
A Hospital Tells Police Where Fights Happen, And Crime Drops - venutip
http://www.npr.org/blogs/health/2013/09/19/224052451/a-hospital-tells-police-where-fights-happen-and-crime-drops
======
alttab
What's most important these days is the data was cleaned first, and was
proactively given out to police which was used indirectly to ward off future
crime. All it took was police presence.

They didn't need to indiscriminately take patient records out of their backend
systems or monitor the hospitals networks and reverse engineer http and
packets. They didn't need to target individuals who are repeat offenders or
violate any privacy consideratio.

I'd say 150 years ago the nurse was telling the sheriff the boys keep getting
too roudy at the saloon, too.

~~~
rhizome
When crime drops, police can get laid off.

~~~
dmix
Real crime statistics dropping? Or fear/perception of crime dropping?

~~~
MBCook
I remember reading about the negative side-effects of crime-stat systems a few
years ago.

When the systems were first installed, they provided a ton of good information
and the crime rate dropped. Homicides were reduced, less gang activity, etc.

Well after a couple of years of reducing crime by double digit percentages,
suddenly that became the standard. So there were perverse incentives to do
things like classify crimes as lesser offenses. If you can talk people into
only complaining about assault, your rape crime count can go down.

At the same time, if there isn't _enough_ crime, you don't need as many cops.
So there are also incentives to write more tickets and criminalize more
things. Since it's now a crime to walk with your shoes untied, the police can
say "Look, this year arrests are up 10%! We're really doing a good job!" or
"New kinds of crime are taking over, we need some people for a task force.".

~~~
brownbat
I think the Freakonomics authors talked about this study... the study's
authors noticed there was some gaming of the statistics going on because while
most stats dropped, the rate of certain offenses held steady. The stubborn
offenses were the ones that were much trickier to reclassify as lower level
crimes, like homicide or arson.

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haldujai
A related, and well studied, debate in medicine was about the right of privacy
for inmates in a correctional institute. Until the final version of HIPAA
inmate health information was not considered protected like for the general
population.

Once upon a time ago it was intensely debated whether the effect of
disclosures of drug or weapon possession to prison administration would
negatively affect prisoner cooperation and the quality of healthcare. Inmates
were known for storing weapons or drugs in their rectum, physicians worried
that if an X-Ray were to reveal such objects and if they were required to
disclose them that inmates would stop accepting X-Rays and general health
would decline.

The general consensus of studies that examined this issue showed that this did
not in fact happen[1]. It was found that as long as only things that risk the
health of the general population (i.e. drugs don't need to be reported but
weapons do) were reported there were no adverse effects.

Extrapolating to the general population, one could conclude that this
hospital's practices wouldn't discourage people from going to the hospital.
Criminals that would be discouraged by this policy would likely not be going
to the ER prior to its implementation (similar to how inmates with knives in
their rectum still won't go to a physician despite HIPAA protection) because
they're afraid of being caught doing something illegal. You can't really do
anything for this subset of the population however you can help the majority
by sharing this information with the police while causing minimal (or no) harm
to any individual patient.

[1] I read this in "Doing Right" by Hebert, PC. In the book they cited a study
but I no longer have it, if someone really wants this reference I can go hunt
for it. I wouldn't recommend buying this book as it's ridiculously overpriced.

------
tobyjsullivan
A good example of data-sharing being put to productive use. Apparently with an
3200% ROI. Not bad.

We all know a lot of crimes go unrelated but I never thought certain classes
of crimes would be so significantly under-represented.

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guelo
Bad idea, people won't go to the hospital. Reminds me of the story about the
CIA going undercover as polio vaccinators in Pakistan and now legitimate
vaccinators are being chased off and polio rates are increasing.

~~~
Wingman4l7
They were pretending to be doing Hepatitis B vaccinations in an attempt to
confirm the presence of Osama bin Laden in the area:
[https://en.wikipedia.org/wiki/Poliomyelitis_in_Pakistan#Fact...](https://en.wikipedia.org/wiki/Poliomyelitis_in_Pakistan#Factors_affecting_eradication)

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dmix
How long are you able to report a crime after the fact?

I remember being hit by a car on my bike (a famously under-reported incident),
but both myself and my girlfriend physically/emotionally were in rough shape
all day. We forgot to report it, then it ended up slipping out of our minds.

This is a challenging problem to solve with technology, similar to getting
patients to take their daily medication on time.

