Till death do us part

Author: Thijs Gras

Published in: Spring 2018 Edition of Ambulance Today Magazine

In one of my earlier columns (Spring 2017) I wrote about an undesirable development in the Netherlands in the domain of integration of control rooms and the strong ‘blue’ (police) influence in this respect. A recent interesting court case shines new light on my point and will certainly raise eyebrows (and mouth corners) with a number of colleagues.

Suppose you are a nurse working in the control room and an emergency call comes in. You talk to the caller and send an ambulance to what later turns out to bea crime scene: a woman is murdered and the caller – her ex-husband – is suspected to be the perpetrator. The police are very interested in this call and think they have the right to listen to it and, out of decency, ask the ambulance service for the recording. But to the utter disappointment of the police, the ambulance service refuses to hand over the call to them stating this is a matter of patient confidentiality. The police go to court but the court rules that the ambulance service is right and is not required to hand over the call. But this is murder! Surely this is important enough to violate the professional confidentiality of the nurse?

The police then appeal to the High Court. The ruling of this court – the highest we have in our country, so its decision is final and there are no further appeal options – is very interesting: they confirm the verdictof the lower court. The key point is patient confidentiality and the fact that the caller spoke to a certified nurse who has a duty to professional secrecy.

An important issue that is raised in this particular case is that of the two conflicting interests that oppose each other. On the one side it is in the interest of the police to find the truth, to conduct an inquiry and to bring culprits to justice. Everybody will agree this is a very important interest.

But on the other hand, there is the interest of – in this case – the ambulance service (but it could also have been a doctor or nursein the A&E department) that everybody should be able to call for emergency medical help no matter what the circumstances are and without fear that the call, or anything that is said to the medical caregiver, will have juridical consequences.

Both courts have been very clear in their ruling and I completely agree with them: patient confidentiality almost always prevails over finding the truth. In one of our laws about the medical profession it is stated very clearly that if one of the professionals mentioned in the law (such as doctors and nurses) is convinced that information given to him or her as a professional, specificallyif it is confided as secret or the professional can guess it is confidential, the professional can call upon the right of non-disclosure. Only in very rare and special cases can a doctor or registered nurse be forced to break this right.

I am glad and relieved because this meansI am better protected on the streets. Not against knives and bullets of course, but our neutrality and trust that everything we do is in our patient’s interest is a key point in our safety and security. This is why I am so critical about the growing influence of the police in our control rooms. I sincerely hope we as an ambulance service work well with the police on the street; we may share, on the control room level, buildings or even rooms but we must be very careful to keep everything elseseparate so that we as professional nurses can use our right of non-disclosure. This is not only important in individual cases forthe persons involved, but on a broader scale, for the trust of the public in the ambulance service and therefore for the safety of ambulance personnel. Any association with the police should be avoided.

Of course, we as ambulance people need the police for our safety and to protect us. They are the only ones in our society (apart from the military) who are allowed to use violence. They have the training and the means. That is okay. We both want to help people in need, but we both have our interests and sometimes these interests differ or even conflict with each other.

We tend to look at the emergency services in colours: white for the ambulance, blue for the police and red for the fire brigade. But what do you get when you mix these colours? An ugly sort of light brown. If we paint with this colour we get a very dull, inexpressive painting. If we want to createa beautiful and harmonious picture, it is far better to use the separate colours. Together, but distinct. That is the best way to serve the interests of the personnel and of the people we serve, in our case patients.

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