Several weeks ago, during an evening shift in my emergency room, a motor vehicle accident victim was brought into my department by ambulance, having suffered minor injuries as a result of her crash.

The patient, a woman in her 40s, had driven her car into the back of another automobile, causing significant damage to her vehicle and injuring the two occupants of the car she struck.

As I examined this woman, it became apparent to me she was likely under the influence of alcohol at the time of the accident. Her breath smelled strongly of liquor, her words were slurred, and her balance was unsteady.

Speaking to the attending paramedics, I was informed police had not interviewed the woman at the scene and she had not yet been subjected to an alcohol breath test. Assessing the patient for injuries, I proceeded to order x-rays and CT scans, as well as lab tests to screen for alcohol and drugs of abuse.

Two hours later, having ruled out any major injuries to my patient as a result of her accident, I was informed she had refused all laboratory investigations I had ordered, as is her right under our laws. Further, inexplicably, police had still not shown up to interview her and she was now stating her desire to go home.

Faced with no reasonable justification to keep her in hospital, I was forced to watch as she got up from her stretcher and walked out of my ER, patient confidentiality legislation preventing me from taking any action to inform police of my suspicions.

As she strolled through the hospital’s exit, she looked back at me and gave me a smirk -- a knowing glance that communicated what we both knew: she had committed a crime that had injured others and gotten away with it.

I have never in my career as a physician felt so powerless to carry out my obligation to protect the public as I did at that moment.

Patient confidentiality is one of the foremost principles by which all physicians must abide. While precise laws differ from province to province, there are only a few very specific instances during which a physician may break confidentiality without repercussions.

These include either threats by a patient to harm another person or themselves, or clear evidence of medical disorders that make driving unsafe -- like epilepsy, blackouts, dementia or ongoing impairment due to a “certainty” of substance abuse.

More recently, however, the provinces of Saskatchewan, Manitoba, Ontario, Québec and Nova Scotia have enacted legislation making it mandatory for physicians to report to police when a victim of a gunshot wound arrives in their care.

When the Ontario gunshot law (Bill 110), the first of its kind in Canada, was enacted in 2005, debate was furious, pitting the societal danger of guns in the community against the risk that such a reporting requirement would lead to shooting victims avoiding hospital care.

However, at the time, it was ultimately felt by the government and by law enforcement that the risk posed by police being unaware of shootings in their community trumped individuals’ rights to doctor-patient confidentiality.

Weighing these same two counter arguments -- societal risk and potential avoidance of medical care due to police involvement -- is an exercise that leads me to believe, as a physician, that if we are willing to break confidentiality over gunshots, we should be open to taking similar action when it comes to suspected cases of impaired driving.

The argument demonstrating societal risk from impaired driving is an easy one to make. In 2011, while only 158 homicides were recorded due to the use of firearms across Canada, over 1,000 Canadians were killed in motor vehicle collisions involving alcohol impairment -- a death rate almost seven times greater, representing a massive danger to society by any measure.

As for the risk of patients not seeking medical care due to fear of legal repercussions, the experience we have with Ontario’s gunshot law is a helpful indicator. A study published in the Canadian Journal of Emergency Medicine in 2009, assessing the effect of Bill 110 appears to vindicate the government’s position that the legislation produced little harm and significant benefit. It found 86% of physicians believed the law had not affected their relations with gunshot patients, while only six cases of patients delaying their hospital visits due to fear of police involvement were reported. At the same time, 100% of police surveyed stated the law had helped with their investigations in such instances.

So, when impaired driving is a leading killer of Canadians, when physicians already routinely break confidentiality to report conditions that are unsafe for driving like epilepsy, and when experience from gunshot laws shows that physicians’ reporting of significant dangers to the public does not affect relations between them and patients, why do our current laws force doctors to prioritize impaired drivers’ confidentiality over the safety of the general public?

It is a question I don’t have an answer for, but one thing is clear: If my motor vehicle accident patient goes on to kill herself or an innocent victim in an alcohol related crash, the guilt for this will lie squarely and inexcusably on a system that stopped her doctor from acting before it was too late.

Dr. Brett Belchetz,
Emergency Room Physician
Medical Expert for Sun News Network

Source: Toronto Sun


Last updated on: 2014-08-29 | Link to this post