Abuse

Holly Asks:

In the very first chapter of the story I’m working on, the main character gets sent to hospital. The character in question is a sixteen-year-old female who has been missing for eleven years. She is found in the woods surrounding the town it’s set in and presents naked, severely malnourished, heavily pregnant, and with a gunshot wound to her leg. There are other superficial injuries that one might get when attempting to flee nude through dense woodland. The town and hospital are relatively small. The hospital has seventy-five doctors and forty-five nurses on staff and it’s in a fairly isolated location.

I’ve got a few questions:

1 – Would the hospital I’ve described be able to treat a patient in this condition? What would be the basics of this treatment?

2 – Is there a procedure hospitals have in place for patients who act violent? My character hasn’t been around people for eleven years. She’s borderline feral and she attacks a doctor when she wakes up. Since she’s pregnant, I wasn’t sure if they’d be able to sedate her.

3 – Can doctors share information about patients with police officers? Since she’s a missing person and a minor, the police are going to be involved but I’m not sure how much doctors can share.

Jordyn Says:

Hi, Holly! Thanks so much for sending me your questions. These are complex ones for sure.

Question #1: Could a small town rural hospital be able to care for this patient? Maybe. One thing I want to clear up is your ratio of doctors to nurses. Usually, there are many more nurses in a given area than physicians so maybe adjust your numbers if you’re making a point about this in your novel.

When I first read your question, I thought the medical care aspects might be cared for by a rural hospital, but it was going to be a tough undertaking. This victimized teen is going to need, at a minimum, five services to be in place to stay in a rural hospital— a good general practitioner (to manage her overall care), a nutritionist (for the malnutrition), a surgeon (surgical evaluation of the gunshot wound), an OB/GYN (for the pregnancy), and a psychiatrist and/or psychologist (just because she’s been held hostage for eleven years.) Already that list is going to be tough and likely insurmountable for the area you mention.

What tilts the balance for me in saying she would have to go to a large, urban center are the psychiatric issues you mention in your second question.

Question #2: Yes, hospitals have procedures in place for violent patients, but the staff and mental health care specialists who will be required to manage her care are likely to be found at an urban center.

Violent patients are generally managed in a step-wise fashion. Can talking to them de-escalate their behavior? Is there something they’re requesting that we can give them to get them to calm down? Does she have some sort of object (like a stuffed toy) that giving her would help if it was safe for her to have?

If it’s more a fight response because of what she’s been through and she’s a danger to herself and others then she’d have to be restrained and placed under one on one observation. This type of patient can tax staffing resources which is another reason why transfer might be best.

Each drug is given a category related to its potential to harm a developing baby that is easily searchable via the internet. The categories go from Category A to Category D. Category A is deemed safest to D which has proven adverse reactions in humans. Just because a drug is listed as Category C or D doesn’t mean it might not be used. Several things would be taken into account— what we call risks versus benefits.

For instance, if she was late in her pregnancy, the doctors could risk it because the baby is fully developed. This is tough, though. Many physicians will err on the side of what’s safest for the pregnancy. However, you can’t leave a patient restrained forever and some form of psychiatric medication could be warranted here.

Question #3: Can doctors share information with police officers? Yes, they can. There is actually a special provision listed in HIPAA (the law that rules over patient privacy) that allows for this. Police officers mostly need to document what “serious bodily injury” the patient has suffered so they can determine what criminal charges to bring against a perpetrator.

The other thing to consider is the size of the local police department. Small towns may not even have their own police department but rely on the county sheriff’s office and/or state police to handle the investigation of this crime.

I actually think the best place for this teen would be the closest children’s hospital. Children’s hospitals have specialized teams in place to manage issues particularly around crimes against children. The caveat would be her pregnancy— for which she would likely deliver at an adult center.

Hope this helps and good luck with your story!

Dale Asks:

I see in TV shows and movies people who are shot or stabbed go to get medical treatment and yet they never deal with the police. Or they refuse to go because they are afraid that it will get reported. If a person is taken to the ER with a knife wound or gunshot wound, would the medical staff have to report it to the police?

Jordyn Says:

Police car lights close up. A group of policemen on the background.

Yes, we have to notify the police if a person is shot or stabbed with nefarious intent. Knives can cause lots of wounds that aren’t criminally motivated. Think about the person slicing vegetables and cuts their finger. Knife wound . . . not criminally motivated. We wouldn’t call the police.

The most important aspect is whether or not the person is being truthful regarding their injury. It’s obvious if someone comes in with a gunshot wound that something criminal has likely happened.

If a person comes in with a knife stuck in their chest, we’re likely getting the police involved even if they say it was an “accident”. However, say a woman comes in with a defensive knife wound to the palm of her hand as she tried to keep her boyfriend from stabbing her, but she tells us that she cut it grabbing a knife from the bottom of a sink full of soapy water. If the woman doesn’t have any other suspicious injuries, we probably wouldn’t question her story.

In all honesty, we can only help patients as much as they are willing to help themselves. If they are truthful about the violence involved in whatever type of injury they have (particularly beatings from domestic abuse) then there is help we can offer them.

Ever wonder why you’re asked when presenting for medical care whether or not you feel safe? This is inherently because we know, as healthcare providers, that it is hard for victims to speak up. That question is your open door. If you feel you can’t answer honestly at the time, then look for a way to speak to your nurse or physician privately. Sometimes we try and facilitate a conversation like this by asking other visitors to step out of the room. If we do this, it should signal to you that we are suspicious that your injury did not happen the way you stated and we’re trying to find a way to help you.

It is true a patient might not seek medical treatment for fear of police involvement. The same can be true for child abuse injuries. A parent may not seek treatment or delay treatment for fear of being reported to child protective services and/or the police.

See how the different variables can vary to increase conflict in your story?