Drunken university students are a dime a dozen on weekend nights in our ER. Many are unconscious, some are abusive, and others are downright funny. Most blame their inebriation on their "friends" who plied them with drinks they don't even remember consuming.
Friends?
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When nurses treat patients whose condition or injuries suggest that a crime may have been committed (e.g., an assault, child molestation, etc.), we are required to report our suspicion (sometimes via our supervisor) to law enforcement, despite the fact that this may place us in an awkward or even adversarial position vis-a-vis some patients, especially those who would rather their injuries not be disclosed to the police or who would rather protect others from prosecution.
However, in the case of underage drinkers (which most of our drunken college students are) when we KNOW a crime was committed (underage drinking), we are not required to report this. In fact, because the drinking age is 21 but patients are legally adults at 18 and therefore accorded certain federal rights to privacy, we are not permitted to report a patient's drunkenness to police, the university or even to the patient's parent(s) without the patient's consent.
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Coincidentally, many underage drunken students are covered by their parent's insurance which ends up being charged for the ER service.
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An underage sorority sister called the other day to find out the details of her ER experience the night before when she was brought in by ambulance after being found unconscious in her sorority house. She wanted to know what tests were done and especially whether or not a drug test had been performed.
I felt sorry for her for several reasons. First, she had no recollection of the experience. Drunk is fun (maybe); drunk and unconscious is dangerous.
Second, we conducted multiple lab tests and very expensive cervical spine xrays and head CAT scans (because in her unconscious state, injury could not be ruled out any other way). Drunk is fun (maybe); drunk, unconscious, and requiring ER treatment is expensive.
Lastly, she wanted to know if a drug test was done because she suspected that someone had slipped her a drug that would explain her unconsciousness. I had to explain to her that, although a drug test was not performed and therefore foul play could not be ruled out, I was pretty certain that her blood alcohol content (BAC) could more than account for her unconsciousness.
Her ETOH (alcohol) level was 0.3...drunk three times over by state standards!
Triply drunk and unconscious with a huge ER bill. There's no crime in that?
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Well, I'm relieved that there is no mandatory reporting by healthcare providers of all crimes. Your job would start to really suck if the state started forcing you to engage in law enforcement activities, on top of everything else you to. And that is what mandatory reporting essentially is.
In general, law enforcement is supposed to be left to the state, and medical care is left to providers.
The major exceptions are (supposedly) narrow, and the result of a balancing test which weight threat to society and difficulty of enforcement against invasions to patient privacy and distracting from the efforts of medical providers. Gunshot wounds, child abuse, etc., are supposed to be serious enough threats to social well-being that their prevention outweighs those other concerns. Presumably someone has decided that underage drinking is not. So, it's not the case that you must report suspicion of all crimes to law enforcement, but only some crimes.
This raises a serious issue of line drawing, as I suspect you can see. There are only two clear lines that can be drawn, neither of which is desirable. One clear line is to just report ALL patients' data to the police. Another clear line is to report none.
The first is undesirable because it would over-deter people from seeking care. The second is undesirable because it would hamper prosecution of dangerous and socially undesirable crimes.
Unfortunately, the middle ground is fraught with absurdities.
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