• environment
• public health

A child falls from an open apartment window without a window guard and suffers a severe, disabling head injury. A teenager amputates his finger while operating machinery at work. A family of four small children are severely burned in a house fire because their rental tenement did not have a smoke alarm. Each of these patients is treated in a hospital; each is left with permanent disability.

A child is admitted to the hospital with bloody diarrhea and develops renal failure secondary to the hemolytic uremic syndrome, and requires renal dialysis. This child's illness is caused by an infection with Escherichia coli 0157 H7, the source of which is unpasteurized apple juice sold at a local fair.

In this latter instance, few physicians would hesitate for more than a millisecond in calling the local health authorities to report this source of contaminated juice once it was discovered. The local health authorities would also not hesitate to close down that producer until the source of the contamination was determined and the problem rectified. This is simply good “public health practice” and has resulted in dramatic reductions in morbidity and mortality from infectious diseases during this century.

Should the same action occur for the injury problems described? Should physicians and hospitals give this information …