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KEY POINTS

KEY POINTS

  • When in doubt and time and life are running out, treat.

  • Have specific instructions for judicial intervention and emergency psychiatric detention available in the trauma center.

  • Be mindful of Hippocrates’s admonition, “Which ought not be spoken of abroad, I will not divulge, as reckoning that all should be kept secret.”

  • Compliance with local reporting laws is essential to avoid potential criminal penalty and civil liability.

  • The police department’s duty is containment and control, whereas the trauma team’s duty is care and cure. To each his own.

  • Avoidance of malpractice claims depends on the exercise of skill based on knowledge of reasonable, ordinary, prudent physicians under similar circumstances.

  • An unfavorable outcome does not, of necessity, imply or result in a legal lawsuit; if such were the case, 50% of all attorneys in court cases would be so guilty.

  • Standing orders, best practices, protocols, guidelines, and electronic recommended practices all have value, but the ultimate hallmark of the professional is the exercise of sound judgment in any particular case.

  • Records must be made for the patient’s benefit, not for the attending physician, hospital, attorneys, or quality surveillance. Corrections to records can be made, dated, and timed, but the original entry must not be removed.

  • Freely use consultation and escalation of concerns when indicated. There are always persons, processes, and resources to provided unknown, unfamiliar, or clarified information.

INTRODUCTION

Interactions between the medical and legal professions increase in both complexity and number with each passing year. No longer is the focus only on fear of being sued, testifying in court, and preparing for a deposition. In-hospital legal counsels, now in most hospitals, add another dimension and play a significant role in any medicolegal situation. This chapter will focus on the major concerns a physician must have when treating an injured patient—the intersection/interaction among trauma, forensic medicine, and the law. The trauma patient with physical and emotional injuries can bring legal issues, some of which can be more challenging to the trauma team than the clinical problems. Legal issues can range from civil rights to criminal law, and the team needs to have some basic knowledge to appropriately address medicolegal issues that may arise. Despite differing and ever-changing laws from state to state, some basic guiding concepts can be set forth.1

CONCEPTS, PRINCIPLES, AND DEFINITIONS

It should be noted that legal and medical definitions or concepts may differ and that such variances are important to medical personnel interacting with forensic and legal personnel, especially in a courtroom, deposition, or adversarial situation. Some general definitions are as follows:

  • Abandonment—Terminating care of a patient without assuring 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—Prohibits the health care provider from disclosing information about the patient’s case to others ...

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