are doctors required to report if a patient states intent to harm

Should there be a mandatory reporting law for violent patients?

Mandatory reporting laws, say some professionals, may discourage people from seeking professional help or fully disclosing their intentions; or providers may be reluctant to treat potentially violent patients because they fear liability for failure to properly fulfill the duty to warn.

What incidents are required to be reported to the Department of Health?

PHL §2805-1 (2) requires that the following Incidents must be reported to the Department of Health: patients' deaths or impairments of bodily functions in circumstances other than those related to the natural course of illness, disease or proper treatment in accordance with generally accepted medical standards;

Should physicians decide whether to report suspected abuse?

The fact that it is often difficult to decide whether to report suspected abuse does not negate one's professional and legal responsibility to protect children by doing so. Physicians are not responsible for determining whether maltreatment occurred, only for reporting reasonable suspicion.

Can a physician refuse to authorize a patient to report?

Exceptions can be made if a physician reasonably believes that a patient’s refusal to authorize reporting is coerced and therefore does not constitute a valid informed treatment decision. Physicians should also protect patient privacy when reporting by disclosing only the minimum necessary information.

Are physicians accountable to their patients for their actions?

In addition to being held accountable by patients, as physicians, we hold ourselves accountable for outcomes. Doctors are trained to remain analytical, objective, and stoic even in the face of difficult situations. Complications are treated as unanticipated clinical challenges.

What are two things a physician is obligated to tell a patient under the informed consent doctrine?

In two informed consent cases following Canterbury, physicians have also been required to disclose (1) personal or economic interests that may influence their judgment (Gates v. Jenson) [6] and (2) all diagnostic tests that may rule out a possible condition (Jandre v. Physicians Insurance Co of Wisconsin) [7].

What is medical ethics violation?

Some examples of violations of medical ethics include: A doctor or psychiatrist who has sexual contact with a patient. Failing to give a patient information that would allow them to make informed decisions about care. Disclosing a patient's confidential information without their consent.

Is a doctor obligated to inform a patient of the diagnosis?

The bottom line is the patient does have a right to know his or her diagnosis, for two main ethical reasons: 1) it is the patient's information, not anyone else's, so the patient is entitled to that information; and 2) there will always be additional decisions to make, even if the diagnosis is terminal, so the patient ...

What is a violation of informed consent?

An example of failure to give informed consent occurs when a doctor gives the patient a written consent form, but fails to explain the medical conditions or jargon the form refers to, or the risk of complication or death from a procedure.

Is lack of informed consent negligence?

In both medical and legal terminology, this is called "informed consent." If a doctor does not get informed consent from a patient, and the patient is injured, the patient may have grounds to sue the doctor for medical malpractice.

What might be considered unethical behavior by a doctor?

Becoming romantically involved with patients or family members of a patient. Cherry-picking patients. Breaching patient confidentiality (violating HIPAA regulations) Joking about patients or acting inappropriately while a patient is under anesthesia.

What is an example of a medical ethical issue?

Patient Privacy and Confidentiality The protection of private patient information is one of the most important ethical and legal issues in the field of healthcare. Conversations between a physician and a patient are strictly confidential, as is information about an individual's medical condition.

What is classed as medical negligence?

Medical negligence is substandard care that's been provided by a medical professional to a patient, which has directly caused injury or caused an existing condition to get worse. There's a number of ways that medical negligence can happen such as misdiagnosis, incorrect treatment or surgical mistakes.

Are doctors allowed to withhold information from patients?

Except in emergency situations in which a patient is incapable of making an informed decision, withholding information without the patient's knowledge or consent is ethically unacceptable.

Do physicians have an ethical duty to disclose information about medical mistakes to their patients?

Do physicians have an ethical duty to disclose information about medical mistakes to their patients? Physicians have an obligation to be truthful with their patients. That duty includes situations in which a patient suffers serious consequences because of a physician's mistake or erroneous judgment.

Are there any situations when a physician is justified in lying to a patient?

But in some cases, physicians need to balance compassion with a patient's right to know. It's never ok to lie or to mislead someone into thinking the situation is better or worse than it is. But it is ok to provide information in smaller doses.

What is the HIPAA Privacy Rule?

