Nursing and legal system “When Police Ask For Help” is an abstract team that brings together the two most powerful system affecting the lives of people throughout the world_ Health and Justice. Nursing as a helping profession, leaves a nurse at liberty of being sorted by the general public (Sick or well) to include police officer’s
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Nurses interact with the police in a number of different ways. They may be asked to respond to inquiries from police or provide a copy of a patient’s chart because they have assessed and treated patients who are alleged victims or suspected perpetrators of crimes. In some instances, a nurses’ own conduct or the conduct of her colleagues may be the subject of a police investigation. In addition, there are times when a nurse may, in the interest of the patient or others, consider initiating contact with police to report information about a particular patient. In these situations, nurses find themselves balancing their obligation to maintain patient confidentiality with their commitment to the public good.
The criminal justice system is complex and its intersection with health care can lead to challenging legal, professional and ethical issues. Nurses should therefore understand their ongoing obligation of patient confidentiality on when they may disclose personal health information (PHI) to police, how much information to disclose, when they need to refer a police inquiry to higher authority and when it would be prudent to decline to respond to police inquiries.
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DUTY OF CONFIDENTIALITY
The Nigeria National Health Act 2014 Part III, Section 26
Subsection: (1) All information concerning a user (client/patient), including information relating to his or her health status, treatment or stay in a health establishment is confidentiaL.
Section: (2) Subject to section 27, no person may disclose any information contemplated in subsection (1) unless-
- (a) The user consents to that disclosure in writing;
- (b) A court order or any law requires that disclosure; or In the case of a minor with the request of a parent or guardian; and In the case of a person who is otherwise unable to grant consent upon the request of a guardian or representative.
- (c) Non-disclosure of the information represents a serious threat to public health.
Nurses are well aware that they owe a duty of confidentiality to their patients. Disclosure of a patient’s PHI without patient consent may lead to a civil action against the nurse, a complaint to his or her employer, or a complaint with the nurse’s regulatory body or the privacy commissioner. Nurses who provide professional services as employees of health care establishments may not be authorized to make decisions about disclosing PHI to police.
EXCEPTIONS TO DUTY OF CONFIDENTIALITY
There are select exceptions that authorize the disclosure of PHI in the absence of express patient consent. Nurses who provide their services as employees should ensure they understand how these exceptions apply in their jurisdiction and that they have authority before relying on them.
These exceptions include:
Court Orders (search warrants and subpoenas) as indicate in the national health act 2014 part iii, Section 26, Subsection (2b).
A Search Warrant is a written order issued by a judge or justice of the peace granting police the legal authority to enter a specified place during a specified timeframe to search for and seize evidence which may include health records.
Only the specific information or records listed in the warrant should be disclosed and the custodian generally retains a copy of the PHI disclosed pursuant to a warrant so that a complete record remains available for treatment purposes.
A Subpoena is a written command or summons requiring the attendance of someone as a witness at a legal proceeding. Failure to obey, may result in legal consequences for the nurse. However, subpoena generally does not permit a nurse to disclose PHI without patient consent, before providing testimony in the legal proceeding
In the course of carrying out their duties, nurses may gain access to information that they might consider relevant to law enforcement. There are limited circumstances in which it is permissible for health care professionals to act upon this information. For Inatance, the national health act 2014 part iii, ssection 26, subsection 2 (c) permits disclose PHI where there are reasonable grounds to believe that the disclosure is necessary to eliminate a risk of death or serious bodily harm.
Legislation governing PHI includes provisions expressly permitting the disclosure of PHI when mandated by other legislation. The provisions contained in other legislation may require disclosure to police or lead to police involvement. For instance, the compulsory treatment and care of gunshot and accidents victims act 2017, Section (4) mandating the report of patients presenting with gunshot wounds and/or stab wounds to the police within 2hours of presentation.
Police Investigation Involving a Patient
Health privacy legislation allows disclose PHI related to a police investigation. It is generally a condition that the investigation authorized by legislation, which would limit the type of police investigations in which disclosure is permissible or required. However, general information such as whether a patient is in the facility, the location of the patient in the facility and the general status of the patient (fair, poor, critical, etc.) can generally be disclosed, provided the patient does not object.
POLICE INVESTIGATION OF THE NURSE
Criminal charges laid against nurses may include theft of narcotics, theft of patient or institutional property, assisted suicide, criminal negligence, threatening harm, physical assault, sexual assault and homicide etc… Typically, a nurse would be the subject of a police investigation prior to the laying of charges. This, however may not always be apparent. During an investigation, the police may seek to interview nurses about their conduct, the conduct of their colleagues or the circumstances surrounding a particular incident. They may also request a statement. It can often be difficult to delineate this information from patient information which can only be disclosed without patient consent in specific circumstances.
Even when nurses consider it in the public interest to disclose PHI in these circumstances, confidentiality should be preserved to the maximum possible extent. Both the amount of information disclosed and the number of people to whom disclosure is made should be restricted to the minimum amount necessary to prevent the feared harm.
CONSIDERATIONS WHEN POLICE ASK FOR HELP:
- The confidentiality of PHI must be maintained, unless disclosure is expressly authorized by patient consent or legislation;
- Police may ask questions or seek evidence; however, they may not have the right to receive the requested information;
- Police are not likely, nor are they qualified, to provide you with legal advice regarding your obligations or ability to disclose PHI;
- Consider asking police to obtain a search warrant or to identify the legal authority allowing the disclosure of PHI;
- If employed, nurses should know who at their health care establishment has the authority to make disclosure decisions, including after hours;
- Consider whether a court order, warrant or subpoena provides sufficient authority for the information being sought and consult with legal counsel, if necessary;
- When required to release PHI to police, provide a copy of the information rather than the original; if disclosure of the original is required in a search warrant or subpoena, retain a copy for health care purposes;
- Document any oral or written disclosure in accordance with the requirements contained in the applicable provincial or territorial health privacy legislation;
- Where a nurse has been charged with a crime or is the subject of an investigation, refrain from making any statement to police before obtaining legal advice; and
- Be polite and professional at all times.
Thank you for explaining this in a way most comprehensible. I’ve always thought about what a nurse is supposed to do when faced with situations in which s(he) is to choose between a patient’s confidentiality and justice.
Thank You For your comment Nurse Halima
Nice write up. I want to ask a question concerning consent seeking , I know if the patient is above 18, he/she can give a consent to a procedure, but why is it that relatives are asked for consent or to sign the consent form before a procedure is done. I just read a story of a pregnant woman who died due to blood loss and the husband refused to give consent to blood transfusion during surgery, since the woman was Alice and conscious why was her consent not sought but the husband’s?
That is the Nigerian deficit mentality. I was the nurse I would have worked with the patient’s Decision so long that she is above 18 instead of the husband’s decision. something was wrong with the health practitioners to have allowed the woman die because of this preventive situation
Thank you very much sir,I have also thought of this,but thank God I know today
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