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6. Violent Injuries
Generally physicians have a responsibility to report violent or suspicious injuries—all
gunshot wounds, knifings, poisonings, serious motor vehicle injuries, and any other
wounds that seem suspicious—to the local law enforcement agency. The legal
assumption is that anyone who has knowledge that a crime may have been
committed has a duty to report the possible crime to the police. If the patient is
brought to the hospital in the custody of the police or from the scene of a police
investigation, the physician may safely assume that the police have been notified. In
all other cases, the physician should call the police and make the report.
Such injuries should be reported despite the wishes of the patient. The patient who
has been shot escaping from the scene of a crime will be more interested in the
wound’s not being reported than the patient who is embarrassed about mishandling a
gun while cleaning it. Some states have made domestic violence a reportable offense.
In states where such reporting is not required, the physician should determine if
battered spouses or partners may be reported under general violent injury laws. This
is very important because of the high probability that the victim will be severely
injured or killed eventually. In some cases, the couple will have made up by the time
the stitches are in and the X rays are read. This should not stop the physician from
reporting. In others, the victim will be too terrified to complain. If the woman who
came in saying her husband cut her now claims she injured herself cooking, the
injury must be reported nevertheless. Domestic violence is one of the most dangerous
areas of police work, and the rate of repeat violence is very high. Medical care
providers should not try to handle these cases privately in emergency rooms.
7. Intoxications
Unlike child abuse or gunshot wounds, most jurisdictions do not have a law requiring
physicians to report intoxications to police authorities. Without reporting laws that
override the patient’s rights of privacy, physicians should remember that they may
not volunteer information about a patient without the patient’s permission. As with
other forms of medical care, physicians may not do testing without the patient’s
general consent. Physicians have the right and the duty to assert their patient’s right
of confidentiality when questioned by police officers about the patient’s medical
condition. If the physician’s testimony is legally required, the court can order the
physician to testify; the investigating officer cannot.
Although the consent of the patient is required for any type of medical care,
physicians usually do not think about obtaining consent for routine laboratory
procedures such as blood chemistry or urinalysis. It is assumed that the patient and
the physician use the general consent to care for these. In addition, the patient may
refuse to allow the drawing of the blood or to provide the urine for testing. This type
of nonspecific consent should not be used when testing for intoxicants. The legal
problems that may arise from positive tests make it necessary for the physician to
obtain a valid, specific informed consent from the patient before doing the test when
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