The HIPAA Privacy Rule permits a covered entity to disclose PHI, including psychotherapy notes, when the covered entity has a good faith belief that the disclosure: (1) is necessary to prevent or lessen a serious and imminent threat to the health or safety of the patient or others and (2) is to a person (s) reasonably able to prevent or lessen the threat. This may include, depending on the circumstances, disclosure to law enforcement, family members, the target of the threat, or others who the covered entity has a good faith belief can mitigate the threat. The disclosure also must be consistent with applicable law and standards of ethical conduct. See 45 CFR § 164.512 (j) (1) (i). For example, consistent with other law and ethical standards, a mental health provider whose teenage patient has made a credible threat to inflict serious and imminent bodily harm on one or more fellow students may alert law enforcement, a parent or other family member, school administrators or campus police, or others the provider believes may be able to prevent or lessen the chance of harm. In such cases, the covered entity is presumed to have acted in good faith where its belief is based upon the covered entity’s actual knowledge (i.e., based on the covered entity’s own interaction with the patient) or in reliance on a credible representation by a person with apparent knowledge or authority (i.e., based on a credible report from a family member or other person). See 45 CFR § 164.512 (j) (4).

Can a minor be disclosed under HIPAA?

For threats or concerns that do not rise to the level of “serious and imminent,” other HIPAA Privacy Rule provisions may apply to permit the disclosure of PHI. For example, covered entities generally may disclose PHI about a minor child to the minor’s personal representative (e.g., a parent or legal guardian), consistent with state or other laws.

Who is not liable for a mental health patient's violent behavior?

Provides that a physician, social worker, psychiatric nurse, psychologist or other mental health professional, a mental health hospital, a community mental health center, clinic, institution or their staff shall not be liable for damages in an civil action for failure to warn or protect any person against a patient's violent behavior. Any such persons mentioned shall not be held civilly liable for failure to predict such violent behavior, except where the patient has communicated to the mental health provider a serious threat of imminent physical violence against a specific person or persons. "When there is a duty to warn and protect under the provisions of paragraph (a) of this subsection (2), the mental health provider shall make reasonable and timely efforts to notify the person or persons, or the person or persons responsible for a specific location or entity, that is specifically threatened, as well as to notify an appropriate law enforcement agency or to take other appropriate action, including but not limited to hospitalizing the patient." Any persons mentioned above shall not beheld civilly liable or professionally disciplined for warning any person against or predicting a patient's violent behavior. This immunity does not cover negligent release of mental health patient information or the negligent failure to initiate involuntary seventy-two-hour treatment and evaluation after a personal patient evaluation determining that the patient appears to have a mental illness, and as a result of that illness would be an imminent danger to others.

Who can review a release of information via 36-504?

A release of information via 36-504 or 36-509 shall, at the request of the patient, be reviewed by a member of his family or a guardian. Section provides for appeal procedures. An agency or nonagency treating professional that makes a decision to release or withhold treatment information in good faith is not subject to liability for this decision.

What is the duty of confidentiality in mental health?

Under ethical standards tracing back to the Roman Hippocratic Oath, doctors and mental health professionals usually must maintain the confidentiality of information disclosed to them by patients in the course of the doctor-patient relationship. With some exceptions codified in state and federal law, health professionals can be legally liable for breaching confidentiality. One exception springs from an effort to protect potential victims from a patient’s violent behavior. California courts imposed a legal duty on psychotherapists to warn third parties of patients’ threats to their safety in 1976 in Tarasoff v. The Regents of the University of California. This case triggered passage of “duty to warn” or “duty to protect” laws in almost every state as summarized in the map and, in more detail, in the chart below.

Why are mental health professionals reluctant to treat potentially violent patients?

Mandatory reporting laws, say some professionals, may discourage people from seeking professional help or fully disclosing their intentions; or providers may be reluctant to treat potentially violent patients because they fear liability for failure to properly fulfill the duty to warn.

When did California impose a legal duty on psychotherapists?

California courts imposed a legal duty on psychotherapists to warn third parties of patients’ threats to their safety in 1976 in Tarasoff v. The Regents of the University of California.

Who is immune from failure to warn or protect from a patient's threatened or actual violent behavior?

June 2, 2000. Any physician, clinical psychologist, or qualified examiner is immune from failure to warn or protect from a patient's threatened or actual violent behavior except where the patient has communicated a serious threat of physical violence against a reasonably identifiable victim or victims.

When did psychologists not disclose to others?

Sept. 4, 1996. A psychologist or psychological associate may not reveal to another person a communication made to the psychologist or psychological associate by a client about a matter concerning which the client has employed the psychologist or psychological associate in a professional capacity.

How long does a hospital have to report a physician's problem?

The law also requires that physician problems be promptly disclosed to the department. PHL §2803-e (l) (a) requires that hospitals must report within 30 days any of the following:

How long does it take for a hospital to report a physician?

The Patient Health Information and Quality Improvement Act of 2000 6 introduced by Senate Health Committee Chairman Kemp Hannon and others, would tighten these reporting requirements by reducing from 60 days to 30 days the time within which hospitals have to conduct their investigations of incidents or to report physician problems.

How long does it take for a hospital to investigate a medical malpractice case?

