Patient Privacy: Discussing Health With Law Enforcement

Doctors are generally not allowed to share patient information without permission. However, there are exceptions to this rule. For instance, if the patient presents a serious and imminent threat to themselves or others, the Privacy Rule permits healthcare providers to disclose necessary information to law enforcement or family members. Doctors are also mandated to report suspected cases of child abuse and any information indicating a threat to public safety. While doctor-patient confidentiality covers medical discussions, it does not extend to admissions of criminal activity, and doctors may report confessions of crimes that do not involve physical harm to others.

Doctors can share patient information without consent in some cases

Doctors are generally required to obtain consent before sharing patient information with other parties. However, there are certain exceptions where doctors can share patient information without consent in specific situations.

One such exception is when there is a risk of harm to the patient or others. The Privacy Rule permits healthcare providers to disclose necessary information about a patient to law enforcement, family members, or other persons when the patient is believed to present a serious and imminent threat to themselves or others. This allows providers to alert those who are reasonably able to prevent or lessen the threat. This exception is not limited to physical harm but also includes mental health concerns. Mental health providers are mandated reporters and must disclose if they believe their patient is a danger to themselves or others.

Another instance where doctors can share patient information without consent is to protect public health. Doctors can use health information to report on public health issues, such as flu outbreaks, pandemics, and suspected cases of child abuse. Physicians are required by law to report certain communicable diseases to state agencies for tracking purposes. Additionally, doctors can share patient information without explicit consent within the same practice or health maintenance organization (HMO) to streamline medical treatment. For example, a new provider within the same practice can access patient records, including medication lists, without consent to ensure safe prescribing practices.

It's important to note that while these exceptions exist, doctors must still adhere to HIPAA guidelines and respect patient privacy. Unauthorized, unnecessary, or unconsented disclosure of protected health information (PHI) is a violation of HIPAA and can have legal consequences. Physicians must exercise caution and only share patient information when necessary, always prioritizing the patient's right to privacy.

Doctors must report suspected child abuse

In the United States, the Privacy Rule permits healthcare providers to disclose patient information to law enforcement, family members, or other persons if the provider believes the patient may pose a serious and imminent threat to themselves or others. This is allowed under HIPAA (the Health Insurance Portability and Accountability Act) to prevent or lessen the threat to health or safety.

Doctors must also report suspected child abuse. This is a legal requirement in most states, and failure to do so could result in criminal or administrative penalties and expose doctors to the risk of future lawsuits. However, the level of suspicion required to report suspected abuse is not always clear, and reporting laws can be imprecise. Physicians must, therefore, be diligent and have a good-faith, reasonable basis for suspecting abuse. They should be aware of the relevant reporting laws and consult with colleagues to assist in the decision-making process.

Child abuse can take many forms, including neglect, physical and sexual abuse, and psychological maltreatment. In 2006, nearly one million substantiated cases of maltreatment were reported, with 66% involving neglect, 16% physical abuse, 9% sexual abuse, and 7% psychological maltreatment. Boys and girls were equally vulnerable to neglect and physical abuse, but girls were sexually abused four times more frequently than boys. African American children had the highest rates of substantiated abuse.

Physicians who work with children should be particularly aware of their obligations to report suspected abuse and the relevant procedures. For example, doctors who practice in school clinics should know when sexual activity must be reported to child welfare agencies. They should also ensure that their personal beliefs do not govern their conduct in this setting.

Doctors must report if a patient may harm themselves or others

Doctors are bound by law to keep patient information confidential unless the patient may harm themselves or others. In the United States, the Health Insurance Portability and Accountability Act (HIPAA) levies penalties on physicians who breach patient confidentiality. Confidentiality benefits the patient, who must feel free to tell the truth about their condition, and the public, which might otherwise face a contagious disease that could have been contained.

