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View Full Version : Hospital protocol re: telling accident victim about another's death



inspiredbymusic
11-10-2013, 08:25 PM
Situation: An eighteen-year-old boy and a seventeen-year-old girl are in a car-accident on their way home from prom, and are brought to the hospital by ambulance. The girl dies from blood loss during emergency surgery. The boy has a concussion, wakes up in the hospital, and asks about the girl's condition.
Question 1: What would medical personnel tell him? If they aren't allowed to tell him what happened to the girl, what would they say, particularly if he became increasingly insistent, agitated, and distraught?
Question 2: If he is not told directly, what could he possibly overhear or see that would clue him in as to what happened?

Maryn
11-10-2013, 10:34 PM
When our daughter was involved in a car accident which included a fatality, the medical personnel did not tell her. Though she was in an ambulance being checked out, the police told us first, then said they could tell her or we could. I did.

While hospital protocol may be different than emergency medical protocol, there was definitely a rule or guideline in place. She had asked those checking her whether anyone else was hurt, but they didn't say. This made her suspect the worst.

Question 1: Speaking as a person not in the medical field, my best guess is if there's a rule in place forbidding them from telling him, when he's getting more agitated they still won't break the rule. More likely, they'd call for a doctor to give him something to calm him down.

Question 2: Not telling probably means not speaking of it where he can overhear. Which doesn't mean he won't catch a snatch of conversation he's not meant to hear. The staff will know she died, so they won't be telling one another that. What they might say is something about it being so sad, or her being so young, or how hard it must be for her family, like that. If he's not in denial, he might make the sort of assumption our daughter did.

Maryn, realizing how very long ago that accident was, yet it seems so recent

Siri Kirpal
11-10-2013, 11:00 PM
Sat Nam! (Literally "Truth Name"--a Sikh greeting)

Have a ((HUG)), Maryn.

Blessings,

Siri Kirpal

melindamusil
11-11-2013, 12:27 AM
Not a medial professional, fyi!
First of all, is this in the US?
Assuming yes...
with all the privacy laws we have, I assume that they would not be able to tell him about the girl's condition. If he became insistent/agitated, I wouldn't be surprised if they gave him a sedative.

BUT - to answer your second question - I'm sure that "everyone" in the hospital has received the privacy lecture, but it might not be taken very seriously by the lowest "class" of workers, like the housekeepers or food service workers. If he's upset and a housekeeper is passing through, they might spill the beans.

jclarkdawe
11-11-2013, 01:41 AM
What does your plot need? If no sooner, he'll be told when the police arrive to interview him.

Depending upon the size of the hospital, communication isn't that good. She'll go to the emergency room, then immediately to surgery. He's a bit more iffy, as his unconsciousness can be caused by brain swelling from a concussion, and he may need surgery to relieve the pressure or they might wait and see. But his track is either going to be emergency room, then ICU, or emergency room, surgery, recovery, then ICU. Either way, he's going to be pretty isolated.

More then likely, if he's unconscious throughout the ambulance ride, he's not going to remember much of anything for a while when he wakes up. In fact, he may never remember the accident. Further, doctors need to balance the medical needs versus the potential criminal investigation. Although medical takes priority, the doctors will be aware of the potential for criminal charges.

If he's in such serious condition that he's unconscious all the way to the hospital, he's going to be in a very controlled environment for a while. Unconscious for that period of time (15 minutes +) is a serious, life-threatening concussion. And this is ignoring his other injuries. If he spears the ceiling or the windshield during the accident, he's got more injuries then just his head.

Best of luck,

Jim Clark-Dawe

nikkidj
11-11-2013, 02:18 AM
Hospital personnel are forbidden from giving information out about another patient. That would be violating HIPAA, and could get a hospital fined and an employee fired. Hospitals have signs all over the building, in elevators and in hallways, reminding staff not to discuss cases in public places where the details might be overheard.

Most likely, the police would tell him during the interview, or his parents could tell him.

