Quick one if poss - DV injuries presented at A&E - responsibilities of A&E staff.

[Pan]

Current incident woman taken in to hosp by ambulance with severe head injury - been whacked by partner with bottle. No children involved. She says what happened but doesn't wish prosecution. Do the A&E people have a duty to report it, even if she indicates no prosecution wanted? I am sure they do, and should 'break confidentiality' thing. Anyone know for sure?
tia.

webarchive.nationalarchives.gov.uk/+/www.dh.gov.uk/en/Publichealth/Healthimprovement/ViolenceagainstWomenandChildren/DH_113753 2010 - don't know if updated since then - will look

Pretty sure the hospital have to ring the police and the police can proceed without permission from woman

Custy - ta, have ploughed through but no definitive answer.
lisad - do you know this? It's a repeat pattern (for her) and little is being done - hence A&E resp. right at the start of things.

I'm 80% certain it was new guidelines but could just be about of child involved because of my work.
Can you report him?

would ringing womens aid to ask be of use?

Not really. no reason I can't ask myself but I don't want a 'why are you asking?' type response.
If any helpful soul has the definitive answer or experience of this could you flag it up please. It's a worky thing and can wait til Monday with no harm to anyone. Just would have been really useful to know this afternoon.
cheers.

have fwd to a mnetter nurse she might be able to help

thanking you kindly, custy. I am surrounded by a whole bunch of people in 'related' fields, and we are sitting here rather uselessly going.."er......"

is there not a legal department you could go to ( not last thing on a fri thats for sure) just thinking if you couched it less about patient care and more about liklihood of being sued - someone might listen?

just a thunk

gud thunk!

The hour has passed tho'. will proceed on Monday.

The GMC has a guidance document on confidentiality that you will be able to google.

The issue of whether the woman has capacity to decide on no police intervention is also relevant.

I work in ed and if a person presented with dv injuries I would ask them if they would like to have the police involved of yes I would call them of no I would give them numbers to call and report the injured party to social services as a vulnerable adult

*if and apologies for no punctuation in on a broken iPhone

If she is mentally capable of refusing to involve the police then she is entitled to have her confidentiality respected the same as someone who has been assaulted by a friend or neighbour and doesn't want them prosecuted.
If victims of DV didn't have confidentiality respected they may decide not to seek medical help or to lie about how they got their injuries.
You can break confidentiality if the victim is a child or is an adult you think lacks capacity, but most doctors would take medicolegal advice and get a psychiatric opinion in the latter case before informing the police.
A male victim of DV is also entitled to medical confidentiality. If the DV was severe enough that a doctor thought the woman's life was in danger then she could inform the police but would usually contact their defence body first and definitely would seek advice of the consultant. This is very rare.

"51. It may be appropriate to encourage patients to consent to disclosures you consider necessary for their protection, and to warn them of the risks of refusing to consent; but you should usually abide by a competent adult patient?s refusal to consent to disclosure, even if their decision leaves them, but nobody else, at risk of serious harm.22 You should do your best to provide patients with the information and support they need to make decisions in their own interests, for example, by arranging contact with agencies to support victims of domestic violence.

52. Disclosure without consent may be justified if it is not practicable to seek a patient?s consent. See paragraph 38 for examples, and paragraph 63 for guidance on disclosures to protect a patient who lacks capacity to consent."

!36. There is a clear public good in having a confidential medical service. The fact that people are encouraged to seek advice and treatment, including for communicable diseases, benefits society as a whole as well as the individual. Confidential medical care is recognised in law as being in the public interest. However, there can also be a public interest in disclosing information: to protect individuals or society from risks of serious harm, such as serious communicable diseases or serious crime; or to enable medical research, education or other secondary uses of information that will benefit society over time.

37. Personal information may, therefore, be disclosed in the public interest, without patients? consent, and in exceptional cases where patients have withheld consent, if the benefits to an individual or to society of the disclosure outweigh both the public and the patient?s interest in keeping the information confidential. You must weigh the harms that are likely to arise from non-disclosure of information against the possible harm both to the patient, and to the overall trust between doctors and patients, arising from the release of that information.
38. Before considering whether a disclosure of personal information would be justified in the public interest, you must be satisfied that identifiable information is necessary for the purpose, or that it is not reasonably practicable to anonymise or code it. In such cases, you should still seek the patient?s consent unless it is not practicable to do so, for example because: (a) the patient is not competent to give consent, in which case you should consult the patient?s welfare attorney, court-appointed deputy, guardian or the patient?s relatives, friends or carers (see paragraphs 57 to 63) (b) you have reason to believe that seeking consent would put you or others at risk of serious harm (c) seeking consent would be likely to undermine the purpose of the disclosure, for example, by prejudicing the prevention or detection of serious crime, or (d) action must be taken quickly, for example, in the detection or control of outbreaks of some communicable diseases, and there is insufficient time to contact the patient."

