When should doctors report gunshot, knife wounds and other violent injuries?

Earlier this month, the BBC reported that some knife crime victims are reluctant to go to hospital to get their wounds stitched as they fear the police will get involved. Some victims are worried that they may be implicated if the police pursue the person who attacked them. Frontline workers who deal with gang violence report that they know people who have paid a vet to treat a stab wound rather than go to their local accident and emergency department.

According to police recorded crime figures, violent crime in England and Wales has risen by 24%, including a 9% rise in knife crime and a 7% rise in gun crime in the 12 months from June 2015 – June 2016. Understanding what has driven this rise in crime is complex – a wide range of factors including improvements in recording as well as an actual rise in knife and gun crime are likely to have contributed. A knife or blade was used in a crime every 16 minutes on average last year.

The General Medical Council (GMC) has published revised guidance on confidentiality for all doctors practising in the UK which comes into effect on 25 April 2017. Until that time existing guidance should be followed. The GMC have also published revised explanatory guidance which sets out how the principles apply when a patient presents with a gunshot wound or knife wound. In addition, this revised explanatory guidance now clarifies that the decision whether or not to call the police when a patient presents with a gunshot or knife wound is a professional judgement and is not mandatory in all cases. This was always the intention, but emergency doctors had expressed concern that the previous guidance could be applied in a way that was disproportionate and harmful to patients’ trust. It also clarifies that the principles set out could apply to other kinds of violent injury.  

Should the police be informed about gunshot, knife wounds and other violent injuries?

Police should normally be informed if a person comes to hospital with a gunshot wound or wound from a knife or other sharp instrument.

The police are responsible for assessing the risk posed by someone who is armed/has used a gun or a knife. The police need this information to consider:-

• Risk of further attack on the patient
• Risk of attack to others in the hospital
• Risk of another attack near or at the site of the original incident
• Statistical information to inform crime reduction priorities and to improve their understanding of how to tackle violent crime.

The Cardiff Model

The ‘Cardiff Model’  developed by the Violence and Society Research Group is a mechanism of sharing and using anonymous data collected from violence related Accident & Emergency admissions about the precise locations and times of violent incidents and weapon used to help support effective policing, such as tackling crime hotspots and informing violence prevention strategies. In areas where it has been implemented it has led to a significant reduction in admissions as a result of violent crime. A study in 2012 found that an effective information-sharing partnership between health services, police and local government in Cardiff led to substantial cost savings for the health service.

Involving the police

• The first responsibility of the healthcare team is to the patient's welfare 
• Personal information about the patient does not need to be disclosed to the police in the initial contact
• The police should not have access to the patient if it will compromise the patient's treatment or recovery
• If the police wish to speak to the patient, a member of the healthcare team should ask the patient if they are in agreement and if they are not everyone must abide by that decision
• The patient's consent should be asked for before providing personal information to the police unless by doing so it
• May put the healthcare team/others at risk of serious harm
• May undermine the purpose of the disclosure
• If the patient is unable to give consent because they are unconscious or refuse consent, the doctor can disclose information if:-
• It is required by law
• Disclosure is justified in the public interest.
• If there is no public interest reason to disclose information to the police, no personal information should be given. In such a situation the police can seek an order from the court.

Disclosures in the public interest 

The decision as to whether there can be disclosure in the public interest should be made by/with the agreement of the:-

• Consultant in charge
• Caldicott/data guardian.

Disclosure may be justified if:-

• Failure to disclose the information may put someone other than the patient at risk
• It may help in relation to the prevention or detection of a serious crime.

A note should be made in the patients record stating:-

• Steps taken to seek consent
• Reasons for disclosing without consent
• Steps taken to inform them about the disclosure/reasons for not doing so.

What if the wound is an accident?

• Guns - The police should normally be informed about an accidental shooting as it will raise serious issues about firearms licensing.
• Sharp instruments - If the wound is an accident or self-harm it may not be proportionate to contact the police if for example:-
• No-one other than the patient is at risk of harm
• Contact with the police may cause the patient harm or distress
• Contact with the police may damage the patient/doctor relationship.

Children/young people under 18

Child protection concerns must be considered and the guidance in Protecting children and young people: The responsibilities of all doctors should be followed.

How Bevan Brittan can help

Making decisions about when to share confidential information can often be difficult and stressful. In relation to any decision, the issues and grounds of disclosure need to be considered, if appropriate debated with a senior colleague and then clearly documented in the notes.

Bevan Brittan has substantial experience in advising healthcare professionals in connection with the disclosure of confidential information. If you would like to discuss any of the issues raised please contact us. 

Resources

• Stab victims paying vets to stitch their wounds – March 2017
• Good practice in handling patient information (coming into force in April 2017)
• Confidentiality: reporting gunshot and knife wounds - GMC (coming into force in April 2017)
• Protecting children and young people: The responsibilities of all doctors – July 2012
• Effective NHS contributions to violence prevention. The Cardiff Model 
• Reducing violent crime – Cardiff university  
• An economic evaluation of anonymised information sharing in a partnership between health services, police and local government for preventing violence-related injury Curtis Florence, Jonathan Shepherd, Iain Brennan, Thomas R Simon 2012
• My GMP – The GMC have created a new app which signposts to the revised guidance and which in April will also have additional resources and case studies.