However, this confidentiality is not absolute. In most states, laws and court decisions address and often require the disclosure of patient information to prevent or lessen the risk of harm. In addition, HIPAA permits sharing protected health information with law enforcement if the provider believes the patient presents a serious and imminent threat to themselves or others. The Tarasoff requirements as to potential violent threats have been extended to reasonably foreseeable potential victims in some jurisdictions. In the Tarasoff case, the patient's psychiatrist was found to have a duty to warn a third party that the patient had threatened to victimize.

In the United Kingdom, the Mental Health Act 1983 may not be used to detain a person against their will "merely because [their] thinking process is unusual, even apparently bizarre and irrational, and contrary to the views of the overwhelming majority of the community at large." However, the Court of Appeal has offered guidance to doctors, stating that doctors must give very careful and detailed consideration to the patient's capacity to decide at the time the decision was made. The more serious the decision, the greater the capacity required. For example, in the case of a patient refusing treatment, doctors should consider the patient's capacity to decline investigation and treatment.

Tarasoff requirements: physicians must report potential violent threats

The duty to warn and duty to protect are important concepts in the field of social work and other helping disciplines. The Tarasoff statute, also known as the Duty to Protect, applies when a patient makes a threat to a psychotherapist of serious violence against a reasonably identifiable victim or victims. The statute applies only to psychotherapists, which generally refers to licensed mental health clinicians, including psychiatrists, psychologists, marriage and family therapists, social workers, and psychiatric nurses.

The Tarasoff statute imposes a liability on all mental health professionals to protect a victim from violent acts. The first Tarasoff case, also known as Tarasoff I, imposed a duty to warn the victim, while the second case, or Tarasoff II, implies a duty to protect. In the original case, Prosenjit Poddar told the university health science psychologist that he intended to kill Tatiana Tarasoff, who was identified as an unnamed woman. Although the psychotherapist did not directly warn Tarasoff or her family, the psychologist notified the police, who interviewed Poddar for commitment. Tarasoff's parents sued the University of California and the therapist.

The duty to protect can be fulfilled in various ways, depending on the clinical situation, including increasing the frequency of therapeutic visits or hospitalizing the patient. This duty overrides concerns about maintaining patient confidentiality, and therapists are expected to make reasonable efforts to communicate the threat to the victim or victims and to a law enforcement entity. Patients who become the subject of a Tarasoff statute that is reported to law enforcement are prohibited by California law from purchasing or owning firearms for five years.

According to HIPAA, if a patient makes a "serious and imminent threat" of violence, the clinician is allowed to disclose protected health information that is necessary to prevent or lessen the threat to the health or safety of the patient or others. This information can be disclosed to a person or persons reasonably able to prevent or lessen the threat. The US Department of Health and Human Services has stated that "HIPAA expressly defers to the professional judgment of health professionals in making determinations about the nature and severity of the threat to health or safety posed by a patient."

Doctors can share patient information with law enforcement in three situations

Doctors are generally not allowed to share patient information without permission. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a federal law that protects "individually identifiable health information" under the Privacy Rule. However, there are exceptions to this rule, and physicians may share medical records and personal medical information without consent in certain situations. Here are three circumstances in which doctors can share patient information with law enforcement:

• Patient Consent: Doctors can share patient information with law enforcement if the patient consents to the release of the information. This is a common scenario when the patient wants to cooperate with law enforcement or believes that sharing their information is in their best interest.
• Mandatory Reporting: In some cases, the law mandates that physicians report patient information to law enforcement. This typically applies to situations where there is a serious and imminent threat to the patient or others, such as suspected child abuse, or when required by state or local laws, such as reporting all gunshot wounds.
• Subpoena or Court Order: Doctors can share patient information if they receive a subpoena or court order from law enforcement. In these cases, physicians should ensure that the request specifically addresses applicable public health statutes and that only the minimum necessary information is released to comply with the request.

It is important to note that while these situations allow doctors to share patient information, they should still exercise discretion and only share the necessary information to comply with the request or address the imminent threat. Additionally, doctors should be mindful of the complex nature of medical privacy laws, which vary by state, and consult applicable laws and ethical standards in their profession and state.

Frequently asked questions