Attachment 21 - VASDHS MCM 00-102 Mandatory Reporting of Injuries from Deadly Weapons.pdf

VA SAN DIEGO HEALTHCARE SYSTEM MEMORANDUM 00-102

SAN DIEGO, CA OCTOBER 31, 2019

MANDATORY REPORTING OF INJURIES FROM DEADLY WEAPONS &

ASSAULTIVE/ABUSIVE CONDUCT

1. PURPOSE: To outline the policy and procedures for the reporting of physical injuries involving knives, firearms, other deadly weapons, or injuries resulting from assaultive or abusive conduct.

2. POLICY: California Penal Code sections 11160 and 11161 requires all health practitioners employed in a health facility to report both by telephone and in writing, all injuries resulting from the use of a gun, knife or other deadly weapon, or otherwise inflicted in violation of the criminal law, whether by the act of the patient or another person. It is the policy of VA San Diego Healthcare System (VASDHS) to cooperate with all law enforcement agencies, including State, County, and local government departments which are charged by law with the protection of the public health and safety.

3. DEFINITIONS:

a. Health Practitioner: A physician, surgeon, psychiatrist, psychologist, dentist, resident, intern, podiatrist, chiropractor, nurse, dental hygienist, social worker, marriage, family and child counselor, paramedic, optometrist, psychological assistant, chaplain, or any other person who is currently licensed or registered under the California Business and Professions Code. Health practitioners, who provide medical services for physical conditions caused by firearms, knives or other deadly weapons or which are the result of assaultive or abusive conduct are mandated by law to report.

b. Assaultive or Abusive Conduct: Includes any of the following offenses:

murder; manslaughter; mayhem; aggravated mayhem; torture; assault with intent to commit mayhem, rape, sodomy or oral copulation;

administration of a controlled substance or anesthetic to aid in the commission of a felony; battery; sexual battery; incest; throwing any vitriol, corrosive acid or caustic chemical with intent to injure or disfigure;

assault with a stun gun or taser; assault with a deadly weapon; rape;

spousal rape; procurement of any person to have sex with another person; child abuse or endangerment; abuse of a spouse or cohabitant;

sodomy; lewd and lascivious acts with a child; oral copulation; genital or anal penetration by a foreign object; elder abuse; or an attempt to commit any of the aforementioned crimes.

c. Injury: Any physical injury which requires any form of professional medical treatment. "Injury" shall not include any psychological or physical condition brought about solely through the voluntary administration of a narcotic or restricted dangerous drug. Reportable self-inflicted injuries are limited to those caused by a firearm; those caused by knives or other deadly weapons do not have to be reported.

4. RESPONSIBILITIES:

a. VA Police Service: Is responsible for notifying the law enforcement agency of jurisdiction immediately by telephone. The VA Police will forward a copy of the VA Police Investigative Report as well as the form initiated by the healthcare practitioner within 48 hours of being notified of the injury. The decision to prosecute or press charges will be determined by the law enforcement agency of jurisdiction.

b. Any health practitioner: Employed in a health facility, clinic, physician's office, local or state public health department, etc., who, in his or her professional capacity or within the scope of his or her employment, provides medical services for a physical condition to a patient whom he or she knows or reasonably suspects is a person described as follows, must immediately make a report:

1) Any person suffering from any wound or other physical injury inflicted by his or her own act or inflicted by another where the injury is by means of a firearm.

2) Any person suffering from any wound or other physical injury inflicted upon the person where the injury is the result of assaultive or abusive conduct.

c. The health care practitioner who discovers the injury: Is responsible for informing other appropriate members of the health care team, documenting any physical or other evidence in the patient's medical chart and for ensuring that the injury is reported according to the procedures outlined below. Mental health professionals who simply learn of such injuries are exempt from reporting.

d. The Social Worker: Is responsible for providing each patient, as indicated, with a list of appropriate resources including the names and addresses of shelters and appropriate hotline numbers, and documenting all contacts in the medical record. Patients suspected or known to be the victims of domestic violence will be referred to local domestic violence resources.

e. When two or more persons who are required to report are present and jointly have knowledge of a known or suspected reportable injury, and where there is agreement among these persons to report as a team, the team may select by mutual agreement, a member of the team to make a report. Any member who has knowledge that the member designated to report has failed to so, shall thereafter make the report. Medical Center personnel are not relieved of their mandated reporting obligation if an individual health practitioner fails to report an injury as defined above.

Any staff member may make a mandated report.

