if patient asks case worker not to mention addiction are they bound to report

by Dr. Bill Kassulke 3 min read

Doctor-Patient Privilege: Does It Cover Illegal Substance …

2 hours ago  · Situation #3: The Employee Voluntarily Raises Addiction but Has Not Engaged in Misconduct. If an employee voluntarily claims to be an alcoholic or substance-dependent (and, e.g., asks for help), but has not engaged in misconduct, of course, no discipline should issue. Voluntary disclosure means the employee has not violated any employer rules ... >> Go To The Portal


Are you legally obligated to report what your clients say during therapy?

However, there are some specific situations when mental health professionals are legally obligated to report something that a client does or says during a therapy session. “I like to tell my clients that therapy is kind of, ‘What happens in Vegas stays in Vegas.’

When do mental health professionals need to report what a client says?

Here’s when mental health professionals need to report what a client does or says during a therapy session. Therapy is where you can share your deepest, darkest secrets, fears and vulnerabilities with the expectation that you won’t be judged and what you say won’t be shared.

What should a physician do if a patient reports an incompetent/unethical?

Physicians who receive reports of alleged incompetent or unethical conduct should: (f) Evaluate the reported information critically and objectively. (g) Hold the matter in confidence until it is resolved. (h) Ensure that identified deficiencies are remedied or reported to other appropriate authorities for action.

Does the hospital staff have a duty to warn the intended victim?

The court ruled in favor of the plaintiff (her husband) in finding that the hospital staff had a duty to warn the intended victim about the threat (2003). In Jablonski v.

What information can be disclosed without specific consent of the patient?

There are a few scenarios where you can disclose PHI without patient consent: coroner's investigations, court litigation, reporting communicable diseases to a public health department, and reporting gunshot and knife wounds.

Does Hipaa apply to substance abuse?

42 CFR Part 2 (“Part 2”) is a federal regulation that requires substance abuse disorder treatment providers to observe privacy and confidentiality restrictions with respect to patient records. The HIPAA Privacy Rule also limits use and disclosures of information found in patient records.

Can you tell doctors about drug use?

Absolutely. It's important for your doctor to know all of your medical history, including any prescription or recreational drugs. Some illicit drugs can interact with medications.

What is confidentiality in substance abuse?

Confidentiality is a cornerstone of any treatment relationship. For people receiving SUD treatment, strict confidentiality protections mean that you can share information about past and current drug use without worrying that it will be used against you by the police or a landlord, employer, judge, or social worker.

What is a patient required to do in order for a request to restrict the use or disclosure of their PHI to their health plan to be granted?

A covered entity is required to agree to an individual's request to restrict the disclosure of their PHI to a health plan when both of the following conditions are met: (1) the disclosure is for payment or health care operations and is not otherwise required by law; and (2) the PHI pertains solely to a health care item ...

In which cases can a healthcare provider legally share patient information?

Where a patient is not present or is incapacitated, a health care provider may share the patient's information with family, friends, or others involved in the patient's care or payment for care, as long as the health care provider determines, based on professional judgment, that doing so is in the best interests of the ...

Is what you tell your doctor confidential?

A: Your doctor will keep the details of what you talk about private, or confidential. The only times when your doctor cannot honor your privacy is when someone is hurting you or you are going to hurt yourself or someone else.

What should you not tell your doctor?

The 10 Worst Things Patients Can Say to PhysiciansAnything that is not 100 percent truthful. ... Anything condescending, loud, hostile, or sarcastic. ... Anything related to your health care when we are off the clock. ... Complaining about other doctors. ... Anything that is a huge overreaction.More items...•

What are the penalties for violating 42 CFR part 2?

New Penalties for Violations of Part 2 Under the CARES Act, Congress gave HHS the authority to issue civil money penalties for violations of Part 2 in accordance with the civil money penalty provisions established for HIPAA violations, ranging from $100 to $50,000 per violation depending on the level of culpability.

Can a therapist report drug use?

Will my therapist report me for my drug use? No, this is unlikely. If you're simply discussing your personal drug use, that information should be protected under therapist confidentiality laws and also under HIPAA, the Health Information Portability and Information Act.

What is the privacy rule in healthcare?

The Privacy Rule protects all "individually identifiable health information" held or transmitted by a covered entity or its business associate, in any form or media, whether electronic, paper, or oral. The Privacy Rule calls this information "protected health information (PHI)."

What is the one exception where records can be released without patient consent?