In addition, the proposed legislation would amend PHL §2805-1 to require that hospitals conduct investigations of incidents within 30 days, and would include among the incidents that must be reported by hospitals: "The receipt of any information which reasonably appears to show that an individual licensed pursuant to the provisions of Title 8 of the Education Law or a medical resident of a hospital is subject to mental or physical impairment, or is guilty of incompetence, malpractice or misconduct or impairment of patient safety or welfare, or has been convicted of a crime."

What is a suspension of a doctor?

The suspension, restriction, termination or curtailment of the training, employment, association or professional privileges of a doctor or resident for "reasons related in any way to alleged mental or physical impairment, incompetence , malpractice or misconduct, or impairment of patient safety or welfare.".

What is a fire in a hospital?

fires in the hospital which disrupt the provision of patient care services or cause harm to patients or staff; equipment malfunction during treatment or diagnosis of a patient which did or could have adversely affected a patient or hospital personnel; poisoning occurring within the hospital; strikes by hospital staff;

How long do hospitals have to report misconduct?

Hospitals also have 60 days within which to report "any information which reasonably appears to show that a physician is guilty of professional misconduct" as defined in New York Education Law §6530-31.

When was the Public Health Law of New York amended?

Accordingly, New York's Public Health Law ("PHL") was amended in 1986 to include a comprehensive set of reporting requirements for incidents affecting patient care in hospitals. PHL §2805-1 (2) requires that the following Incidents must be reported to the Department of Health:

When Is Reporting Required?

B did, that the information will be shared with another party. However, in situations in which this information might further agitate or anger the patient, physicians might decide not to disclose that they are reporting in the interest of their own safety or that of a third party.

How does a firearm affect a physician?

Depending on their personal experience with guns, physicians might have varying levels of concern about or comfort with the implications of a firearm’s involvement in a given case . They might also be hesitant to question a patient further on the topic, as they might be concerned about offending the patient by asking about what many perceive to be a private issue. However, ascertaining the types of guns owned, how they are stored, and if the patient has any intentions of using them are important components of risk assessment.

What is the HIPAA exception for PHI?

One type of exception involves threats made by a patient to harm him- or herself or another person . HIPAA’s implementing regulations allow disclosure of PHI when disclosure “is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public; and … is to a person or persons reasonably able to prevent or lessen the threat, including the target of the threat” [6]. The persons “reasonably able to prevent or lessen the threat” might be law enforcement, family members, or the victims themselves. The key term “imminent” is not defined, but in studies of violence prediction, imminence has been taken to mean time measured in days to months [7]. In addition to the HIPAA exception for imminent danger, most states have laws that mandate or permit disclosure of PHI in the event of a threat [8].

Why is mandatory reporting required?

Mandatory reporting of persons believed to be at imminent risk for committing violence or attempting suicide can pose an ethical dilemma for physicians, who might find themselves struggling to balance various conflicting interests. Legal statutes dictate general scenarios that require mandatory reporting to supersede confidentiality requirements, but physicians must use clinical judgment to determine whether and when a particular case meets the requirement. In situations in which it is not clear whether reporting is legally required, the situation should be analyzed for its benefit to the patient and to public safety. Access to firearms can complicate these situations, as firearms are a well-established risk factor for violence and suicide yet also a sensitive topic about which physicians and patients might have strong personal beliefs.

Do medical laws fit into real life cases?

Despite their attempts at specificity, these laws often do not fit neatly onto real-life patient cases. In some jurisdictions, the statements made by the patient can meet the threshold at which a physician is mandated to report in order to warn or protect a potential victim.

How should physicians protect patient privacy when reporting?

Physicians should also protect patient privacy when reporting by disclosing only the minimum necessary information.

When is informed consent not required?

Obtain the patient’s informed consent when reporting is not required by law. Exceptions can be made if a physician reasonably believes that a patient’s refusal to authorize reporting is coerced and therefore does not constitute a valid informed treatment decision.

What is the abuse in the exam room?

Patients in your exam room may be experiencing one of a number of forms of abuse—domestic violence, human trafficking or other violence— and identifying those being abused can sometimes be tough.

What to do when a patient is suspected of abuse?

Discuss any suspicion of abuse sensitively with the patient, whether or not reporting is legally mandated, and direct the patient to appropriate community resources.

How many victims of trafficking had contact with a health professional?

The authors noted research showing that 88% of victims had contact with a health professional while being trafficked, but none were identified or offered help in getting out of their situation during the medical encounter.

Do you have to see one on one for a trafficked patient?

Dr. Ravi said it is also important to establish a policy—even putting it in writing in the exam and waiting rooms—that says a patient needs to be seen one-on-one for part of the visit. Trafficked patients may come in with a man or woman who is trafficking them; sometimes that person could even be a relative.

