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Thu Aug 17 16:50:03 BST 2006

Ron,

Way to go on helping to get the law repealed.

Your are totally correct re: Social Service. There are not enought of them to take on this new burden. You need dedicated referral specialists.

Rob

-------------- Original message -------------- 
From: "Ronald Gross" <Rgross at harthosp.org> 

> Tim, 
> I know exactly what you are talking about - our hospital had the same 
> social worker to ward ration for the longest time, and they actually 
> thought that was too many social workers. it just took a whole lot of 
> pressure on a whole lot of levels to move the rock..... 
> As to the issue of violating the rights of the entitled (you know - "I 
> am entitled to do what ever I want whenever I want to do it - regardless 
> of who I hurt, maim or kill in the process"), we here in the States have 
> the ACLU. 
> As my Daddy once said, tongue in cheek, "It just don't get no better 
> than that, do it!" 
> 
> Be well, 
> Ron 
> 
> >>> "Hardcastle, Tim, Dr " 8/17/2006 
> 10:42 AM >>> 
> Ron 
> 
> At least you have ready access to social workers - in the South African 
> scenario we are lucky if we have once dedicated SW for entire unit which 
> sees in excess of 20K trauma cases per year. For us also the government 
> would close the hospital if we screened for ETOH on every patient as 
> this would use up the entire lab budget, not to mention be in breach of 
> the "rights" of the citizen to privacy and lifestyle choice (no matter 
> who else is injured because of it, mind you!!!!) 
> 
> Tim 
> Dr T C Hardcastle 
> M.B.,Ch.B.(Stell); M.Med(Chir); FCS(SA) 
> Senior Surgeon / Senior Lecturer: Surgery (Trauma and ICU) 
> ATLS instructor and DSTC Cape Town Course Director 
> Intern program Coordinator: Surgery 
> Program Manager: Emergency Medicine (SU) 
> Clinical Head (Director): Diana Princess of Wales Trauma Unit 
> Department of Surgery Room 4064 
> Tygerberg Hospital / University of Stellenbosch 
> PO Box 19063 
> Tygerberg 7505 
> Western Cape 
> South Africa 
> e-mail: tch at sun.ac.za 
> Cell: +27824681615 
> Office: +27219389281 or 4911 pager 0302 
> 
> 
> 
> -----Original Message----- 
> From: trauma-list-bounces at trauma.org 
> [mailto:trauma-list-bounces at trauma.org]On Behalf Of Ronald Gross 
> Sent: Thursday, August 17, 2006 4:26 PM 
> To: trauma-list at trauma.org 
> Subject: Re: Alcohol Screening 
> 
> 
> I don't think anyone is going to argue with you on anything but the 
> presumptuous part. True, the information we gather is important as it 
> will assist us in managing a patient and help clarify the reason(s) 
> behind altered states of consciousness. True, too, that we are not 
> enforcers, and that the results of drug and alcohol screening/testing 
> must remain a part of the medical record and not the purview of the 
> law 
> UNTIL subpoenaed. And true again that the primary diagnosis might 
> just 
> be EtOH intoxication, with MCC or MVC as the second in the list, for 
> without the EtOH it could be argued that the crash just might have 
> never 
> occurred to begin with! 
> 
> However, the longer we say that we cannot successfully intervene or 
> have any effect on the lives of "those already befallen", the longer 
> those lives will remain wasted, and the longer we will allow those 
> wasted lives to waste and destroy the lives of the innocent people who 
> happen to be in the wrong place at the wrong time - right in the path 
> of 
> the befallen bent on continuing his/her wasted ways 'cause no one gave 
> a 
> damn enough to make the effort to redirect! And lastly, true yet 
> again 
> that success here will require "significant social resources" that we, 
> as clinicians are obliged to find and engage. 
> 
> OK, I will put away my soap box and go back to work. Heavy 
> sigh....... 
> 
> Ron 
> 
> >>> 8/17/2006 10:06 AM >>> 
> I feel that screening trauma victims for alcohol and drugs of abuse is 
> medically necessary to give the provider information necessary for 
> optimum care. Drugs and alcohol can complicate diagnosis and 
> management. 
> However, it is rather presumptuous to believe that the 
> emergency/trauma 
> team can 'intervene' with any real degree of success. Although 
> sentinel 
> events in the life of addicts/alcoholics are opportunities for 
> intervention, success in this area usually requires significant social 
> resources that are lacking in the lives of many people (family 
> support, 
> etc). Further, physicians must avoid becoming involved in the role of 
> enforcement, lest we loose the trust of our patients. Patient 
> information about drug/alcohol use acquired by physicians to assist in 
> providing medical care should remain part of the medical record, and 
> should not be available to insurance companies and law enforcement to 
> further destroy the lives of those already befallen. State laws which 
> provide for the a 
> cquisi 
> tion of evidence when officials are investigating a crime have been in 
> place for years, and have been successful. DB 
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