Mandatory Reporting Laws and the Emergency Physician

doi:10.1016/j.annemergmed.2006.05.017

Annals of Emergency Medicine

Volume 49, Issue 3, March 2007, Pages 369-376

https://doi.org/10.1016/j.annemergmed.2006.05.017 Get rights and content

Introduction

During the course of any one shift, most emergency physicians will juggle various medical and public health responsibilities, some of which extend outside the emergency department (ED) setting. In addition to caring for patients' immediate medical illnesses, these responsibilities include promoting safety measures, patient advocacy, and, in many cases, a requirement to report certain conditions to local authorities for further action.

Modern day mandatory reporting laws in the United States commenced at the turn of the century through public health efforts to track and control infectious diseases. By 1925, all states had some form of infectious disease mandatory reporting law.¹ Over time, legislators expanded these laws to include multiple infectious as well as noninfectious conditions such as those discussed in this article. These laws have always been contentious.¹

This article examines mandatory physician reporting laws as exemplified by 2 conditions, namely, impaired driving and abuse-related reporting laws, to define the debate concerning these laws. The latter laws are further subdivided into child abuse, elder abuse, and intimate partner violence. The discussion of each condition is divided into 3 subsections. The first describes the state of US laws. The second provides rationale for the law, and the final examines concerns with that condition's mandatory reporting law. Data are provided when relevant and available.

Section snippets

Impaired Driving

Ever since the first documented seizure-induced motor vehicle crash, legislation has been established to govern who can and cannot drive.² Given the extent of vehicle-related trauma in the United States, the topic of fitness to drive has been given considerable attention. Motor vehicle crashes are a leading cause of death in the United States, with approximately 2 to 2.6 million crashes causing 40,000 to 50,000 deaths yearly.3, 4 Driver licenses have been denied on grounds of previous

Abuse

The consequences of abuse are witnessed in the ED throughout the entire range of the lifespan, from infants to the elderly. This section will address child abuse, elderly abuse, and intimate partner violence in turn. Although many issues are shared among these groups, each has its own set of unique issues that emergency physicians should be aware of.

Child Abuse

In 2003, an estimated 906,000 children were abused in the United States; 1,500 died. Eighty percent of the perpetrators were thought to be the parents. During the same period, 2.9 million referrals were made to Child Protective Services, with two thirds being accepted for investigation.²⁹ Given these numbers, as well as the vulnerability of this population, the omnipresence of child abuse mandatory reporting laws is not surprising.

Elder Abuse

Elder abuse is the most recent demographic group in which abuse has been described, with the first report of “granny battering” appearing in the medical literature in 1975.36, 37 Though accurate statistics are difficult to obtain, an estimated 700,000 to 2.5 million cases occur yearly.³⁸ The incidence is likely to increase as the population ages, with 25% of the population estimated to be older than 65 years by 2050.³⁸ Not surprisingly, emergency physicians are in a position to identify elder

Intimate Partner Violence

An estimated 2 to 6 million women per year are victims of intimate partner violence, an incidence of 6% to 15%, with a lifetime prevalence of 28% to 54%.⁴⁶ Almost 1 million women are physically assaulted yearly, and half of these assaults result in injury. Up to one third of the injured women will seek care in an ED.⁴⁷ In one study of women in an ED waiting room, the lifetime prevalence for sexual assault was 39%.⁴⁸ In another study, 44% of female domestic violence homicide victims had visited

Conclusion

Emergency physicians are asked to juggle multiple responsibilities daily. Mandatory reporting laws have become a part of the multitasking required of emergency physicians and will continue to play a role in our practice in the future. The list of mandatory reporting laws continues to evolve, and emergency physicians should remain abreast of changes in reporting requirements, as well as liability associated with these laws.

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Cited by (26)