Also, if the accident took place out in the country, the girl may have been taken to a trauma center and the boy may have been taken to a lower-acuity facility. The folks at that facility might not even know about the fatality.

melindamusil
11-11-2013, 03:35 AM
Another thought... If the boy is 18, it is possible that there could be some confusion/frustration between the parents and medical personnel. Legally, he's able to consent, and with HIPAA, it's possible they may not even be allowed to discuss his condition with his parents, without his he consent. Could be a complication.

inspiredbymusic
11-11-2013, 04:29 AM
Thanks, everyone, for the responses. I really appreciate the help.

OK, now I have more questions (and I need to research concussions some more). 1) Why would the boy's parents be told about the girl's condition? Wouldn't that violate HIPAA too? 2) Under what circumstances are police brought in to conduct an interview? 3) So if medical personnel can't give out the info, do they just say something like, "I'm sorry, we're not permitted to discuss another patient" or something like that when asked? 4) I'm still looking for things a smart boy could see or hear that could tip him off.

In the situation I've written, the girl was driving, if that makes a difference, and the accident was the other driver's fault. They are in a city and are both taken to the same hospital. The hospital is initially unable to contact the boy's family. Although I'm not sure what they would do about contacting patents since he's 18. And, yes, it is in the U.S.
Thanks!

Pyekett
11-11-2013, 04:40 AM
HIPAA does permit identification of a patient's status as a single word if asked for by name and unless that information is specifically made private by the patient request.

The American Hospital Association weighs in on HIPAA as regards releasing patient status here (http://www.aha.org/advocacy-issues/tools-resources/advisory/96-06/030201-media-adv.shtml), with references. A hospital can release the "general condition" (e.g., critical, stable, fair, etc.) of a patient over the phone to anyone that asks for it, unless otherwise prohibited. This has been interpreted to include "deceased," but HIPAA itself does not define what is meant by "general condition."

jclarkdawe
11-11-2013, 05:06 AM
Thanks, everyone, for the responses. I really appreciate the help.

OK, now I have more questions (and I need to research concussions some more). 1) Why would the boy's parents be told about the girl's condition? Wouldn't that violate HIPAA too? The boy's parents would not be told. 2) Under what circumstances are police brought in to conduct an interview? It's a fatal accident. It will be investigated. 3) So if medical personnel can't give out the info, do they just say something like, "I'm sorry, we're not permitted to discuss another patient" or something like that when asked? Yep. 4) I'm still looking for things a smart boy could see or hear that could tip him off. They do this all the time and they'll know. However, if he's well enough (not unconscious until he gets to the hospital), he'll be left his cell phone. Does a google search for the accident. It will hit the news within a few hours.

In the situation I've written, the girl was driving, if that makes a difference, and the accident was the other driver's fault. Doesn't make a difference. The police need to talk to all witnesses, and see what they remember, even if it is nothing. If the other driver was at fault and he/she survived, there's a strong possibility of a negligent death statute against that driver. Further, there are going to be civil suits. They are in a city and are both taken to the same hospital. But how big is the hospital, although virtually any city hospital is going to be big enough that the only way most hospital employees are going to know about it is when the story appears on the news. The hospital is initially unable to contact the boy's family. Although I'm not sure what they would do about contacting patents since he's 18. If he's 18, the hospital will not contact his family. Potential HIPAA violation, unless there's a need to contact next-of-kin. And, yes, it is in the U.S.
Thanks!

Best of luck,

Jim Clark-Dawe

melindamusil
11-11-2013, 06:35 AM
In the situation I've written, the girl was driving, if that makes a difference, and the accident was the other driver's fault.

Also remember that, especially if it goes to civil court, it's pretty common for them to determine that both drivers were at fault, to different degrees. (i.e. it was 80% driver 1's fault and 20% driver 2's fault.) Numbers like that make insurance companies happy.



They are in a city and are both taken to the same hospital.

How big is the city?
I went to college in an isolated city of 15,000 people, with a hospital that is well known as being the worst in the state. I now live in a city of 115,000 that is in a metropolitan area of at least two or three million. Point being - "city" is a relative term. Are we talking about the city of Mayberry RFD or New York City?