5. PROCEDURES:

a. Upon discovering a reportable injury, the treating health practitioner will contact the VA Police Service and request that the law enforcement agency of jurisdiction be contacted immediately.

b. Police Service, will immediately telephone the law enforcement agency of jurisdiction to report the injury and request that a police officer respond to the Medical Center to conduct an investigation if appropriate.

c. In addition to requesting that Police Service make a telephonic report, the health practitioner will complete their portion of the "Report of Injury Caused by a Deadly Weapon or by Assaultive or Abusive Conduct" form and submit it to on-duty VA Police. The form will be completed by the VA Police Officer who will see that copies of the form as well as the VA Police Investigative Report are provided to the appropriate law enforcement agency within 48 hours.

d. The report shall include, but not be limited to: the name of the injured person, if known; the injured person's whereabouts; the character and extent of the person's injuries; the identity of any person alleged by the injured person to have inflicted the wound, other injury, or assaultive or abusive conduct upon the injured person.

e. Forms used to report are available in the following offices: Police

Service, room 1615, ext. 3931; the main Social Work Service office, room 1538, ext. 3671; and the Emergency Department, office of the Medical Administrative Officer of the Day, room 1503, ext. 4344.

6. REFERENCES:

a. California Penal Code, Sections 11160, 11161 and Amendment AB

7. REVIEW DATE: October 2022

8. FOLLOW-UP RESPONSIBILITY: Director (00)

9. RESCISSION: Medical Center Memorandum 11-32 dated August 17, 2016.

10. DATE APPROVED BY MEC: December 4, 2019.

Expired certificate

X Kathleen Kim Kathleen Kim, MD, MPH Chief of Staff Signed by: Kim, Kathleen M.

Expired certificate

X Robert M. Smith, MD

DIRECTOR

Signed by: Smith, Robert M.

Attachments: A, B, C, D Distribution: Docushare

Attachment A October 31, 2019

INDICATORS FOR PHYSICAL ASSAULT

a. Physical Findings:

(1) Trauma especially to head, neck, abdomen from beating (i.e., soft tissue injuries; major organ injuries in specific area of blunt trauma).

(2) Stab wounds, usually to the chest or abdomen, resulting in major blood loss, sucking chest wounds, organ penetration. Missile injuries (i.e., projectile from pistol, rifle, shotgun or explosion enters and exits the body or lodges in the body).

(a) Injuries range from minor puncture wounds to life threatening wounds of the chest, abdomen, or head.

(b) Lacerated tissue in bullet's path, possible injury to remote organs.

(c) Initial wound, subsequent tissue injury (not necessarily in direct path of the bullet); secondary infection.

(d) Internal tissue and bone damage.

b. Crime Victim Reactions:

(1) Fear, anger, grief, resentment, dependency, powerlessness, desire for revenge, and perhaps shame and guilt.

(2) Victims may experience troublesome mood swings, mental confusion, hypersensitivity to the reactions of others and to noise.

(3) Physical symptoms include (but are not limited to) headaches, backaches, and other body pains; nausea and other gastrointestinal problems; intense shaking.

(4) Preexisting medical, physical or psychological problems can be exacerbated.

(5) Post-Traumatic Stress Disorder may develop.

Attachment C October 31, 2019

INDICATORS FOR DOMESTIC VIOLENCE

a. Medical Indicators (Female):

(1) Injuries to head and neck are most common: periorbital hematoma, fractured mandible, orbit fractures, nasal fractures, perforated tympanic membranes, lacerations around the eyes and lips, contusions and soft tissue injuries, and injuries above the hairline.

(2) Injuries to breasts and broken ribs (usually from kicking).

(3) Arm injuries (fractures from warding off blows to the head or from severe pulling or twisting of the arm).

(4) Strangulation, bilateral carotid artery compression and resulting bruises.

(5) Back or spine injuries from being thrown, pushed, or kicked.

(6) Soft-tissue injuries to the torso or extremities that may be hidden by clothing.

(7) Injuries to the abdomen during pregnancy or miscarriage due to trauma.

(8) Injuries sustained from weapons of any type.

(9) Burns as a result of cigarettes, appliances (irons), friction (rug) burns, scalding liquids, chemicals, or arson.

(10) Multiple injuries, particularly in combination with evidence of old injury.

(11) Chronic pain, psychogenic pain, or pain due to diffuse trauma without visible evidence.

(12) Physical symptoms related to stress, chronic Post-Traumatic Stress Disorder, other anxiety disorders, or depression (e.g., sleep and appetite disturbances;

fatigue, decreased concentration, sexual dysfunction; chronic headaches;

abdominal and gastrointestinal complaints; palpitations, dizziness, paresthesia, dyspnea; atypical chest pain).

(13) Gynecologic problems, frequent vaginal and urinary tract infections, dyspareunia, pelvic pain.

(14) Frequent use of prescribed minor tranquilizers or pain medications.

(15) Frequent visits with vague complaints or symptoms without evidence of physiologic abnormality.

(16) Exacerbation or poorly controlled chronic illnesses such as asthma, seizure disorder, diabetes, arthritis, hypertension, and heart disease.

(17) Frequent visits with increasingly severe trauma.

b. Mental Health/Psychiatric Indicators (Female):

(1) Feelings of isolation and inability to cope.

(2) Suicide attempt or gestures.

(3) Depression.

(4) Panic attacks and other anxiety disorders.

(5) Alcohol or drug abuse.