Identifying overlaps and disconnects between media reports and official records of nonfatal firearm injuries in Indianapolis, Indiana, 2021–2022
2024, Preventive Medicine
Open-source data systems, largely drawn from media sources, are commonly used by scholars due to the lack of a comprehensive national data system. It is unclear if these data provide an accurate and complete representation of firearm injuries and their context. The study objectives were to compare firearm injuries in official police records with media reports to better identify the characteristics associated with media reporting.
Firearm injuries were identified in open-source media reports and compared to nonfatal firearm injury (n = 1642) data from official police records between January 1, 2021 to December 31, 2022 in Indianapolis, Indiana. Events were matched on date, location, and event circumstances. Four multivariate, multi-level mixed effects logistic regression models were conducted to assess which survivor, event, and community characteristics were associated with media reporting. Data were analyzed 2023 – January 2024.
Media reported 41% of nonfatal shootings in 2021 and 45% in 2022(p < 0.05), which is approximately two out of every five shootings. Shootings involving multiple survivors, children, and self-defense were more likely to be reported, whereas unintentional shootings and shootings that occurred in structurally disadvantaged communities were less likely to be reported.
Findings suggest that relying on media reports of firearm injuries alone may misrepresent the numbers and contexts of shootings. Public health interventions that educate journalists about these important issues may be an impactful firearm violence prevention strategy. Also, it is critical to link data systems at the local level to ensure interventions are designed and evaluated using accurate data.
Emergency Department Management of Patients With Alcohol Intoxication, Alcohol Withdrawal, and Alcohol Use Disorder: A White Paper Prepared for the American Academy of Emergency Medicine
2023, Journal of Emergency Medicine
Mental health outcomes from direct and indirect exposure to firearm violence: A cohort study of nonfatal shooting survivors and family members
2022, Journal of Criminal Justice
Citation Excerpt :
Future research should expand the definition of family connections using other data sources, such as police records, to better capture all family links. Nonfatal shooting incidents not reported to police may be missed, however, police records are known to be more complete than clinical records due to mandatory reporting laws (Gupta, 2007; Kaufman et al., 2019; Magee, Ranney, et al., 2021). Lastly, the index nonfatal shooting may not be the first nonfatal shooting if the prior shooting preceded our study period or due to other community exposure, though our data do cover eight years.
Firearm violence is a public health crisis in the US. Beyond the survivor, firearm violence also impacts family members and communities of firearm violence survivors. Despite the known health inequities that exist among nonfatal shooting survivors, little research has focused on the mental health needs of family members of nonfatal shootings survivors.
Police and Medicaid claims data linked at the individual level between January 1, 2007 – December 31, 2016 in Indianapolis, Indiana. The Medicaid case number was used to identify nonfatal shooting survivors and family members. Differences in mental health prevalence and clinical care utilization were examined in the 12-months preceding and following an index nonfatal shooting for both survivors and family members. Results were stratified by age.
Mental health prevalence rates increased by nearly 3 % for family members of nonfatal shooting survivors in the 12-months following a nonfatal shooting, compared to the preinjury period. Among youth with a new mental health diagnosis over half were family members and no differences were observed in mental health conditions between survivors and family members.
Findings indicate a need for improved trauma informed services and connection to mental health care for both youth survivors and family members of nonfatal shootings.
Healthcare utilization and mental health outcomes among nonfatal shooting assault victims
2022, Preventive Medicine Reports
Citation Excerpt :
First, our study links police and clinical data that includes comprehensive inpatient and ED encounters with capture of most outpatient encounters, though some encounters may be missing or unmatched due to inaccurate data or smaller clinics that do not share data with the local health information exchange (Gichoya et al., 2012; Dixon et al., 2013). NFS victimizations not reported to police may be missing from our study, however, due to mandatory reporting laws (Gupta, 2007), police data provide more complete records than clinical data (Magee et al., 2021; Kaufman et al., 2019; Post et al., 2019), Secondly, other health conditions may influence healthcare utilization patterns and we did not assess the number of diagnoses by race. Such encounters could be opportunities to screen and connect patients with needed behavioral health services, which is clearly a deficient given the low mental health prevalence among our cohort.
Victims of nonfatal shooting (NFS) assaults suffer from emotional and physical trauma; however, little is understood about clinical care utilization patterns among victims. This study examines the healthcare utilization and mental health outcomes before and after an index NFS victimization. A longitudinal dataset of police and clinical data were linked at the individual level to define a cohort of NFS victims with one or more clinical encounter in the 24-months preceding an index NFS injury (N = 2,681) in Indianapolis, Indiana between 2005 and 2018. Mental health was defined using ICD diagnosis codes from any emergency department, inpatient, or outpatient encounter and clinical care utilization was the number of unique encounters within the 24-months preceding and following an index NFS injury. Multivariable logistic regression was conducted to examine factors associated with a mental health diagnosis in the post injury period. Analyses were conducted in October 2021-March 2022. Overall clinical care utilization (Mean: pre = 277.7 (SD 235.3) vs. post = 333.9 (SD 255.1), p < 0.001) and mental health prevalence (14.4% pre vs. 18.8% post, p < 0.001) increased in the 24-months following an index NFS compared to the prior 24-months. Preinjury mental health utilization increased the odds of receiving a mental health diagnosis in the 24-months following an index NFS injury – particularly for Black victims (Odds Ratio 1.69, 95% CI 1.01, 2.85). The findings indicate missed opportunities within the healthcare system to connect NFS victims with needed mental health services, as well as the importance of premorbid connection to mental health care.
Identifying nonfatal firearm assault incidents through linking police data and clinical records: Cohort study in Indianapolis, Indiana, 2007–2016
2021, Preventive Medicine
Citation Excerpt :
To ensure the incident involved a penetrating gunshot wound victim, all UCR narratives were queried, coded with multiple sets of key words: (1) “person shot,” “gunshot wound,” “gsw,” “people shot,” “shots fired,”; (2) “firearm,” “gun,” “bullet,” “armed”; and/or (3) “hospital,” “transported,” and then reviewed (Hipple and Magee, 2017), and verified by querying clinical records for an ICD gun-assault code to confirm a gunshot injury. Given mandatory reporting laws that require hospitals to report all gunshot wounds to law enforcement (Gupta, 2007); our population of nonfatal firearm assaults should be inclusive for all nonfatal firearm assault incidents treated at a hospital or reported to police within IMPD jurisdiction. We matched incidents by date to identify the same police incident with the corresponding clinical encounter between 2007 and 2016.
Nonfatal firearm assault incidents are more prevalent than gun homicides, however, little is understood about nonfatal firearm assault incidents due to a lack of accurate data in the United States. This is a descriptive study of all nonfatal firearm assault incidents identified through police and clinical records from 2007 to 2016 in Indianapolis, Indiana. Records were linked at the incident level to demonstrate the overlap and non-overlap of nonfatal firearm assault incidents in police and clinical records and describe differences in demographic characteristics of the victims. Incidents were matched within a 24-h time window of the recorded date of the police incident. Data were analyzed in fall 2020. There were 3797 nonfatal firearm assault incidents identified in police reports and 3131 clinical encounters with an ICD 9/10 diagnosis-based nonfatal firearm-related injury. 62% (n = 2366) of nonfatal firearm assault incidents matched within 24 h to a clinical encounter, 81% (n = 1905) had a firearm related ICD code: 40% (n = 947) were coded as a firearm-related assault, 32% (n = 754) were coded as a firearm-related accident; and 8.6% (n = 198) were coded as undetermined, self-inflicted or law enforcement firearm-related. The other 20% (n = 461) did not have an ICD firearm related diagnosis code. Results indicate most nonfatal firearm assault incidents overlap between police and clinical records systems, however, discrepancies between the systems exist. These findings also demonstrate an undercounting of nonfatal firearm assault incidents when relying on clinical data systems alone and more efforts are needed to link administrative police and clinical data in the study of nonfatal firearm assaults.
Law Enforcement and Emergency Medicine: An Ethical Analysis
2016, Annals of Emergency Medicine
Emergency physicians frequently interact with law enforcement officers and patients in their custody. As always, the emergency physician’s primary professional responsibility is to promote patient welfare, and his or her first duty is to the patient. Emergency physicians should treat criminals, suspects, and prisoners with the same respect and attention they afford other patients while ensuring the safety of staff, visitors, and other patients. Respect for patient privacy and protection of confidentiality are of paramount importance to the patient-physician relationship. Simultaneously, emergency physicians should attempt to accommodate law enforcement personnel in a professional manner, enlisting their aid when necessary. Often this relates to the emergency physician’s socially imposed duties, governed by state laws, to report infectious diseases, suspicion of abuse or neglect, and threats of harm. It is the emergency physician’s duty to maintain patient confidentiality while complying with Health Insurance Portability and Accountability Act regulations and state law.