You may only disclose confidential information in the public interest without the patient's consent, or if consent has been withheld, where the benefits to an individual or society of disclosing outweigh the public and patient's interest in keeping the information confidential.

Which of the following is not protected health information PHI subject to the HIPAA privacy Rule?

The Privacy Rule excludes from protected health information employment records that a covered entity maintains in its capacity as an employer and education and certain other records subject to, or defined in, the Family Educational Rights and Privacy Act, 20 U.S.C. §1232g. De-Identified Health Information.

Which of the following is considered PHI under HIPAA?

PHI is health information in any form, including physical records, electronic records, or spoken information. Therefore, PHI includes health records, health histories, lab test results, and medical bills. Essentially, all health information is considered PHI when it includes individual identifiers.

Who is covered by HIPAA privacy Rule?

The Privacy Rule, a Federal law, gives you rights over your health information and sets rules and limits on who can look at and receive your health information. The Privacy Rule applies to all forms of individuals' protected health information, whether electronic, written, or oral.

What information is protected under 42 CFR part 2?

The 42 CFR Part 2 regulations (Part 2) serve to protect patient records created by federally assisted programs for the treatment of substance use disorders (SUD).

What happens if an employee doesn't claim substance abuse?

If the employee doesn’t claim addiction or substance abuse issues, the employer should impose the discipline—if warranted—without any discussion of addiction or substance abuse.

What happens if an employee declines an LCA?

If an employee declines an LCA, subject to state law limits on discharge, employer flexibility to retain the employee will likely cease, and many employers will move to terminate employment.

What is a LCA?

If the employer wants to retain the employee but impose some lesser form of discipline for misconduct, most employers institute—with legal review—some kind of continuing work agreement such as a last chance agreement (LCA). Typical LCA provisions include a requirement that an employee submit to a substance abuse assessment by a qualified substance abuse professional (SAP), as employers are not qualified to make those assessments. Court decisions have also faulted employers that force employees to enter rehab when they might not actually be substance-dependent. The employee, for example, might have simply been on a weekend binge that carried over into the beginning of the workweek.

What is voluntary disclosure?

Voluntary disclosure means the employee has not violated any employer rules or policies or failed to satisfy performance or behavior expectations nor has he or she been referred for a proper test under an employer’s workplace drug/alcohol testing policy. The most common and defensible employer approaches to voluntary disclosure situations is to offer express support, refer an employee to any Employee Assistance Program available and offer leave consistent with disability and leave laws and employer policies and practices. In voluntary disclosure situations, if an employee works in a safety-sensitive position or his or her disclosure relates to illegal drugs, continuing work agreements such as a return-to-work agreement (but not a last chance agreement) may be appropriate and lawful, but in most if not all other situations would be inappropriate.

What is observable indicia of impairment?

The latter can come in many forms, including observable indicia of impairment (e.g., slurred speech, staggered gait), a verified confirmed positive test result on a workplace test, or an admission of impairment. These are all scenarios in which discipline would likely be appropriate in most cases.

Can a discipline be a violation of the drug policy?

If the answer to this question is “no,” the discipline should not proceed. If the answer is “yes,” the discipline can proceed. In proceeding with discipline, the employer should generally avoid any discussion of the suspected addiction or substance dependence—even if the basis for discipline is in violation of the employer’s drug ...

Is rehab leave a violation of employer performance and behavior standards?

Thus, while violations of employer performance and behavior standards need not be excused, in general, leave for rehab is for a “serious health condition.” If the employee is eligible for legally mandated leave or leave has been afforded under comparable circumstances, the failure to offer (not force) the opportunity to take leave and honor any request for leave could trigger risk under disability law reasonable accommodation mandates or technical risk under work-related leave laws, particularly if the employer intends to sever the employment relationship. To help reduce these risks, some employers that wish to terminate employment consider a strategy of offering leave and honoring any leave requests when an employee claims to be an alcoholic or addict, but these employers reserve the right following reinstatement from any leave to take action based on preleave conduct.

Why do addiction counselors use disclosure?

Most novice addiction counselors in recovery will use disclosure as a shortcut, to bypass the work necessary to establish and maintain a therapeutic alliance. This is a very natural (and very common) tendency, but can easily backfire, as clients can view the therapist as trapped in his approach or view.

Who is the editorial staff of rehabs.com?

The editorial staff of Rehabs.com is comprised of addiction content experts from American Addiction Centers. Our editors and medical reviewers have over a decade of cumulative experience in medical content editing and have reviewed thousands of pages for accuracy and relevance. Our reviewers consistently monitor the latest research from SAMHSA, NIDA, and other reputable sources to provide our readers the most accurate content on the web.

