The chavs believing that you regularly report to the police won't stop them from calling you for a stubbed toe, but does make it more likely that they'll be hostile/agressive towards you.

    j

  27. The pt has self-harmed, had one big blade that you've recovered, has stated they are a wanted criminal, and suggested that they are a very nasty character (you name it, I've done it). You've stabilised their condition, putting your own safety at risk, but are you sure you've got all the weapons this person had when they came out tonight? Notifying the Police that you have a patient claiming they are wanted is the quickest way to find out if they are wanted/dangerous/not safe to ride in the back with, or just a pt in need of serious help. You won't know unless you ask.Not checking, and not ascertaining if the pt is a violent criminal before getting in the back of the van with them seems the politically correct but most dangerous route, so I'd say call it in,

  28. But what if it's to protect someone else who is vulnerable – a wife, a child, a mother, a member of the general public?Could you live with yourself if you let him get away, and the next day his daughter came in battered and bruised?

  29. If we worried about people stabbing us all the timewe'd never get any work done.

    I'll have that on a T-Shirt soon.

  30. It's quite simple. There are reasons when you can, and reasons when you must, breach patient confidentiality. One reason you must breach confidentiality is in the interest of public safety, eg if you had reason to believe that a patient was going to kill his attacker, or if a patient was a potential terrorist, for example. If you are asked by a police officer to assist you with enquiries regarding a serious crime (murder, rape) then you must help them to the best of your abilities. However, there is no requirement to breach confidentiality, just because a patient tells you he is wanted for the police.

  31. Ugh, how I hate those words. 'Potential terrorist'.We're all potential terrorists. if the government scares or hurts us enough, or decides something previously harmless (like having sharp knives in your kitchen) is now 'terrorist behaviour'.

    As to the cut chap, I go with the report the words to the mental health assesor route.

  32. Presumably this just comes back to whether or not it is in the public interest to tell them. The laws exist (or should exist) because it is in the interest of the general public to follow them, so if someone admits to doing something that seriously contravenes that, perhaps its the duty of everyone to help stop it. Arguably the police are there to “police”, but its everyone's responsibility really. The police just help enforce the law, they are useless if nobody respects it.

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