Unit 9 Final Project: Ethical Issues Requesting Mental Health

Unit 9 Final Project

Mental health involves psychological, emotional and social well-being. It dictates how we feel, think and behave. It can determine how we deal with stress, relate to other people and make decisions. Mental health is important in all parts of someone’s life, from childhood through adulthood.
There are a lot of local agencies that people can call if they are in need of services for someone with a developmental disability. Some agencies will provide help to people with intellectual or developmental disabilities, and they offer a many different services: Home care, housekeeping, respite, transportation, counseling, health services and even help building wheelchair ramps.
Some reasons for requesting mental health and
developmental disability records can be: civil court [guardianship or custody hearing], criminal court or maybe because a patient is being transferred from one facility to another.
HIPAA provides national standards to protect the privacy of individually identifiable mental health information that is transmitted electronically. This includes patients that have developmentally disabling conditions. Laws vary state to state due to the ability of each state to implement additional more stringent statutes regarding privacy in addition to the HIPAA laws already in place. It is more common for a state to have several specific statutes governing different types of medical records and information. Every state has some form of legislation governing mental health records. These generally take four forms. First, many states have laws governing the records of patients in state mental hospitals or mental health programs. These are in some instances part of general statutes governing state health records and are sometimes specific to mental hospitals (see N.Y. Mental Hygiene Law 33.13; N.C. Gen. Stat. § 122C-55).
Second, a number of states have laws governing the records of specific mental health practitioners, most commonly psychologists, social workers, and counselors. Colo. Rev. Stat. Ann. § 12-43-218, for example, requires patient consent for any disclosure by a psychologist or psychotherapist, with no treatment exception. Massachusetts law (Mass. Gen. Laws. ch. 112 § 129A) provides that the records of psychologists are confidential, and makes no exception for sharing of information for treatment. Missouri law (Mo. Rev. Stat. § 337.636) contains similar provisions governing psychologists, social workers, and professional counselors. The obligations imposed by these laws may pose the most substantial threat to the broad sharing of treatment information contemplated by HIPAA. Third, a number of states have specific statutes governing the records of patients who are involuntarily committed to mental institutions (see Idaho Code § 66-348; Neb. Rev. Stat. § 71-961; Wash. Rev. Code Ann. § 71.05.390). These statutes recognize, presumably, that patients who are involuntarily committed to institutions might have a special claim to privacy, though these laws also usually make provision for the use of records in the commitment process. The Tennessee Code, for example, has a special provision for sharing of information for mandatory outpatient treatment in section 33-6-601. Fourth and finally, most states have statutes that generally govern the records of all mental patients (NCBI, 2006). Physicians have always had a duty to keep their patients ' confidences.
In essence, the physician 's duty to maintain confidentiality means that a physician may not disclose any medical information revealed by a patient or discovered by a physician in connection with the treatment of a patient. In general, AMA 's Code of Medical Ethics states that the information disclosed to a physician during the course of the patient-physician relationship is confidential to the utmost degree. As explained by the AMA 's Council on Ethical and Judicial Affairs, the purpose of a physician 's ethical duty to maintain patient confidentiality is to allow the patient to feel free to make a full and frank disclosure of information to the physician with the knowledge that the physician will protect the confidential nature of the information disclosed. Full disclosure enables the physician to diagnose conditions properly and to treat the patient appropriately. In return for the patient 's honesty, the physician generally should not reveal confidential communications or information without the patient 's express consent unless required to disclose the information by law. There are exceptions to the rule, such as where a patient threatens bodily harm to himself or herself or to another person (AMA,
1995-2013). Hospitals, physician practices, and other health care facilities are repositories for much medical information.
Safeguarding the confidentiality of such information is a significant issue for any hospital or other health care entity that keeps patient medical records to maintain patient confidence and to avoid liability. Because damages could ensue should inappropriate disclosure occur, patient records containing behavioral health, developmental disabilities, HIV, and substance abuse information must be handled with special attention, in accordance with state and federal laws, rules, and regulations. Individuals involved in health information management should be well-informed about patient confidentiality requirements overall and should also track these areas carefully to develop and implement appropriate policies and procedures governing the release of patient information. The purpose of this paper is to provide such individuals with an overview of the applicable state and federal rules and regulations for these highly protected areas to assist in policy and procedure. While federal laws are consistent for all states, individual state rules and regulations do vary to some extent (U&H,
2013).
A breach of confidentiality is a disclosure to a third party, without patient consent or court order, of private information that the physician has learned within the patient-physician relationship. Disclosure can be oral or written, by telephone or fax, or electronically, for example, via e-mail or health information networks. The medium is irrelevant, although special security requirements may apply to the electronic transfer of information. The legal basis for imposing liability for a breach of confidentiality is more extensive than ethical guidelines, which dictate the morally right thing to do. Although current law in this area has been referred to as "a crazy quilt of state and federal law," protecting patients ' confidentiality is the law of the land. Included in the patchwork are federal and state constitutional privacy rights, federal and state legislation and regulation governing both medical records and licensing, and specific federal and state legislation designed to protect sensitive information (e.g., HIV test results, genetic screening information, mental health records, and drug and alcohol abuse rehabilitation information). The general rule regarding release of a patient 's medical record is that information contained in a patient 's medical record may be released to third parties only if the patient has consented to such disclosure. The patient 's express authorization is required before the medical records can be released to the following parties: patient 's attorney or insurance company; patient 's employer, unless a worker 's compensation claim is involved; member of the patient 's family, except where the family member has been appointed by the patient 's attorney under a durable power of attorney for health care; government agencies; and other third parties. Some state laws expressly allow disclosure to any person upon consent of the patient. Other state laws permit release on patient consent only to specified classes of persons. Further, once the patient has given consent to release the record, the disclosure requirement may be mandatory for the holder of the medical record or merely permissive. HIPAA has created additional patient confidentiality considerations. Under the privacy regulations, covered entities may usually release protected health information without authorization only to facilitate treatment, payment or health care operations. Who may grant permission to release medical record information is likewise governed by state law. Generally, the authority to release medical information is granted to: (1) the patient, if a competent adult or emancipated minor; (2) a legal guardian or parent if the patient is incompetent or a minor child; and (3) the administrator or executor of the patient 's estate if patient is deceased. The patient 's right to authorize release of medical records is codified in many state statutes. These statutes all state that medical records are confidential and cannot be disclosed, except in specifically provided circumstances. However, the extent of the patient 's right to access varies from state to state. Some states allow the health care professional or provider to determine patient 's right of access. In comparison, some states expressly grant patients access to the medical information contained in their medical records. Failure to get the appropriate release for medical records may have serious results. Twenty-one states punish disclosure of confidential information by revoking a physician 's medical license or taking other disciplinary action (AMA, 1995-2013).

References:
AMA. (1995-2013). Retrieved from: http://www.ama-assn.org//ama/pub/physician-resources/legal-topics/patient-physician-relationship-topics/patient-confidentiality.page
NCBI. (2006). Retrieved from: http://www.ncbi.nlm.nih.gov/books/NBK19829/#a2000e8e1ddd00269
Ungaretti & Harris. (2013). Retrieved from: http://www.uhlaw.com/release_of_behavioral_health/