(6) Post-Traumatic Stress Disorder Reactions.

c. Behavioral Indicators (Female):

(1) Seeming discrepancies between injury and explanation.

(2) Delay in seeking medical care.

(3) Partner accompanies patient, insists on staying close, and answers all questions directed to patient.

(4) Reluctance of a patient to speak or disagree in front of partner.

(5) Intense irrational jealousy or possessiveness expressed by partner or reported by patient.

(6) Denial or minimization of violence by partner or patient.

(7) Exaggerated sense of personal responsibility for the relationship, including self-blame for partner's violence.

(8) History of drug/alcohol abuse by either the patient or partner.

(9) History of child abuse/neglect in the family.

(10) History of rape by partner.

d. Profile of an Abused Man:

(1) Manifests injuries primarily on legs, back, head or shoulders.

(2) Presents with injuries requiring emergency attention.

(3) Maintains strong, rigid expectations of each parent's specific role.

(4) Has body size or shape not relevant to the type or degree of injury.

(5) Indicates, on questioning, that verbal aggression led to physical aggression.

INDICATORS FOR RAPE AND OTHER SEXUAL MOLESTATION

a. Rape:

(1) Special Considerations for Health Care Providers:

(a) Only a small minority of rape victims seek assistance soon after they are raped and acknowledge that they have been raped.

(b) Other victims seek medical care with complaints based on symptoms, but do not disclose than an assault has occurred.

(c) Others do not present until months after the incident, but then contact the medical community repeatedly over time.

(2) Immediate Impacts on Physical Health and Well Being:

(a) Physical effects of trauma may include soreness, bruising and rectal bleeding.

(b) Gastrointestinal irritability, fatigue, tension headaches, intense startle reactions, and disturbed sleeping and eating patterns also are noted.

(c) Gynecological trauma, pregnancy, HIV and other infections, and sexually transmitted diseases are potential consequences and pose further fear.

(d) Alcohol and other drugs may be used for escape, sleep aid, or self-medication.

(3) Long Term Effects:

(a) Chronic anxiety and feelings of vulnerability, loss of control, and self-blame.

(b) Catastrophic fantasies, feelings of alienation and isolation, sexual dysfunction, and physical distress.

(c) Post-Traumatic Stress Disorder indicators such as numbing of affect, chronic states of arousal, nightmares, and flashbacks.

(d) Mistrust of others, phobias, depression, hostility, and somatic symptoms.

(4) Other considerations:

(a) Partner rape is frequent among women who are being physically assaulted by their partners.

(b) Women sexually abused as children are at increased risk of rape.

b. Indicators for Adult Survivors of Child Sexual Molestation:

(1) Symptoms of PTSD without an apparent history of current or past rape, date violence, partner abuse, or other trauma.

(2) Evidence of ongoing severe depression, especially if accompanied by self-harm and suicide attempts.

(3) Evidence of sexual dysfunction or unusual anxiety involving sexual activities or exposure of the body, including medical & gynecological exams.

(4) Early onset of alcohol or drug abuse.

(5) Childhood history of running away.

(6) History of repeated physical or sexual victimization.

(7) Somatic disorders, i.e., abdominal pain, headaches, & eating disorders.

Attachment D October 31, 2019

REPORT OF INJURY RESULTING FROM A DEADLY WEAPON OR

ASSAULTIVE/ABUSIVE CONDUCT

California Penal Code sections 11160 and 11161 require hospitals, health practitioners and physicians to report immediately, both by telephone and in writing, any injury resulting from the use of a firearm, knife or other deadly weapon, or otherwise inflicted in violation of criminal law, whether by act of the patient (self-inflicted) or by another person.

EXCEPTION: Any physical or psychological condition brought about solely by the voluntary self-administration of any narcotic or restricted dangerous drug is not reportable. Reportable self-inflicted injuries are limited to those caused by/as a result of a firearm.

This section to be filled out by the responding health practitioner:

Date/time called VA Police Service: By (print name):_______________________________

REASON FOR REPORT:

Firearm related injury (self-infliction or by another):

Wound by knife or other deadly weapon (specify):

Injury from another criminal law violation (specify):

Patient’s name:

Patient’s address:

Patient’s whereabouts:

Facility name and address:

Nature & extent of injury:

Name and address of alleged perpetrator (if known:

By ______________________________________________________________

Attachment D October 31, 2019

Signature of treating physician or other reporting party Date/Time

This section to be completed by Officer, VA Police Service

Telephone Report Given To:

Name/ID# of law enforcement officer to whom reported:

Name of law enforcement agency of jurisdiction:

By _______________________________________________________________________

Signature, VA Police Officer Date/Time

Distribution:

1. Copy to law enforcement agency of jurisdiction***

2. Copy to patient’s administrative chart

3. Copies mailed to:

District Attorney Domestic Violence Unit 101 W. Broadway San Diego, CA 92101

***If law enforcement agency of jurisdiction chooses not to investigate in person.