View all citing articles on Scopus

: Supervising editors: Troy E. Madsen, MD; Debra E. Houry, MD, MPH

: Funding and support: The author reports this study did not receive any outside funding or support.

: Reprints not available from the author.

View full text

The practice of emergency medicine/residents' perspectiveMandatory Reporting Laws and the Emergency Physician

Introduction

Section snippets

Impaired Driving

Abuse

Child Abuse

Elder Abuse

Intimate Partner Violence

Conclusion

First page preview

Ann Emerg Med.

J Emerg Med.

Ann Emerg Med.

Child Abuse Negl.

Child Abuse Negl.

Ann Emerg Med.

Ann Emerg Med.

Ann Emerg Med.

Ann Emerg Med.

Ann Emerg Med.

Ann Emerg Med.

Ann Emerg Med.

Ann Emerg Med.

Ann Emerg Med.

Ann Emerg Med.

Ann Emerg Med.

Am J Prev Med.

Curr Surg.

The “names debate”: the case for national HIV reporting in the United States

Albany Law Rev.

Epilepsy and driving: an international perspective: Joint Commission on Drivers' Licensing of the International Bureau for Epilepsy and the International League Against Epilepsy

Epilepsia.

The injured intoxicated driver: analysis of the conviction process

J Trauma.

Medical conditions and driving: legal requirements and approach of neurologists

Med Law.

Reporting by physicians of impaired drivers and potentially impaired drivers: the Committee on Bioethical Issues of the Medical Society of the State of New York

J Gen Intern Med.

Mandatory physician reporting of drivers with cardiac disease: ethical and practical considerations

Can J Cardiol.

Medical Oversight of Non-Commercial Drivers: Special Investigation Report

Individual state driving restrictions for people with epilepsy in the US

Neurology.

Driver Information by state

Risk of recurrent seizures after two unprovoked seizures

N Engl J Med.

Physician's Guide to Assessing and Counseling Older Drivers

The demented driver: the doctor's dilemma

Alzheimer Dis Assoc Disord.

The practice of emergency medicine/residents' perspective
Mandatory Reporting Laws and the Emergency Physician