Missed out a bit

"38. Before considering whether a disclosure of personal information would be justified in the public interest, you must be satisfied that identifiable information is necessary for the purpose, or that it is not reasonably practicable to anonymise or code it. In such cases, you should still seek the patient?s consent unless it is not practicable to do so, for example because: (a) the patient is not competent to give consent, in which case you should consult the patient?s welfare attorney, court-appointed deputy, guardian or the patient?s relatives, friends or carers (see paragraphs 57 to 63)
(b) you have reason to believe that seeking consent would put you or others at risk of serious harm
(c) seeking consent would be likely to undermine the purpose of the disclosure, for example, by prejudicing the prevention or detection of serious crime, or
(d) action must be taken quickly, for example, in the detection or control of outbreaks of some communicable diseases, and there is insufficient time to contact the patient."

If no children involved and woman categorically states she does not wish for police to be involved, then A&E cannot break her confidentiality - they can however ensure it is very well documented so that a future prosecution would be possible.

Well thanks very much for all of this. She is sane and there is no grounds to break confidentiality, though even the A&E staff are aware who is repeatedly assaulting her. She presents with falls in the bath etc. This time it was falling over the cat on the stairs.
It's difficult to accept though. It's all v apparent and documented but no grounds to intervene to stop it.

I'll copy/paste this to work and talk with others about it.
Again many thanks for your assistances.

Do the A&E people have a duty to report it

No this is not the US where, in many states, gunshot wounds have to be reported.

The A and E staff have a duty to provide care, and to keep patient confidentiality unless the woman is going to hurt herself or someone else.

Ah, I am v reliably informed that in the UK here injuries from firearms must be reported.

just by way of an update, we have argued that as a repeat victim in a life-threatening situation we are treating her as a 'vulnerable adult', legally. So the question of 'confidentiality' will be put aside. It hinges on this bit from rebecca above: "You must weigh the harms that are likely to arise from non-disclosure of information against the possible harm both to the patient...".
The overall question is, at what point do you take the initiative away from a woman, and essentially treat her like she can't make her own decisions?

Even if you are looking at vulnerable adults legislation, the issue of capacity is still relevant, and your actions are extremely limited where a person does have capacity.

gmc have issued guidance about gunshot and knife wounds

in absence of children at home depends on whether the risk to others supersedes the pt confidentiality

53.Disclosure of personal information about a patient
without consent may be justified in the public
interest if failure to disclose may expose others to
a risk of death or serious harm. You should still seek
the patient?s consent to disclosure if practicable
and consider any reasons given for refusal.

54. Such a situation might arise, for example, when a disclosure would be likely to assist in the prevention, detection or prosecution of serious crime,1 especially crimes against the person. When victims of violence refuse police assistance, disclosure may still be justified if others remain at risk, for example, from someone who is prepared to use weapons, or from domestic violence when children or others may be at risk.

55 If a patient?s refusal to consent to disclosure leaves
others exposed to a risk so serious that it outweighs
the patient?s and the public interest in maintaining
confidentiality, or if it is not practicable or safe to
seek the patient?s consent, you should disclose
information promptly to an appropriate person or
authority. You should inform the patient before
disclosing the information, if practicable and safe,
even if you intend to disclose without their consent

in reality would seek consultant and senior staff advice, and maintain robust documentation

re:capacity. in a nutshell pts are assumed to have capacity unless it is demonstrably absent. and capacity assessment is decision specific- that a specifc decision is being assessed eg do you want to report dv

It must be a difficult position for you to be in as professionals who want to help this woman.

A question though - what happens if you report it and no conviction is achieved?

Could the outcome be that she stays away from hospital in the future? (Perhaps he doesn't let her go?)

I'm not saying you shouldn't do it, just that you do need to consider this.

thats a lot of what ifs
if injured but ambulant its up to pt were to present. her partner may well exert pressure where she presents but that wont alter assessment or treatment
if brought in by ambulance they go closest A&E that open