When do therapists file a report?

In the case of suspected child abuse, therapists must file a report if they have “reasonable suspicion” about child abuse.

What happens if a therapist violates the ethics of the state?

Therapists are held to very high ethical standards by their governing state board and a violation of those ethics could result in fines, loss of licensure, or even jail time , said Walwyn-Duqesnay. While each state has its own set of guidelines and regulations on what its mental health professionals are required to report, there are common themes that transcend across the country.

What happens if a therapist fails to take reasonable steps to protect the intended victim from harm?

“If a therapist fails to take reasonable steps to protect the intended victim from harm, he or she may be liable to the intended victim or his family if the patient acts on the threat ,” Reischer said.

Who does Cinéas say has to step in and report a situation when vulnerable people are threatened?

Cinéas said a therapist may have to step in and report a situation when vulnerable people are threatened, which could include children, elderly individuals and those living with a disability.

Can a therapist report a patient's intent to harm someone else?

A therapist may be forced to report information disclosed by the patient if a patient reveals their intent to harm someone else. However, this is not as simple as a patient saying simply they “would like to kill someone,” according to Jessica Nicolosi, a clinical psychologist in Rockland County, New York. There has to be intent plus a specific identifiable party who may be threatened.

Can a therapist disclose a divorce?

Most situations will stay under wraps. For instance, Reed noted that even if a wife is cheating on her husband and they are going through a divorce, the therapist has no legal obligation whatsoever to disclose that information in court.

Should clients withhold anything from their therapist?

“Clients should not withhold anything from their therapist, because the therapist is only obligated to report situations in which they feel that another individual, whether it be the client or someone else, is at risk,” said Sophia Reed, a nationally certified counselor and transformation coach.

Why is it so hard to document the number of children who are maltreated annually in the United States?

The number of children who are maltreated annually in the United States is difficult to document because: (1) definitions vary across tribal, state, and federal jurisdictions; (2) the standards and methods of collecting data vary considerably; and (3) many cases go unrecognized and unreported [5].

Why do physicians discuss cases with a knowledgeable colleague?

Physicians reported that discussing the case with a knowledgeable colleague helped them decide whether or not to report suspicious injuries. The clinician's past experiences with CPS. Clinicians who believed that CPS involvement would result in a negative outcome for the child or family were less likely to report.

How to report child abuse?

The level of suspicion required to report suspected abuse is not clearly defined. But, with the knowledge that physicians tend to underreport suspected abuse, the following recommendations are made to increase physicians' confidence in making appropriate reports: 1 Obtain continuing education regarding child maltreatment. Routinely seeking out local and national opportunities for continuing education related to child abuse and neglect can help you maintain a current understanding of child maltreatment. 2 Know reporting laws. Familiarizing yourself with the reporting laws and to whom reports should be made in your state (i.e., CPS or law enforcement) can lessen the ambiguity in the reporting process. 3 Consult with colleagues. Establishing collaborative relationships with colleagues to consult with regarding difficult cases can assist in the decision-making process. Physicians in private practice who do not have colleagues readily available may want to create a referral process with local agencies that have teams who make these decisions. 4 Know your local CPS staff. Forming relationships with your local CPS staff members can facilitate an open line of communication and establish a better sense of the guidelines used by the agency.

How to maintain a current understanding of child abuse and neglect?

Obtain continuing education regarding child maltreatment. Routinely seeking out local and national opportunities for continuing education related to child abuse and neglect can help you maintain a current understanding of child maltreatment.

What is the failure to meet a child's basic needs?

Neglect is the chronic failure to meet a child's basic needs-clothing, nutritious food, cleanliness, educational opportunity, medical and dental care, protection, shelter, and supervision. Though the four forms of maltreatment are defined separately, they often co-occur against one child.

What are the physical injuries that a child may have?

As a result of these actions, a child may have bruises, broken bones, burns, or internal injuries that document the occurrence, as well as imprints of the specific object used to inflict the injury (e.g., belt buckle, hand, and knuckles). In sexual abuse, an adult or older child engages a child in sexual activities such as fondling, intercourse, ...

Is it the responsibility of a physician to determine if a child is being neglected?

Such instances present physicians with difficult decisions. It is not the physician's responsibility to determine the intent of the parent or caregiver, or whether abuse or neglect occurred.

Case

Commentary

Disclosing Protected Health Information

Counseling Patients About Firearm Safety

When Is Reporting Required?

• Physicians also face the difficult task of deciding whether or not the situation constitutes enough of a risk to breach the patient’s confidentiality. In many cases, physicians might choose to tell the patient, as Dr. B did, that the information will be shared with another party. However, in situations in which this information might further agitat...

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