LEGAL ISSUES
DOMESTICVIOLENCE
This form of assault often causes a dilemma for emergency physicians. Many
of the victims do not want reports made. There are reporting rules that
include injuries resulting from domestic violence in only 7 states. In many
states, if the patient does not want a report made, you cannot call the police.
However, some states require reporting of injuries that appear to be intention-
ally inflicted.
CHILDABUSE
This is another form of assault, but it deserves its own category because the
reporting rules are clearer and more consistent. Children cannot decide that
they do not want an assault reported. They still have privacy interests, but the
society’s interests in protecting children are universally understood and
accepted.All states have laws protecting children and require mandatory
reporting of child abuse.Some even include express immunity from suit for
reporting health professionals. In all jurisdictions, the good faith communica-
tion is privileged.
There Are Still Some Variations for Emergency Physicians to Learn When
They Go to a New State to Practice
■ Definition of “child” may vary with statutory language or by reference to
other concepts, such as emancipated minors.
■ What constitutes abuse is inconsistent. Generally it is any nonaccidental
serious physical injury inflicted by any adult responsible for the child.
Some states include neglect as a form of abuse.
■ Mechanisms of reporting vary. Sometimes, the staff member tells the
authority in charge of the hospital. Many states require a verbal report fol-
lowed by a written one.
Child abuse is one of only two situations where patients may be held in the
ED against their and their parents’ wishes, the other being the patient who
lacks capacity and puts himself at immediate great risk by leaving. Sometimes
the only way ED staff can assure protection for the child is to arrange admis-
sion. Hospitals have been successfully sued for failing to report abuse in chil-
dren who are subsequently reinjured. Criminal penalties for failing to report
appear in many state laws.
ELDERABUSE
Neglect can also present as apparent self-care deficit. Many states now have
adult protection laws, some for all adults, some only above a stated age. These
reporting rules usually call for initial contact with a social service agency, like
adult protective services.
Monitoring
Births and deathsinvolve forms and certification best left to hospital officials or
personal physicians. Adverse drug and device event reporting is voluntary,
unless hospital rules require it. Some reports are made by notations kept in logs
distinct from the medical record and those logs submitted periodically or simply
kept for access by reviewing authorities. Examples include the EMTALA man-
dated log of those who “come to the emergency department” and traumareg-
istries. Other situations involve purported physician or hospital misdeeds.
Except in a small handful of
states, emergency physicians
may not report rapes or
domestic violence not
involving a lethal weapon,
over the victim’s objection.