ICU and Forensics

1.Describe information which should be consistently communicated by healthcare providers for those patients thought to be injured due to a violent crime. 2.List items which the healthcare provider may see that could be considered evidence. 3.Review the steps in preserving evidence with the chain of custody. 4.Discuss HIPAA, Protected Health Information (PHI) and how these impact information relayed to detectives or investigators OBJECTIVES

Nurse to Nurse Report Report from unit to unit and shift to shift should include information related to: patient status any ongoing evidence collection pertinent information related to an ongoing criminal investigation

Care of the patient/care of the evidence “Gone are the days when the healthcare clinician could opt out of addressing forensic issues with patients by claiming their need to save a life or to focus soley on physical care needs at the cost of preserving evidence and all that is entailed with forensic considerations” (Sekula, 2005)

Maintain airway Maintain hemodynamic stability Replace volume Watch for signs and symptoms of complications. PATIENT CARE

Holistic nursing includes: Evidence collection Preservation of evidence Maintaining chain of custody of evidence EVIDENCE CARE

What items can be considered evidence? Patient clothing Debris from patient hair or body The description of the wound

Maintaining the chain of custody for evidence includes documentation of its possession from the time the item(s) are removed from the patient until shown in court.

Patients who are victims of violent crimes Should be listed in the hospital directory as a “No Information” Protecting healthcare providers, other patients and the victim are a priority Watch for visitors who exhibit suspicious or negative behaviors

FAMILY Immediate family may visit if approved by security Medical information should only be given as approved by patient. If patient is unable to respond give information as designated by law.

WHAT CAN BE TOLD TO DETECTIVES/INVESTIGATORS Verbal comments made by family or patients that may be pertinent to the investigation Don’t forget to document this information in quotes in the nursing record

Detectives/Investigators Per the Department of Health and Human Services PHI may be shared with law officials for enforcement purposes in 6 defined scenarios and specific conditions:

As required by law such as a court order, court ordered warrant, subpoenas and administrative requests To identify or locate a suspect, fugitive, material witness or missing person In response to a law enforcement request for information about a victim or suspected victim of a crime

To alert law enforcement of a person’s death if the healthcare entity believes that criminal activity caused the death If the protected health information is evidence of a crime that occurred on the entity property By a covered health care provider in a medical emergency not occurring on the premises and the information is needed to describe the crime, the victims and the perpetrator.

If none of these criteria are met than the patient must consent to the release of PHI

What if the patient is incapacitated and unable to consent?

PHI may be released if The information is needed to determine if a law was violated and the PHI will not be used against the patient (victim) The investigation would be negatively impacted by a delay in getting this information. The entity believes the release of the information is in the best interest of the patient.

For further information related to the release of PHI for law enforcement purposes visit the Department of Health and Human Services website. Additionally check with your entities specific guidelines related to PHI.

Written documentation Should include: Statements made by the patient, visitors or family that the in the healthcare providers’ professional judgment could be important to the investigation. Use quotation marks in your documentation. Types and locations of the wounds If evidence was collected how, where, what and who

Medical Examiner This patient developed ARDS, renal failure and continued to decline. After 3 days the patient expired. Medical Examiner’s office notified of his death and an autopsy was ordered.

REFERENCE Department of Health and Human Services. (2002). Standards for privacy of individually identifiable health information; final rule. (45 CFR Parts 160 and 164) [On-line]. Available: Department of Health and Human Services. (2003). OCR Privacy Brief. [On-line]. Available: Evans, M.M., Stagner, P.A. (2003). Maintaining the chain of custody, evidence handling in forensic cases. AORN Journal 78 (4), Sekula, K.L. (2005). The Advance Practice Forensic Nurse in the Emergency Department. Topics in Emergency Medicine 27 (1), 5-14.