The Emergency Department is probably the first place that you will encounter many issues of forensic and legal concern as part of your day-to-day practice. The following advice is given for broad guidance. Each case is individual and should be considered on its own merits. Links to more details on individual topics are in then left margin.
It is most important (for your sake) that comprehensive and clear, contemporaneous notes are maintained in relation to any matter of forensic significance.
The age of consent is 16 years old. However, when there is any doubt or potential for conflict, an Emergency Medicine consultant should be involved as soon as possible. The main situations in which you will encounter difficulty will be where parents refuse treatment or advice with regard to children and where consideration is being given to commit someone for psychiatric treatment. Consult with your senior colleagues in these situations. More information.
There are consent forms (see Forms) available which must be completed before the disposal of any body tissue (e.g. small amounts of amputated tissue unsuitable for grafting/re-plantation).
It may occasionally arise that a family requests the use of their loved-ones organs for donation after death in the ED or a donor card is found amongst a patient's effects. In this situation the patient's eyes would be suitable for donation. The following is the current policy:
- Contact the ophthalmic doctor on-call when there is a potential eye donation
- Obtain (pre-mortem) 2 donor samples for the eye bank. 1 in an EDTA (purple top) bottle and 1 in a plain (red top) bottle.
- The ophthalmologist will pick up the samples and arrange for harvesting. This can be done when other organs are being taken or with 24 hours of death.
Death in the ED
- You are in a position to sign the death certificate. This would be unusual.
- The patient saw their GP recently, who might be in a position to sign a certificate.
- Usually in the case of sudden death, traumatic death and death in the postoperative period, a post mortem will be required. The coroner will advise you on the need. Consent is not necessary in these situations but the family should be dealt with sensitively.
More-details. It is our desire to be as helpful as possible to the police at all times. However, all inquiries by the police must be on a named patient basis only. If asked if Mr. X has been in the ED at such and such a time, it is right and proper to answer as appropriate. However, if asked if you have seen a patient with X or Y injury or complaint, then you should politely decline answering and refer the matter to a senior, preferably a consultant. From time to time the police will request a written report. This should be referred to a consultant.
Your notes are particularly important when you encounter someone alleging assault. Document everything and use body maps where possible. It is very important that you refer patients to their GP if they are not followed in the ED or other hospital clinic, as bruising often takes many hours to develop and should be documented early. Patients should be counselled to contact the police and advised of the availability of Victim Support.
The ED has a comprehensive domestic violence policy, which must be consulted in every case.
It is not unusual to encounter a drunk driver. The Gardaí have the right to request to speak to such patients and to seek appropriate samples. If the Gardaí want samples, then they will do so through their doctor who they will bring to the ED. Do not get involved in collecting evidence for the Gardaí.
As the treating physician your primary role is to provide relevant clinical information to Garda and (where applicable) to the designated doctor (garda doctor) or nurse concerning any health condition affecting the capacity of the driver to consent and any prejudice to the driver’s health at the time of taking the specimen.
Non Accidental Injury
More information in the paediatric section of EMed.ie
If you suspect NAI, do not allow the patient to leave the ED without a full evaluation of the situation by senior staff and paediatric advice. At a minimum you should:
- Take a detailed history
- Do a head to toe examination
- Ensure that there is a nurse assisting at all times
- Ensure complete documentation
- Clearly identify next of kin
Medico legal reports
On occasion, a solicitor may contact you and request a written report on a patient's presentation and clinical condition with relation to a civil lawsuit. All such requests must be directed to the Emergency Medicine consultants.