Canada: "Doctors urge ERs to report gun injury"

[cuchulainn]

from the Toronto Star

http://www.thestar.com/NASApp/cs/Co...209&call_pageid=968350130169&col=969483202845

Doctors urge ERs to report gun injury

Chief complains police aren't told
OMA group wants to resolve tension

BETSY POWELL
CRIME REPORTER

Emergency room physicians across the province should be required to report to police when a patient turns up with a gunshot wound, says a new position statement adopted by the emergency medicine section of the Ontario Medical Association. Ontario law doesn't compel hospitals to inform police when it appears a patient was injured by a gun during a crime, though physicians are obligated to report suspected child abuse, patients unfit to drive and a long list of communicable diseases.

This has led to occasional emergency-room showdowns, police clashing with hospital officials who deny access to information, citing patient confidentiality. The OMA section that represents emergency doctors, a semi-independent body, has concluded it's time to resolve the impasse, says the paper published in this month's Ontario Medical Review.

"We're approaching this from a public health and safety perspective; we're not approaching this from a criminal justice perspective," said Dr. Howard Ovens, director of the Schwartz-Reisman Emergency Centre at Mount Sinai Hospital and one of the paper's four authors. "If we're going to violate our patients' privacy and confidentiality, there has to be an overriding public interest. With gunshot wounds, because of the lethality of guns, we feel it meets that test."

Toronto police Chief Julian Fantino has repeatedly criticized hospital officials for not alerting police when people arrive with gun wounds.

In a recent radio interview, he attributed statistics showing a lower crime rate to, among other things, people showing "up at hospitals with bullet holes in them ... (that) we don't even hear about."

But the recommendation doesn't suggest that a significant number go unreported, Ovens said yesterday.

"I am not any kind of expert on crime rates, (but) I don't think that our paper supports the notion that this is a very frequent occurrence," he said. "I think it should be reportable, as suggested in the paper, but I don't want to give the impression that this is happening every day."

The paper follows a peer-reviewed survey sent to 788 emergency room physicians last fall, 227 of whom responded.

Seventy-five per cent were of the view that there should be mandatory reporting of gun wounds, regardless of whether the injury was suspected to be intentional or accidental.

The survey also found considerable confusion about the issue. Some 58 per cent indicated they didn't know whether reporting was mandatory.

The emergency room doctors were asked how many gunshot wounds they had seen during their ER careers in Ontario. Almost 20 per cent said none; 46 per cent said they had seen one to five; and 17 per cent reported seeing more than 10.

More than half of those who had treated gunshot wounds had never notified police. But that statistic doesn't distinguish between accidental wounds, such as hunting mishaps, and those potentially crime-related.

A compelling argument for making reporting mandatory is that it will allow better data collection, Ovens said. "Our public health people can tell you exactly how many cases of genital herpes we had in Toronto. We can't tell you how many gunshot wounds there's been. That doesn't seem right to me."

Ovens said the emergency-medicine section developed its position after considerable research and discussion within the broader OMA.

"It is our feeling that this represents a majority position. There will certainly be voices we hear from who feel differently, but I think it's fair to say we've gone through a process and this represents sort of a consensus statement," he said.

The physicians are calling on the province to draft legislation to resolve the "source of conflict between health-care workers and law enforcement officials."

Copyright 1996-2003. Toronto Star Newspapers Limited