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Call for mandatory reporting of “body-packers”
Body packing, pushing and stuffing are methods by which people conceal illicit drugs in order to transport them across borders or evade police discovery.
Body packers swallow drugs in rubber or latex packets for trafficking; body pushers insert drug packets into their rectum or vagina; and body stuffers swallow wrapped or unwrapped drugs to dispose of the evidence when fearing apprehension by the authorities.
Current Australian laws on reporting of these incidents by doctors are not uniform, resulting in potential legal problems for both doctors and patients.
A case report published in the latest issue of Emergency Medicine Australasia, the journal of the Australasian College for Emergency Medicine, and an editorial on the subject, call for the development of uniform guidelines for clear cases of body packing in the setting of drug trafficking.
Emergency physicians Dr Biswadev Mitra and Dr de Villiers Smit from the Alfred Hospital and Monash University, with Mr Bill O’Shea, legal counsel for Alfred Health, describe the case of a 30-year-old man who was brought to the emergency department (ED) by his “tour guide” with symptoms of nausea, vomiting, and diarrhea.
He was a national of a southeast Asian country and had arrived in Australia two days previously.
A CT scan of the abdomen was performed, revealing multiple foreign objects in the small bowel, consistent with a diagnosis of “body packing”.
“Heroin is the commonest opiate transported and complications in symptomatic patients include respiratory depression, acute lung injury, bowel obstruction, intestinal perforation and death,” said Dr Mitra and his colleagues.
“Most cases of body-packing requiring medical treatment are brought into ED by law enforcement agencies.
“Where the diagnosis is made independently in ED, the issue of reporting the case to law enforcement officials poses a difficult scenario given the legal obligations of patient confidentiality.
“Given the urgent need for treatment in these cases it is not often possible for a clinical team to fully explore all these scenarios before making the decision on whether or not to breach the patient’s privacy.”
In the editorial, Dr Nicola Cunningham, emergency physician at St Vincent’s Hospital in Melbourne, and forensic physician at the Victorian Institute of Forensic Medicine, said “In most Australian jurisdictions, mandatory reporting is only stipulated for notifiable infectious diseases, impaired medical colleagues, and cases of suspected child abuse.
“Yet on a day-to-day basis, medical practitioners are called upon to make significant decisions in many other common scenarios where their ethical and legal responsibilities are ill-defined.
“The decisions made at the time, with little opportunity for reflection or consultation, may unwittingly lead to legal ramifications both for the practitioner and the patient.
“These patients represent a challenging cohort of individuals for emergency department staff, with each scenario raising complex ethical and medicolegal questions.”
She said there are a number of significant healthcare issues specific to emergency department presentations with drug concealment.
“The drugs may have been wrapped in cellophane, aluminium foil, plastic bags, or paper of variable strength and quality; often an ingestion is suspected but not witnessed; the type of drug, dose and purity is frequently unknown; patients may present with confounding clinical effects of co-ingested drugs; and there may be a prolonged time interval between concealment and onset of symptoms making it difficult to differentiate between false claims and delayed symptomatology.
“In general, the more spontaneous the ingestion, the less secure the packaging and potentially greater risk to the patient of drug toxicity.”
The legal position of medical practitioners in the setting of illicit drugs, regardless of quantity, is not clearly defined, leaving many doctors at risk of legal action for breach of privacy laws.
“Body packing could be regarded as an attempt to engage in trafficking rather than just possession for personal use given the organization and quantity of illicit drug involved in such conduct,” said Dr Mitra and his colleagues.
“Rather than let doctors and their legal representatives speculate on the right course of action, clear national statutory amendments should be developed and applied in the setting of managing patients with illicit drugs.
“The health and justice systems must combine their efforts to tackle this growing problem in society.”
"The privacy laws make it difficult for clinicians to decide whether they can report cases of body packing to law enforcement authorities" Mr O'Shea said.
"There has to be a statutory exception to allow disclosure.
“I suppose you could argue there is a serious or imminent threat to the others in the group, but it's far from clear without legislative change to cover these cases," he said.
Media contact: Marilyn Bitomsky [firstname.lastname@example.org]