Case study - The man in the van

A specialty registrar in emergency medicine – Dr K – is working in A&E one Saturday night just before Christmas. Two policemen come into the department and approach a sister at the desk. They inform her that they have just arrested a man for domestic breach of the peace and assault. He is now out in the van and “full of drink” and the officers want someone to come and check if it is just the drink.

Dr K is sitting at a nearby computer and overhears the request. He tells the officers that it is not the department’s responsibility to check for alcohol or drugs in such cases and certainly not in the back of a police van. One of the officers says “fine” and the two turn and leave A&E.

A short time later the department receives a phone call from the duty sergeant at the local police station complaining that a patient had been “turned away” without examination. He tells Dr K that the man in the van had been unable to stand and was unresponsive to questions and commands, and the officers had been concerned that he might not be fit to be detained due to some other condition or injury.

Dr K responds that the officers had not made him aware that the patient was unresponsive and possibly in need of medical attention. The duty sergeant asks why else would they have brought him to hospital and informs Dr K that the man will be seen by a police surgeon. Later that night the subject is brought back to A&E and examined by another doctor and discharged back to the police.

A few weeks later a complaint is sent to the hospital from the local police force. In it the duty sergeant sets out his version of events that night. He states that Dr K refused to assist in the medical assessment of an arrested male. In his account the two officers asked Dr K directly to determine if the man was drunk or possibly suffering from some other condition, and they offered to carry the man into A&E or allow for the check to be done in the van. Both suggestions were allegedly refused by Dr K. Only on the insistence of the police surgeon was the man returned to hospital and fully assessed and indeed found to be just intoxicated.

The complaint stated that despite the final outcome the police still found Dr K’s attitude unhelpful and irresponsible. Had the man’s condition been due to diabetes or a head injury this would have been missed and possibly with serious consequences. A copy of the document is also sent to the General Medical Council.

Analysis and outcome

Dr K contacts MDDUS and forwards the complaint to a medical adviser. He discusses the matter and with the help of the adviser writes a reply. In it he disputes the account provided by the two officers, stating that no concerns were expressed as to the medical condition of the patient and that no offer was made to bring the man into the department as is normal procedure. This can be corroborated by the sister at the desk.

He agrees that no doctor should assume that alcohol is the sole cause of a patient’s condition but that a full physical examination is necessary to make such an assessment and this is not possible in the back of a police van.

A similar response is sent to the GMC and after an investigation the case is referred back for local resolution at the employing hospital. A meeting is convened to discuss the matter with the senior consultant A&E physician and management. No further action is taken against Dr K.

Key points

• Doctors should not be coerced into examining patients in circumstances which are unsuitable unless there is a very good reason, e.g. when it may be detrimental to move them prior to assessment.

• Doctors must be sure of all relevant facts before refusing to see any patient or potential patient.

• It would have been prudent to invite the police to formally bring the patient into the A&E department if they were concerned, as this would allow proper note keeping and recording.

• Always discuss any such matters or complaints with the responsible consultant and MDDUS.

• Remember that NHS indemnity will not provide you with advice and legal support in GMC/ disciplinary actions and thus maintaining private indemnity is recommended for all doctors.