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TRAUMA, MEDICINE, AND THE LAW

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The complexity of the interactions of the medical and legal profession has increased in both complexity and number with each passing year. No longer does the focus relate only to fear of being sued, testifying in court, and preparing for a deposition. There is the added dimension of in-hospital legal council in most hospitals, and they play a significant role in any medical legal situation. This chapter cannot cover all aspects, but will attempt to focus on the major concerns a physician must have when treating an injured patient—the intersection/interaction among trauma, forensic medicine, and the law. Forensic and legal issues surface daily in trauma care but may be overlooked or unidentified due to the urgency of the situation. Health care providers are able to and, indeed, need to provide lifesaving measures and “think forensically” at the same time. By considering the forensic and legal implications, evidence that may be vital to the outcome of a legal case is preserved without impeding appropriate medical care.

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Trauma team and law enforcement activities repeatedly intersect in various locations for a variety of reasons in the course of mutual and integrated responsibilities:

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  • System and organizational regulation and review

  • Preventive strategies

  • Prehospital care and patient protection

  • Disaster planning and response

  • Emergency center

  • Operating room

  • Intensive care units and hospital nursing units and clinics

  • Office practice

  • Patients complaints and undesirable results

  • Formulation of patient care policy and laws

  • Licensure

  • Quality review and reporting obligations

  • Disaster medical response

  • Professional liability

  • Testifying in court/depositions.

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Each year, over 1.6 million people lose their lives throughout the world as the result of violence.1 Countless others sustain injury. Violence and the social disruption that follows are addressed by everyone involved in trauma care. By understanding the law and the health care forensic implications of the law, identifying and preserving evidence during the course of evaluation and treatment, and accurately describing wounds, the surgeon is not only an indirect advocate for the patient, but also provides much needed information that will be used by law enforcement and the justice system.

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Concepts, Principles, and Definitions

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Although not standard in every political jurisdiction, some general principles and commonly used definitions are cited in this section. Often a legal and a medical definition or concept might differ. Such variances are perception is important to medical personnel interacting with forensic and legal personnel, especially in a court room, deposition, or adversarial situation.

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  • Abandonment: Terminating care of a patient without ensuring that a continuum of the same or higher level of care exists

  • Assault and/or battery: Unlawful touching of a person or patient without appropriate consent for that contact

  • Confidentiality: Protecting medical information for any patient under the care of a hospital, nurse, doctor, or other medical personnel

  • Competence: The ability of a patient to understand the questions put to them by health care ...

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