Collaborating With Police in the Emergency Department While Maintaining Patient Confidentiality: How Can We Improve?

Police are commonly encountered in the emergency department (ED). They support EMS, transport patients, are a source of collateral information for health care professionals, and help provide a safe environment for hospital staff. However, there is a potential for conflict due to the nature of police investigation and the emergency physician’s duty to protect patients’ confidentiality and personal health information. Although individual privacy legislature varies slightly by province, personal health information can be loosely defined as any identifying information about an individual that relates to their physical or mental health. Personal health information includes, but is not limited to, an individual’s name, age, medical record number, address, telephone number, and general medical status. Any disclosure of patient information to police without consent could potentially violate the patient’s right to privacy of personal health information. Unfortunately, it is not uncommonly the case that patients in the ED for whom the police have an interest are unable or unwilling to provide consent. In such circumstances patient health information can only be legally given to police through an exception to consent, such as if the police obtain a search warrant, court order, or subpoena. Education for emergency medicine (EM) residents on police-physician exchanges is variable; it is mostly comprised of direct observation of how various staff physicians interact in such scenarios. It is important for EM residents to understand the legislation surrounding these practices to ensure patients’ rights are protected and avoid any potential for litigation. We conducted an extensive review of the current literature and legislation surrounding two common interactions between emergency physicians and police: the trauma patient and the emotionally disturbed patient. In our experience, these scenarios represent challenging interactions that highlight the dichotomy between the perspective of the police and emergency physicians. Following each of the case vignettes below, we outline how perceptions differ during these scenarios and offer suggestions on how the resulting interactions can be improved.