Shoot to Tell

Question 1

What is the framing of this problem

Answer 1

They are extremely rare but more in rural areas
Disease prevention is facilitated when good data is collected
Public health is declaring violence to be an issue of concern to public health and important determinant of health

Question 2

What are some ideas surrounding this issue

Answer 2

Indvidualism vs collectivism
Making communities safer vs avoiding treatment
Public health concern vs criminality

Question 3

Whos job was it before the act was passed

Answer 3

HCP to use professional opion when it should be reported to police

Question 4

What is the difference between proactive vs retroactive

Answer 4

Prevention - put money towards programs and policy that help reduce gunshot wound inguries
Treatment - put money towards treating gunshot wounds and police reosurces

Question 5

What does HPPA

Answer 5

These diseases or suspected occurrence of these diseases must be reported to the local Health Unit by physicians laboratories administrators of hospitals schoolas and institutions reley on these reports of communicable disease to monitor the health of the community and to provide basis for preventive action

Question 6

What is under mandatory reporting legislation

Answer 6

Gunshot wounds
Child abuse or neglect
Suspected elder abuse or death
Health conditions that make it dangerous to drive operate rail equipment
Birth stillbirths and deaths
Communicable disease or adverse reacations to immunizationtion
Fraud in health cards
Sexual abuse

Question 7

What does the law say about gunshot wounds

Answer 7

Gunfire poses serious risk to public safety prevent further violence injury and death
Must be reported as soon as possible

Question 8

What is the federal firearms act

Answer 8

Required individuals to obtain a license to purchase a firearms and or ammunition
Mandatory traning program when purchasing of firearms
Tougher border control

Question 9

What does the Personal Health information protection act and regulate health professions act

Answer 9

Both acts required that all regulated health care providers in Ontario have duty to respect patient confidentiality unless the individual consented to disclosure or unless disclosure was permitted in limited circustmases

Question 10

Whats the difference between ontario and saskatchewan

Answer 10

Saskatchewan is mandatory gunshot and stab wounds

Question 11

What are some policy options to reduce violent crime

Answer 11

1. Mandatory reporting of all cases of criminal activty
2. Mandatory reporting of certain types of criminal activity
3. voulntary reporting of criminal acts with or without the consent of the indivdual invovled
4. Increased educational support to address the connection between the social determinants of health and gunshot wound reporting
5. Increased support of healthcare provider confidentality

Question 12

What are the two sets of arguments being made for reporting gunshot wounds

Answer 12

Protection of the public
violence prevention

Question 13

What are issues with shoot and tell

Answer 13

Fiduciary duty - highest standards of care at law - requires physicians to act in good faith for the sole benefit and best intrests of their patients
Confidentiality - owe patients a physical legal ethical and professional duty to not disclose PHI expect in a limited circumstance
Autonomy - patients have a right to make decisions about their care without influence of their physican

Question 14

Who si for this and who is against it

Answer 14

Public policy people for and HCP are against it

Question 15

What are some ethical considerations that HCP say

Answer 15

Retaliation by the perpetrator and concern re: breached confidentiality this can damage trust relationships between victim and the HCP
Compromise of trust deters victims from seeking help or returning
Law removes ability to exercise judgment and make decisions

Question 16

What is exceptions to duty of confidentiality include

Answer 16

Patient consent
Duty to warn - patient poses a foreseeable risk to an idnetifiable 3rd party
Public safety exception clear serous and imminent threat of physical or psychological harm

Question 17

What is PHIPA

Answer 17

Establishes rules for the collection use and disclosure of personal health information while at the same time facilitating the effective provision of health care

Question 18

What is PHI

Answer 18

Any indetifiable information about an individual either living or deceased and includes information about their health
Includes information collelcted in the course of providing health services to the individual

Question 19

What are examples of identifiable patient information

Answer 19

Name, medical record number or health card number

Question 20

What is circle of care

Answer 20

A person/ group of persons providing care to the individual
Episode of care
Informal refrence and is not defined under PHIPA but can include

Question 21

What is information that when used in conjucation with other information could re-identify an indivual

Answer 21

Date of birth + surgical procedure + name of surgeon + date of surgery
Postal code + diagnosis/condition

Question 22

Who or what is HIC

Answer 22

Person or organizatio who has custody and control of personal health information
Legally responsible for personal health information on all of its patients regardless of the purpose for which the PHI is used

Question 23

What are examples of HIC

Answer 23

Include a hospital an independent health facility, a physician in a private practice, a physician as part of a family health team

Question 24

Who or what is an agent

Answer 24

A person that with authorization of the custodian acts for or on behalf of the custodian in respect of personal health information for the purposes of the custodian and not for the agenst own purpose

Question 25

Examples of an agent

Answer 25

Employees physicians third party vendors voulnteers students

Question 26

What is the use of PHI by the HIC

Answer 26

For the purpose it was collected
Obtaning payment for providing health care
Risk management/ error management
Program planning / delivery
Education of agents to provide health care
Proceeding where the custodian/ agent or former agent of the custodian is expected to be a party or witness
Research conducted in accordance with PHIPA

Question 27

What are acceptable reasons for disclosure

Answer 27

Within the circle of care
Chief medical officer
Prescribed entity
Significantly reduce the risk of harm
SDM or acting power attorney for care
The parent of a child
And other circumstance defined in the legislation

Question 28

What is the disconnect between PHIPA and the Mandatory Gunshot Wound Reporting Act

Answer 28

Provider - patient relationships
Collection, use and disclosure of PHI
MGWRA becomes an acceptable reason for disclosure and supersedes PHIPA
Police do not have to abide by PHIPA
Accidental incidents still must be reported

Question 29

Violence and a Public Health Approach

Answer 29

Aim: prevent the loss of lives and countless traumas
Violent behavior arises from contextual biological environmental
The public health approach to violence focuses on prevention through addressing the known factors that increase or decrease the likelihood of violence

Question 30

What else does violence increase the risk of (APHA)

Diseases

Answer 30

Asthma hypertension cancer stroke
Psychiatric illness
Sleep poorley and smoe
Negative health outcomes seen in statistics releated to HIV maternal health

Question 31

What are some Trade offs to think of

Answer 31

Who should report
Who should the report go to
Providers may be subjected to repercussions for their reports

Question 32

What are some good examples that happend in the States

Answer 32

Chiago reduced homicides and shooting
Baltimore went over a yeat without a homicide
New york city almost have reudction in hun injuries