When Does Therapist Self-Disclosure Work?

For those that are able to care for their own recovery at a very high level, a career working with addicts and alcoholics can be tremendously rewarding. One of the questions that comes up is whether to disclose their own recovery to their patients. Volumes (actual volumes!) have been written on the subject of therapist self-disclosure, so I won’t rehash the full debate here. By way of summary, the analysts generally believe in the idea that therapists should be a blank screen. They insist on minimal disclosure. Nevertheless, many other therapies rely heavily on limited, carefully determined disclosures.

Can a therapist disclose their recovery status?

In many addiction treatment settings, avoiding self-disclosure of the therapist’s recovery status is essentially impossible. Counselors may go to recovery meetings where patients are present, and the community of patients in treatment settings may pass on this information to each other over many generations of admissions (and in my experience invariably do). However, even when disclosure is inevitable, care should be taken to avoid therapeutic approaches that rely on the therapist’s personal recovery experience rather than tried-and-true therapeutic techniques, as the effects on the therapy can be irreparable. In the 12-step parlance, “that’s what a sponsor is for.” Thus, even when disclosure is inevitable, steps should be taken to protect the therapeutic relationship from effects of emphasizing the therapist’s personal recovery.

Do therapists have to disclose their therapy?

Even when therapists elect to disclose, there is value to delaying disclosure, even in time-limited and structured therapies. In addiction counseling, patients may often inquire about the therapist’s recovery-orientation. Exploring those questions without immediately answering them can yield fruitful material that can enhance the therapeutic process and alliance. Therapists who do eventually disclose should ask themselves why they are doing it. Is it for their own ego, or to help the client?

Can disclosure enhance a therapeutic relationship?

Each case is unique, and there are circumstances where disclosure may enhance the relationship without significant risk. But even seasoned counselors should seek counsel with colleagues prior to disclosure, check their motives, and take steps to mitigate the risks to the therapeutic relationship.

Can a client learn about a therapist through Internet searches?

And clients themselves can now learn much about therapists through Internet searches, which adds a new layer of complexity. But it is still generally possible to maintain some lack of transparency in most cases in the therapeutic relationship.

Why does Gretchen need to report abuse?

If Carly had younger siblings living with her father, for instance, she might need to report the abuse in order to protect the children. If Carly lived in a state that legally required social workers to report past abuse ...

What is the code of ethics for social workers?

As noted above, the Code of Ethics does not authorize Gretchen to release confidential information for safety concerns unless there is a risk of serious, imminent harm.

Does Gretchen allow Carly to report abuse?

On balance, given the facts of the case as interpreted by Gretchen, she decides to permit Carly to decide whether or not to report the abuse. This course of action not only respects Carly’s rights to self-determination and privacy, but also affords Gretchen with the opportunity of continuing to work with Carly.

What are the ethical challenges of working with a dangerous client?

It is clear that work with a dangerous client poses many therapeutic and ethical challenges. Clinicians may be concerned about the liability that a breach of confidentiality may pose. Dickson (1998) suggests that “When there is no statutory protection, consultation combined with careful documentation should minimize the chances of successful litigation” (p. 164). In many states, mental health practitioners are protected from litigation when they are following, for instance, mandated reporting guidelines. A careful assessment and consultation with a supervisor are often the first steps in making an appropriate plan of action. Reamer (2003) further outlines ten steps to be taken by clinicians if their clients pose a threat to another party:

What are the codes of ethics for social work?

The NASW (1996) and CSWA (1997) codes of ethics outline the values and principles that govern social work practice and guide our profession in making ethical decisions. They compel licensed social workers to maintain the client’s privacy and confidentiality except under very specific circumstances. There is a particular portion that serves as a guide from which social work professionals may draw upon surrounding certain legal proceedings. It is as follows:

What is therapeutic jurisprudence?

Therapeutic jurisprudence is a term coined by David Wexler and Bruce Winick that describes the problem-solving process between two systems—a study of the impact of the system of law on mental health, as well as the impact of the social sciences on the law (Wexler, 1990; Wexler & Winick, 1991, 1996; Winick, 1997). With the increase in societal problems such as divorce, crime, substance abuse, and family violence, as well as the clear impact of mental illness on crime, scholars and professionals in the practice of law and the social sciences have been inextricably linked when looking at societal and systematic responses to these phenomena (Levine & Wallach, 2002). Those concerned with the practice of therapeutic jurisprudence focus on such problems as the manner in which the court system deals with the issues of domestic violence and substance abuse. The mental health system and our nation’s criminal justice systems (as well as civil court systems) depend on the expertise and knowledge base from each respective discipline, as well as the prudence of those specialists who have combined expertise (i.e., forensic social workers and psychologists), in attempts to address and solve problems. Both fields inform the practice of one another.