~~~
inafield
Depends on the country and the crime. In Canada it is 24-48 hours to report
your tires being slashed, 1 year to prosecute a vehicle collision, but 25
years for something like rape and/or molestation.

~~~
kenjackson
In most places in the US I believe there is no statute of limitations for
murder.

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ginko
This is interesting. Hospitals in Austria are actually required by law to
report such incidents as far as I know. The same is true for results of
domestic violence.

~~~
Wingman4l7
Isn't this the case in the US as well, for injuries like gunshot wounds? Or is
that just Hollywood telling me that?

~~~
ImprovedSilence
No, gunshot wounds are definitely required to be reported. But fights/blunt
trauma and the like of non mortal wounds probably aren't required to be
reported.

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sandGorgon
i wonder whats the modus operandi around this ?

let me explain - in India, it is mandatory for hospitals to reports all
"unnatural" incidents to the police - which means crime, traffic accidents,
etc. Now because of the already understaffed police and/or corruption in the
force itself, what happens is that the hospital tends to withold critical care
until the police report is completed. In recent times, this has snowballed
into a huge controversy and caused some other laws being passed to ensure care
first.

Now here's the issue - this is still a gray area. Let's say you are a newly
minted doctor working in the hospital and a patient comes in with several
injuries and who tells you that there is a gang incident in a pub and likely
many people are injured. What is the _mandated process_ \- do you have to make
a police report first, or do you provide medical care first ? Doing either can
result in the doctor being blamed for something or other.

Or is there a dedicated "liason" whose job is to do the reporting and leave
the care to the doctors. Which would mean staffing for a role like that would
be difficult in a non-publicly funded medical institution.

~~~
leoedin
Going by the article and my knowledge of the UK healthcare system, it's almost
certainly care first, report later. It seems that the hospital is collating
records of fights over longer periods of time - perhaps weeks or months - and
providing that data to police. The article isn't really about reporting of
individual crimes, but broader statistics for more targeted policing.

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a_bonobo
Unintended side-effect:

When two gangs fight and people get injured but don't want the police to know
about the location of the fight (an illegal clubhouse?), wounds are either
ignored or stitched up by backalley doctors.

~~~
DanBC
> When two gangs fight and people get injured but don't want the police to
> know about the location of the fight (an illegal clubhouse?),

Gangs tend to use social networks to organise fights. People in the UK tend to
get wounds treated.

([http://www.scotland.gov.uk/Publications/2011/07/05130225/3](http://www.scotland.gov.uk/Publications/2011/07/05130225/3))

> _89\. Another innovative idea being taken forward is the sharing of
> 'anonymised' information collected at Accident and Emergency (A & E)
> departments in hospitals concerning the incidence of violence and use of
> weapons at particular geographical 'hotspots' so that police can track
> violence trends and take preventative measures. Many victims of violence do
> not report the crime to the police but do attend at A & E with their
> injuries. The National Violence Surveillance Network established by the
> Cardiff University Violence Research Group in England and Wales found that
> such measures led to decreased numbers of wounded victims attending A & E as
> a result of violence and a decrease in serious assaults reported to the
> police. A pilot study is underway in Lanarkshire hospitals along the same
> lines._

Here's what the Royal College of Nursing says about reporting crime:
([http://www.rcn.org.uk/__data/assets/pdf_file/0009/287793/03....](http://www.rcn.org.uk/__data/assets/pdf_file/0009/287793/03.09_Dealing_with_Knife_Injuries_v2.pdf)).
This mentions the Cardiff Model.

2006: ([http://www.independent.co.uk/news/uk/crime/the-streets-of-
sc...](http://www.independent.co.uk/news/uk/crime/the-streets-of-scotland-
britains-knife-capital-480981.html))

> _But doctors have admitted that the vast majority of stab wounds treated in
> the city 's hospitals go unreported to the authorities. The scale of the
> violence is feared to be much greater than officially acknowledged._

[...]

> _Last September the United Nation 's crime research institute said Scotland
> was the most violent country in the developed world. Scots were nearly
> three-times more likely to be the victims of violent assaults than people
> living in the United States. More than 50 per cent of knives found by the
> police in Scotland are seized in Glasgow. Stabbings account for half of all
> murders._

2011: ([http://www.heraldscotland.com/news/home-news/shocking-
rise-i...](http://www.heraldscotland.com/news/home-news/shocking-rise-in-
scottish-knife-crime.15457796))

> _According to the newly-published annual Global Study on Homicide, the
> homicide rate in Glasgow stood at 3.3 per 100,000, compared to 1.6 in the
> English capital._

> _The report also shows Scotland’s homicide rate remains higher than in many
> other European countries, including England and Wales, Poland, Hungary,
> Croatia, Spain, Portugal and Italy. Figures for France were not available._

2013: ([http://www.scotsman.com/news/glasgow-knife-crime-falls-
by-a-...](http://www.scotsman.com/news/glasgow-knife-crime-falls-by-a-
third-1-3062657))

> _There were 903 assaults involving blades in the period 2012-2013, compared
> with 1,439 the year before, a fall of 37 per cent. The rate is down 57 per
> cent since 2006-2007, when 2,138 knife attacks were recorded in the city._

> _Officers have attributed the fall in knife crime to an increase in stop and
> search procedures across Glasgow. In November, 2007 the number of such
> searches carried out in the city was 4,356. Five years on, this figure has
> risen to 26,669._

