A 32-year-old man presents in police custody for bizarre behavior. He was the driver of a vehicle which struck a telephone pole. He was reportedly singing and dancing naked in the street following the motor vehicle collision. The police would like to ask him some questions about what happened. Should the patient talk with the police? What is your role as the emergency physician?

Introduction

Law enforcement officers frequently accompany emergency department (ED) trauma patients or patients who are under arrest or require assistance. At times, law enforcement officers may request assistance from ED staff to gather information or evidence. Ethical dilemmas may arise when balancing the physician’s moral duty to act in their patients’ interests and protect patient confidentiality with the physician’s legal obligations.¹ ACEP’s Policy Statement, “Law Enforcement Information Gathering in the Emergency Department,” provides guidance for these situations. The policy states that physicians can release patient information to law enforcement in three situations:

1. The patient consents to the release of the information
2. The law mandates that physicians report such information
3. Law enforcement officers provide a subpoena or court order²

Confidentiality

Protecting patient confidentiality is an important duty.³ One of the clauses of the Hippocratic Oath states: “Whatever I see or hear in the lives of my patients, whether in connection with my professional practice or not, which ought not to be spoken of outside, I will keep secret, as considering all such things to be private.”⁴ This obligation to protect patient privacy is also iterated in federal and state laws, including the Health Insurance Portability and Accountability Act of 1996 (HIPAA).⁵ Any identifiable information is considered PHI (Protected Health Information). Specific elements considered PHI include:

• Names
• Dates, except year
• Telephone numbers
• Geographic data
• Fax numbers
• Social Security numbers
• Email addresses
• Medical record numbers
• Account numbers
• Health plan beneficiary numbers
• Certificate/license numbers
• Vehicle identifiers and serial numbers including license plates
• Web URLs
• Device identifiers and serial numbers
• Internet protocol addresses
• Full face photos and comparable images
• Biometric identifiers (i.e., retinal scan, fingerprints)
• Any unique identifying number or code

There are important exceptions to confidentiality, to protect the patient and/or the public.⁶ All states have mandatory reporting laws that establish a duty to report certain types of abuse or mistreatment to state and local authorities. Report of other conditions of public health concern also may be required (for example, tuberculosis, gonorrhea, etc.). Most states also have requirements to report specific injuries, such as gunshot wounds and knife wounds.