Magazine article Clinical Psychiatry News

Families in Psychiatry: Advancing Treatment and Respecting Privacy

Magazine article Clinical Psychiatry News

Families in Psychiatry: Advancing Treatment and Respecting Privacy

Article excerpt

While reading a recent article about Richard Fee, a 25-year-old college graduate who committed suicide in 2011, I couldn't help wondering whether things might have turned out differently had his family--particularly his parents--had more to say about his psychiatric care.

Richard's parents reportedly had a hard time accessing appropriate care for their son and suggested that his doctors' adherence to privacy laws might have explained their behavior. Dr. Waldo M. Ellison, the psychiatrist who conducted Richard's initial evaluation, "explained that federal privacy laws forbade any discussion of an adult patient, even with the patient's father," the article said ("Drowned in a Stream of Prescriptions," New York Times, Feb. 2, 2013).

The Times article discussed Richard's struggles with attention-deficit/hyperactivity diagnoses, his dark mood and growing paranoia, and his agitated, violent behavior.

Richard's father, Rick Fee, reportedly tried to share details about his son's behavior with the doctor but was met with resistance. "I can't talk to you," Mr. Fee recalled Dr. Ellison telling him. "I can't talk with you unless your son comes with you." Later in the article, however, Mr. Fee noted that Dr. Ellison "had spoken with him about his son for 45 minutes, then they scheduled an appointment for the entire family."

The Health Insurance Portability and Accountability Act (HIPAA) sets rules for the use of health information. The intent of the federal privacy law is to give patients more control over their care, but, unfortunately, the intent is often misunderstood as restricting to whom professionals can talk. What do federal privacy laws actually say about talking with family members?

The HIPAA Privacy Rule at 45 CFR 164.510(b) specifically permits covered entities to share information that is directly relevant to the involvement of a spouse, family members, friends, or other persons identified by a patient, in the patient's care or payment for health care.

If the patient is present, or is otherwise available prior to the disclosure, and has the capacity to make health care decisions, the covered entity may discuss this information with the family and these other persons if the patient agrees or, when given the opportunity, does not object. The covered entity also may share relevant information with the family and these other persons if it can be reasonably inferred, based on professional judgment, that the patient does not object. Under these circumstances, for example:

* A physician may instruct a patient's roommate about proper medicine dosage when she comes to pick up her friend from the hospital.

* A physician may discuss a patient's treatment with the patient in the presence of a friend when the patient brings the friend to a medical appointment and asks if the friend can come into the room. Even when the patient is not present because of emergency circumstances or incapacity, a covered entity may share information with the person when, in exercising professional judgment, it determines that doing so would be in the best interest of the patient. See 45 CFR 164.510(b).

In light of those allowances:

* A surgeon may, if consistent with such professional judgment, inform a patient's spouse who accompanied her husband to the emergency room that the patient has suffered a heart attack and provide periodic updates on the patients' prognosis. …

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