MEDICOLEGAL ASPECT OF ER PRACTICE PREPARED BY ABU GHARBIEH MAZEN, MD. EMERGENCY DEPARTMENT MAKASSED HOSPITAL JERUSALEM

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MEDICOLEGALASPECT OF ER PRACTICE PREPARED
BYABU GHARBIEH MAZEN, MD.EMERGENCY
DEPARTMENTMAKASSED HOSPITALJERUSALEM
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• Palestinian laws
• Standard medical
• practices

• ER
• Physician
• health care providers

Obligate
ACT
patients
Interface within the context of the legal and
justice systems
the state
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CASES WITH LEGAL ASPECTS
ASSAULT INJURIES
POISONING
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What should ER health Care providers know ?
Their duties
Rights of the patient
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• Duties of Physician health care providers
• in ER
• Awareness of legal obligations.
• Recognize patterns of injury.
• Documentation of Observations.
• Processing evidences.
• History and data collection patient
  witnesses.

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• Documentation of physical examination.
• Using diagnostic and documentary tools.
• Documentation of the injury by photography.
• Case reporting to state social services or law
  enforcement agencies.
• Death declaration.

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• RIGHTS OF THE PATIENTS
• Respectful care.
• To know, by name, the physician responsible for
  coordinating his or her care.
• To obtain from his or her physician complete
  current information about diagnosis, treatment,
  and prognosis in easily understandable terms.
• To receive from his or her physician information
  necessary to give informed consent prior to the
  start of any procedure or treatment. Except in
  emergencies.
• To refuse treatment to the extent permitted by
  law.

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1. To be transferred to another facility, providing
   the transfer is medically permissible, and the
   facility has agreed to accept the patient.
2. To expect that medical information, will be
   communicated to the referring physician.
3. To privacy concerning the medical care program.
   Case discussion, consultation, examination, and
   treatment are confidential and will be conducted
   discreetly.
4. The patient has the right to know in advance what
   appointment times and physicians are available
   and where to go for continuity of care provided
   by the Clinic.

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• Cases to be reported
• Child and elderly abuse.
• Domestic violence.
• Suicidal cases.
• Gun shot injuries.
• Rape.
• Illegal pregnancy.
• MVA.
• Infectious diseases
• AIDS.
• TB.
• Meningitis.
• Cholera etc.
• Drug and narcotic abuse.
• Mammals bite mainly rabies prone.
• Unexplained death for any age.

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PATTERNS OF INJURY
Mode of production
circumstances
components

• Abrasion
• Bruise (ecchym)
• Contusion
• Laceration/tear
• Stab/cut
• Bite
• Burn
• Missile
• penetration
• 9. Strangulation

Homicidal
Accidental
blunt force
Suicidal
sharp force
electricity
chemicals
missile
heat
Wound Description
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MISSILE PENETRATING WOUNDS
Entrance wounds Exit wounds
1 Circular, oval, or triangular Longitudinal
2 Circumferential rim of abrasion Do not sustain friction damage
3 Presence of gunpowder Absent
4 Minimal bleeding Large amount of bleeding
5 Smaller in size Larger in size
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• Physicians without forensic training should avoid
  giving any opinion regarding a wound being an
  entrance or exit.
• Identification of the site of the entrance and
  exit of a gunshot wound path is an important step
  in the reconstruction of the shooting incident.
• Clothing soiled with gunpowder residue must be
  protected and retained for collection by
  law-enforcement agencies for analysis in the
  crime lab.

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HISTORY EVALUATION
POISONING
TOXIC INGESTION
NON TOXIC INGESTION
SUBSTANCE/S
QUANTITY
ROUT
REASON
TIME
AVAILABILITY
S/S TOXODROMES
LOCATION Home/work
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• MEDICAL RECORDS
• Confidential.
• Subject of a legal proceedings.
• Central part of the court deliberations.
• Testimony from the physician that created that
  record.
• Cross-examine by the defendant or the accused.
• Physicians must recognize the legal
  responsibility
• that society places on them and be prepared
  to
• provide competent, professional testimony
  when
• required.

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• Should contains proper documentation
  information.
• make the record more representative gt use tools
  and photos etc.

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• What do my medical records contain?
• Patient medical history (mainly patients own
  words).
• Familys medical history.
• Lab test results.
• Prescribed medications.
• Details of patients lifestyle (which can include
  smoking, high risk sports and alcohol and drug
  use).

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• Who holds and gives access to records?
• GPs.
• Hospitals.
• Social Workers.
• Courts.
• Law enforcing agencies.

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• Who can see patients medical records?
• Patient.
• Anyone who has patients written permission.
• Patients parent or guardian if they are under
  16.
• A representative appointed by a court.
• After patients death gtgt his personal
  representative.

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• PRESERVATION AND COLLECTION OF EVIDENCE
• extremely valuable.
• Protocol gt consultation with the local law
  enforcement agency.
• The use of a simple envelope that enables a
  physician to
• Identify the patient.
• The date the evidence was recovered.
• Where it was recovered from.
• And to whom it was given.
• Signed and sealed by the physician for its
  protection.
• Use of an appropriate receipt form documenting
  the transfer
• of this evidence.

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• Evidences to be collected and preserved
• Weapons ( bullets, knifes etc ).
• Wounds particles ( gun shot powder ).
• Clothing.
• Blood and other body materials. (evidence of
  sexual assault).
• Gastric content.
• Poisons and medications.
• Photographs.
• X rays.
• Notes consultations.

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• REPORT OF DEATH
• An important responsibility of the emergency
  physicians.
• Notification local law-enforcement agency
  attorney general.
• Case identification those require an
  investigation of the
• 
  circumstances of the death.
• Determination whether an autopsy is necessary or
  not.

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• Such deaths are generally those
• individuals who die suddenly while not under
  theimmediate care of a physician.
• any death associated with some type of injury.
• suspicious or unusual death.
• It should be emphasized that

1. the length of time a patient has been in
   hospital
2. the age of an injury associated with the
   underlying cause of death

Are not a factor in determining whether the death
should be reported to the law authority.
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Legal aspect of CPR
Rescuers are Volunteers (Good samaritan)
Rescuers are Professionals CPR is part of their
job
Protected
Not protected (Gross mistakes)
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• CPR WHEN TO STOP IT ?
• 1. The victim's breathing heart beats begin on
  their own.
• 2. Until other rescuers take over your effort.
• 3. Until you are exhausted unable to continue.
• 4. Obvious signs of death are apparent.
• 5. A medical professional tells you to stop.

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• When not to start CPR
• Obvious signs of death
• Dependent livido black, blue or reddish
  discoloration of
• the skin.
• Rigor mortis rigidity.
• Algo mortis low temperature.
• Injuries that are incompatible with life.
• Threats to rescuers safety.
• Valid order of DNR ???.