In my current city, a medium-sized US city, there are at least a dozen hospitals in the metro area, with three or four trauma centers to which your patients might be taken. It's not unlikely that they would be taken to different hospitals. Even if they're at the same hospital, it's totally believable that your boy's doctors or nurses have NO IDEA what's going on with the girl - they may not even know which hospital she is at!

frimble3
11-11-2013, 09:20 AM
Question 2: If he is not told directly, what could he possibly overhear or see that would clue him in as to what happened?


4) I'm still looking for things a smart boy could see or hear that could tip him off.

I think the tip off would depend less on what he hears or sees, and more on what kind of person he is.
One smart boy might wake up in hospital, not see his girlfriend, and figure, she's not here, good, she's okay. Or maybe just a little banged up, not hooked up to monitors in the ER like he is. If they aren't telling him anything, well, no news is good news.

Another equally smart kid might wake up, not see his girlfriend, and figure, she's not here, so if she's not getting fixed up, it's because she's dead. They aren't telling me anything, because if you can't say anything good, don't say anything at all.

I think to a kid who's just been in a life-threatening crash, they're not going to think about legal rules stopping people from talking, it's got to be an unspoken message. Adults don't tell kids anything, anyway. And even adult patients have trouble getting information (about themselves!) from hospital personnel.
So, is your boy a cheerful optimist, or a broody pessimist?

MDSchafer
11-11-2013, 04:18 PM
It depends on the relationship. If the boy and girl are brother and sister than they're probably going to be told something.

1. It depends on the nurse, or the doctor if they're around. Typically, staff say something noncommittal like, "You know, that's not my patient, let me find out, and I'll get back to you." The general rule is that unless someone has asked for privacy the hospital can disclose a patient's name, location and one-word report on their condition, serious, critical, stable, whatever. If the person has specifically requested to not let anyone know they're at the hospital the hospital is prohibited from telling anyone anything.

This is difference with death. If the next of kin hasn't been told we're not telling anyone, legally until the next of kin hasn't been notified you can't inform anyone of the death. If there's a patient who is agitated and growing more anxious most nurses are going to inform him of the death, so long as next of kin has been notified, in the nicest, most compassionate way possible.

2. Typically he'll be on a med-surge floor and most of those floors are all private rooms or double rooms. Staff is protective of information, but there's always a chance he could overhear staff discussing their conditions, especially if he's close to nursing station. There's also the white board. Most hospitals and most floors have dry erase boards. If he got out of his room and looked at the board and started looking for the girl's name and didn't see her initials on the floor that could tip him off. Other than that hospitals are typically pretty good about this stuff, what with the lawsuits and everything.

Also, if he's 18, a standard protocol is to wait until he regains consciousness to see if there is anyone he wants notified, but that can vary from institution to institution.

frimble3
11-12-2013, 06:55 AM
There's also the white board. Most hospitals and most floors have dry erase board.
Yes, god bless the nursing station white board: that's how I found out that I was up for an angiogram. And a gastroscopy. And some kind of nuclear cardio scan.
And, it was a kindly nurse who came in, theoretically to bring me a blanket, who told me the procedure for getting a second opinion, and, indeed, changing doctors.

MDSchafer
11-12-2013, 07:59 AM
And, it was a kindly nurse who came in, theoretically to bring me a blanket, who told me the procedure for getting a second opinion, and, indeed, changing doctors.

You need to never repeat that to anyone in the hospital where that happened. Nurses have lost their license for that.

I just came back to add that it's fair game to explain what the condition means.

frimble3
11-16-2013, 11:56 AM
You need to never repeat that to anyone in the hospital where that happened. Nurses have lost their license for that.

I just came back to add that it's fair game to explain what the condition means.
Not to worry, I never would. That much I knew: nurses must never, ever overstep, and take upon themselves the duties and role of doctors. But thank you for the reminder.

And, thank you for explaining that it's fair game for the nurse to explain what a condition means, once the doctor has told the patient the condition. I gather from your name that you're an MD yourself?

Cath
11-16-2013, 03:18 PM
Okay, not the place for that discussion, frimble. Let's leave it there.

frimble3
11-17-2013, 07:18 AM
Okay, not the place for that discussion, frimble. Let's leave it there.
You're right. I have removed the OT and inappropriate last line, and apologise for derailing the OP's thread with the rest of it.