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What Exactly Can I Tell the Cops about the Patient with a Gun? - May 23, 2018

As a healthcare provider, it can be extremely difficult to assess when you should reach out to law enforcement for assistance managing patients.  There is a wide array of laws which impact how you communicate with law enforcement relating to patient care or other concerns. 


Pursuant to HIPAA, in the event there is an active investigation, law enforcement officers can inquire at your ED or another area about certain basic facts relating to people who may have been recently treated or admitted. 

This includes:

  • name and address
  • date and place of birth
  • social security number
  • ABO blood type and RH factor
  • type of injury
  • date and time of treatment
  • date and time of death, if applicable
  • a description of distinguishing physical characteristics, including height, weight, gender, race, hair and eye color, presence or absence e of facial hair (beard or mustache), scars and tattoos

This basic identifying information may be provided upon verbal request and does not require a warrant, subpoena, or other official court order.  However, you should note in your records that such an inquiry has been made, who made the inquiry, including the name, affiliation and badge number of the officer(s), and the information provided.


Note that this exception to the rules requiring subpoena, warrant, or court/agency order is limited to the identifying items listed here.  The rules specifically prohibit you from releasing DNA, dental records, or any analysis of body fluids or tissue which you may have.  Any release of blood tests, drug tests, or other analysis of this type would have to be handled under the standard procedure which generally requires a specific court order.


The HIPAA exception is primarily limited to identifying information for a suspect or person of interest or witness and is intended to allow the police to identify people who may be either the victims of or participating in criminal activity.


Mental Health Information Sharing

Mental health issues and the provision of information regarding mental health documentation is subject to additional restrictions outside of HIPAA including specific requirements pursuant to Iowa Code Chapter 228 and 229.  Different rules may apply depending upon the nature of the treatment and whether the person was involuntarily or voluntarily hospitalized. 


There has long been concern within the mental health community about providing specific information to law enforcement if a patient was a danger to himself/herself or others based on the patient’s current condition.  While the Tarasoff Standard, derived from a California case from July 1976, has long been used, this was not fully codified within Iowa law until recently. 


In the 2018 legislative session, House File 2456 was enacted and signed by the Governor.  While the bill deals primarily with the creation of various mental health services, a portion of amends Iowa Code 228 to add a new section, 228.7A.  This new section specifically provides, in accordance with the Tarasof Standard, that mental health information relating to an individual “may be disclosed to a law enforcement professional if; a) the disclosure is made in good faith; b) the disclosure is necessary to prevent or lessen a serious or imminent threat to the health or safety of the individual or to a clearly identifiable victim or victims, and c) the individual has the apparent intent and ability to carry out the threat.”  This new section goes on to state that a mental health professional will not be held criminally or civilly liable for failure to disclose mental health information “except in circumstances where the individual has communicated to the mental health professional an imminent threat of physical violence against the individual’s self or against a clearly identifiable victim or victims.” 


While this new section is helpful providing direction to mental health professionals, it does require review and record keeping. Records should show if an individualized and particular threat had been made.  In choosing to report or not to report, the record should clearly and specifically articulate why with a comprehensive threat assessment. 


Reporting Wounds and Injuries     

Additional reporting to law enforcement may be required under the Wounds of Violence Section 147.111. This requires that the treating provider or facility report gunshot or stab wounds, as well as other serious injuries which appear “to have been received in connection with the commission of a criminal offense, or motor vehicle accident or crash”.  Such injuries must be reported no later than 12 hours after treatment to the local law enforcement agency. 


Iowa Code 147.113A specifically addresses burn injuries. Providers are required to report a burn if that burn is “of a suspicious nature on the body, a burn to the upper respiratory tract, laryngeal edema due to the inhalation of super-heated air or a burn injury that is likely to result in death which appears to have been received in connection with the commission of a criminal offense . . .” Such burn injuries, like gunshots and stab wounds, must also be reported within 12 hours to local law enforcement. 


These statutes also require the reporting of severe injury which is likely to have been received within the commission of a crime.  A serious injury occurs if there is a disabling mental illness or a bodily injury which creates a substantial risk of death, serious permanent disfigurement or protracted loss or impairment of the body.  The governing statute, 702.18, goes on to state that injuries include, but are not limited to, “skull fractures, rib fractures, and metaphyseal fractures of the long bones of children under the age of 4 years.” 


Further, any injury to a child that requires surgery or general anesthesia is reportable.  For child injury, providers also have extremely broad mandatory reporting requirements under the child abuse statutes and would be reporting directly to DHS/DIA/CPI regarding any suspicious injuries relating to a child, regardless of if the injury amounted to the definition of serious injuries under 702.18. 


Ed Thomas Law

While not strictly an information provision law, the Ed Thomas Law, codified in Iowa Code Section 229.22 allows local law enforcement to complete a form which is submitted to the healthcare facility regarding a patient.  This requires that the facility notify the law enforcement agency of discharge “of a patient brought to a hospital facility for emergency mental health treatment by a law enforcement agency for whom an arrest warrant has been issued or charges are pending.”  Form DPS229 can be found at the Iowa Department of Public Safety website.


Responding to a Search Warrant or Subpoena

Police departments and others can also receive a wide array of medical information pursuant to a search warrant or subpoena.  Other investigators have administrative authority and access relates to the conduct of license holders such as the Iowa Board of Medicine.


Recordkeeping

The release of data, regardless of who asks, must be carefully monitored.  You, as a facility, must clearly document to whom such records are released and under what authority.  However, certain statutes require that you do not provide notice to the patient that records or information has been provided.  This includes reporting under the mandatory adult or child abuse statutes or if the facility were to receive something such as a Grand Jury Subpoena.  While the release of such records should be logged, they are not logged in the standard log available to the patient.As a healthcare provider, it can be extremely difficult to assess when you should reach out to law enforcement for assistance managing patients.