~~~
pjc50
Yeah, Glasgow is a bit of an outlier; a nasty mixture of poverty,
unemployment, alcohol, and sectarianism gives it a long history of knife crime
in some areas.

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bsullivan01
_So the hospital started sharing its information with the police, after
removing names and other identifying information._

Strange, I thought they were obligated to call the cops when someone with
obvious such injuries went to the hospital. You know, if you have a black eye,
broken nose and a stab wound, "I fell from the stairs" probably not gonna do
it.

~~~
haldujai
Laws don't mandate this like they do for gunshot wounds. Doctors do have
discretion, and if they feel that there is a danger to the public (i.e. a
nutjob stabbing people) they are legally able to report it (it wouldn't be a
HIPAA violation).

That said, due to the litigious nature of the US some patients are still
likely to sue and/or generate bad press. While it's unlikely that a court
would find the doctor/hospital guilty of any HIPAA violations it's a giant
headache the hospital and their lawyers don't want to deal with.

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misiti3780
Better idea - save the data to a server, make an API (free), and let
engineershelp visualize where the violence is occuring / predict where it will
occur based on date/time

~~~
sliverstorm
So, basically, you want someone else to do all the legwork and give you access
to their data for free. Cool, we'll get right on that.

~~~
misiti3780
also - "their data" is public information anyways (or at least should be) - is
basic crime statistics

~~~
sliverstorm
I'm not claiming it's secret information that they own. But this is like the
FOIA. Some smartass comes along, hears about FOIA, and declares "Well they
should just digitize the entire archive, make it available in a queriable SQL
database, and be done with it". The problem is, while the public has a right
to the information, the _representation_ , the _storage_ of that data has
issues. Digitizing millions of pages of records is not an afternoon's work
(triply so if you want OCR). The reason we _don 't_ have such a database is
_not_ because John Spook is too lazy to spend thirty minutes doing it.

When you put hundreds of thousands of man-hours into digitizing an archive,
there's essentially a cost/value-add. If there wasn't a value-add, why would
you want this hypothetical database anyway? The crime information is public,
why don't you just go compile it yourself!

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timmyelliot
Whatever. Nothing special.

The whole thing of hospitals reporting violence police sounds is a gangster
movie cliche: someone gets shot and his friends rush him to a disgraced
dentist who removes the bullet on the kitchen table with a splash of whiskey
and a dirty switchblade.

