Avoiding Breach of Confidentiality When a Patient Attempts or Successfully Commits Suicide

The Risk Management Consultation Service Helpline (RMCS) often receives calls from Program participants asking for consultation concerning requests for information about a patient who has attempted or committed suicide. The psychiatrist is wondering what information they can release or if they have already mistakenly released too much information. In either instance, RMCS representatives will counsel the doctor or assist with risk prevention.

Hypothetical: You are awakened at 3:00 a.m. by a call from a police officer asking you for details about a meeting the previous evening with a patient and his wife. The wife had told you at the meeting that the patient was talking about killing himself and their six-year old son. You are shocked to hear the officer say that the patient and his son were found dead in their apartment two hours ago. The police officer insists that he needs the answers to his questions so the investigators at the scene can wrap up their investigation and go home. How should you respond?

If you don’t know how you should respond if faced with this hypothetical, you are at risk of breaching patient confidentiality. To talk or not to talk, that is the question.

In order to avoid breaching physician/patient confidentiality, you should understand your state laws regarding the release of information about a deceased patient. If you "spill the beans" - based on the false assumption that the physician-patient privilege ceases with death - you face potential exposure to ethical and statutory violations and an investigation by the state’s medical licensing board. In the above scenario, the state in which the doctor practiced had a statute that provides an avenue for the officer to legally obtain the information he needed to complete his investigation. In this case, the officer would have had to request the assistance of the local district attorney, who would then obtain a judge’s order directing the doctor to release the requested information. Another option would have been for the officer to provide the doctor with a release signed by a personal representative of the deceased’s estate who had been established by the deceased’s will. In this hypothetical case it was the deceased’s brother, not his wife. Remember, it is usually not urgent for you to release a deceased patient’s medical information.

If you ever face a similar situation, consider asking the caller to put the request in writing and to include the legal basis for the request; however, knowing the statutory source prior to a request will enable you to respond more quickly. Knowing the statutory basis of the request will enable the RMCS staff or your personal counsel to assist you more quickly. Be polite, and assure the caller you are not trying to impede the investigation but, explain that you have a professional obligation to protect your patient’s confidentiality. Thank them for their assistance and respond to their request as soon as possible. By following these guidelines, you will be able to respond when you are more composed. You will know your legal obligation, and you will have had the opportunity to obtain the information requested.

Hypothetical: You receive a call from an emergency room doctor who was assessing your confused or comatose patient. The doctor requests the release of medical information because the patient is in a medical crisis and an immediate response is required. How should you respond?

Any information that would assist the emergency room doctor in preventing serious imminent harm to your patient should be released. You should provide information about medication the patient is taking, whether or not it has been prescribed by you. Also inform the doctor of any medications the patient may have taken in the past in case the patient has ingested them. Information should be immediately provided about allergies, lab work, vital signs, as well as the patient’s state of mind that could assist the emergency room doctor in assessing the patient’s condition.** Keep your mental guard up and maintain confidentiality. Information about the affair the patient had discussed with you would not fall under pertinent emergency medical information; furthermore, information about the patient should not be shared with other non-treating individuals who are present such as the patient’s sister or spouse. They may feel that they have a right and a need to know, but you might not have permission to release any information to them. This is a time when you should be assisting them with their shock and grief, but you should not breach confidentiality and share privileged information during an emergency with non-treating individuals. But remember, you have to take care of your needs too.

Behavioral healthcare providers do not have an automatic immune response when it comes to shock or grief. If one of your patients commits suicide, there is no delete key to avoid the guilt, blame or shock you may feel. You do not have a fast forward button to instantaneously process the feelings you may experience. Many therapists believe that they posses superhuman qualities when tragedy strikes in the professional setting. However, sharing information with colleagues, staff, your spouse or other family members - yours or the patient’s - may very well be a breach of confidentiality. In certain circumstances this could be a boundary violation. Remember, your professional responsibility to maintain physician/patient confidentiality does not cease because an emergency medical situation or death occurs. You do not want to expose yourself to ethical and statutory violations. Furthermore, sharing confidential information about the patient may affect your ability to properly respond to queries from others including your staff, colleagues, the patient’s spouse and/or significant other, family members, the police and media.

How do you manage your grief and feelings while maintaining patient confidentiality? Handling yourself in a caring manner at this time of emotional stress reduces your exposure to personal and professional risks. You should consider establishing a therapeutic relationship as a patient with another therapist to help you get through your own crisis. You will be able to process your own feelings and claim the therapist-patient privilege for yourself. This will enable you to better handle the professional and personal issues facing you and others at this critical time.

In Summary: If your patient is deceased or seriously injured, it does not negate your obligation to maintain confidentiality. You should never discuss details about the patient at home or with peers over lunch. Anything you say may be used against you to establish that you failed to meet the standard of care in providing patient care and treatment by divulging privileged information. You should educate yourself about the state laws that would dictate how you respond to any non-emergency request to release information about the patient. If you do not know, respectfully inform the person requesting information to place the request in writing. Have them provide you with either a copy of the state’s statute or citation under which they obtained legal standing to make their request for information. If you have any questions or concerns about the request, immediately check with counsel or call the Risk Management Consultation Service at 1-800-245-3333. We are here to help you.

*To maintain confidentiality, the information compiled from calls and cases for this article has been modified.

**Most, if not all jurisdictions include, by law, either an exclusion from statutory requirements of confidentiality, consent or an immunity from liability for release of clinical information to another healthcare professional for the purpose of providing necessary emergency care for a patient, even when the patient has not authorized such a release.