Trauma team and law enforcement activities repeatedly intersect in various locations for a variety of reasons in the course of mutual and integrated responsibilities:
- 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
- Quality review and reporting obligations
- Disaster medical response
- Professional liability
- Testifying in court/depositions.
This chapter addresses 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.
(Adapted from Weigel, Charles in Trauma, Moore, Feliciano, Mattox, 2nd edition).18
When in doubt and time and life are running out, TREAT
Have specific instructions for judicial intervention and emergency psychiatric detention readily available in the trauma center.
Be mindful of Hippocrates 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 the avoidance of potential criminal penalty and civil liability.
The police department’s duty is containment and control; the trauma team’s 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 the attending physician, hospital, attorneys, or quality surveillance. Records must be complete, accurate, timely, legible, and honest. Corrections to records can be made, dated, and timed, but the original entry must not be removed.
Difficulty and recurring problems can be more efficiently resolved through judicious preconsideration and planning.
The physician is an integral and essential part of the judicial system, and knowledgeable participation will benefit the physician, his or her patient, and health care in general.
Commonsense and human care and communication can be as important insulation factors from legal liability as good technique and clinical care.
Freely use consultation and escalation of concerns when indicated. There are always persons, processes, and resources to provided unknown, unfamiliar, or clarified information.
Over 1.6 million people lose their lives throughout the world each year as ...