How can confidentiality be traced?

The history of confidentiality and how it has been guarded and breeched can be traced through pertinent case law. Familiarity with pertinent case law related to confidentiality can also be helpful in guiding practitioners negotiating work with a client, for example, who has threatened harm. As discussed earlier, the Tarasoff ruling in 1976 formed the foundation of case law that guided practice with regard to a clinician’s duty to warn others of a client’s intent to harm.

What is the importance of guarding Bobby's confidence?

In addition to issues surrounding the parental separation and divorce, particularly as it related to and was experienced by Bobby, it was important to guard his confidence within the therapeutic relationship. Work with children is specialized in that a clinician must balance the confidentiality of the client while maintaining an appropriate alliance with the caregivers and/or legal guardian (s). The contentious nature of the divorce and the interference by the grandparents certainly made this case much more complex than some. I needed to balance and protect Bobby’s needs and our therapeutic alliance and confidence with the sometimes competing interests of his estranged adult caregivers.

Why did Jill seek play therapy?

Jill sought play therapy treatment for her son Bobby, age 6, because of his reported difficulty revolving around his parents’ divorce. Jill and William (Bobby’s father) share custody. Bobby was allegedly exposed to a great deal of his parents’ marital strife by his mother’s report. She stated that prior to the divorce, there was constant tension and turmoil in the home. Jill attributed much of this to his father’s alleged untreated mood disturbance and substance use. In a separate meeting with William, information concerning Bobby’s exposure to marital conflict was not confirmed. His father was suspicious of why I was asking about this and stated that his relationship with his former wife did not have “anything to do with Bobby” and his treatment. It was one of my main hopes for his treatment that the contentious nature of the parental separation and divorce would not contaminate Bobby’s ability to use the therapeutic relationship most effectively.

Who was the murderer in the Tarasoff case?

Briefly, the Tarasoff case involved a murder victim, Tatiana Tarasoff, who was killed by an alleged acquaintance, Prosenjit Poddar.

How to keep your addiction private?

You may think the best way to keep your addiction private is to not use drugs or alcohol on the job. Keep in mind that abusing substances outside of work can still affect your job performance, and many substances stay in your system for a while, so they might show up on drug tests.

What is reasonable accommodation?

In the case of a substance use disorder, a reasonable accommodation might be something like a modified schedule that allows you to attend counseling sessions.

What if I’m using an EAP or health insurance?

If you plan on using an employee assistance program ( EAP) or your company’s insurance to cover the cost of treatment, you may worry your employer will be able to view your treatment information. Fortunately, EAPs are completely confidential.

What is the Family and Medical Leave Act?

The Family and Medical Leave Act also guarantees you unpaid time off to get treatment (if you and your employer meet certain eligibility requirements). If you do decide to get treatment, you may wonder how to tell your boss, or if you even need to let them know you’re seeking treatment.

Can an employer view medical records without your consent?

Thanks to federal protections under the Health Insurance Portability and Accountability Act (HIPAA), your employer cannot view your medical records without your written consent.

Do you have to make a request for FMLA before rehab?

If you decide to use FMLA, you must make the request before entering re hab, or you will not be protected by the law.

Can employers see how many claims they have made?

They may know how many claims were made overall. They can see how many claims each employee made, but they cannot find out what the claims were for, or the facility names or treatment providers.

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.

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 is the purpose of therapy?

Therapy is where you can share your deepest, darkest secrets, fears and vulnerabilities with the expectation that you won’t be judged and what you say won’t be shared. In fact, that’s the whole point of the whole process.

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.

Why report a colleague who is incompetent?

Reporting a colleague who is incompetent or who engages in unethical behavior is intended not only to protect patients , but also to help ensure that colleagues receive appropriate assistance from a physician health program or other service to be able to practice safely and ethically.

Why is medicine a self-regulated profession?

Medicine has a long tradition of self-regulation, based on physicians’ enduring commitment to safeguard the welfare of patients and the trust of the public. The obligation to report incompetent or unethical conduct that may put patients at risk is recognized in both the ethical standards of the profession and in law and physicians should be able ...