Confidentiality, Privilege, and Tarasoff Flashcards
A psychiatrist is asked to testify in court about a patient’s mental state at a particular appointment and has asked about what the patient said in a psychopharmacology visit, given that the patient is being sued by a neighbor. What might allow this communication?
a. The fact that this is a psychopharmacology visit.
b. The fact that there is no exception of confidentiality in this type of case.
c. The fact that any information about mental state introduced by either party in any litigation can bring information into court.
d. The fact that the patient has waived the privilege.
e. The fact that the plaintiffs attorney has waived the privilege.
d. The fact that the patient has waived the privilege.
Under 42 CFR Part 2, which information is protected:
a. Psychotherapy notes
b. Physical examination findings.
c. Substance use treatment records.
d. Criminal sexual psychopath history.
e. Payment for services.
c. Substance use treatment records.
In Jaffe versus Redmond, the police officer’s private information was determined privilege based on what legal provision?
a. The 5th Amendment.
b. Rule 501 of the Federal Rules of Evidence.
c. The confidentiality exception doctrine.
d. The 14th Amendment.
e. The Frye test.
b. Rule 501 of the Federal Rules of Evidence.
In the California Tarasoff II ruling, the Supreme Court of California clarified which of the following from Tarasoff I:
a. The duty to warn should be a duty to protect.
b. The victim must be named and readily identifiable.
c. The case law only applies to California.
d. The duty To protect, must always include a warning of the victim.
e. The warning of the victim must be done by a certified letter to ensure protection.
a. The duty to warn should be a duty to protect.
In In re Lifshutz, The doctor went to jail because the court determined:
a. The doctor was fraudulently billing and should go to jail.
b. The patient had been willing to sign a consent to release information.
c. The court owns the confidentiality of the records, not the doctor.
d. The patient owns the privilege, not the doctor.
e. Privileged information about the care provided was so damaging that the doctor went to jail.
d. The patient owns the privilege, not the doctor.
The Tarasoff case had several “Progeny”. Pick the case with the matching key finding:
a. Tarasoff versus Regents of the University of California - Unclear victim but a clear threat.
b. Lipari versus Sears - clear victim, and clear threat.
c. Peterson versus Washington - erratic flying by a pilot.
d. DeMeerleer versus Washington - specific Threats of a specific victim.
e. Peck versus Addison County - a threat to property.
e. Peck versus Addison County - a threat to property.
The following option exists in many statutes delineating one way to discharge the duty to protect:
a. Hospitalize the patient voluntarily.
b. Suggest the patient relocate.
c. Call the victim and tell them they may want to hire security without breaching more information about the patient.
d. Ask the police to come and evaluate the patient.
e. Seek the patient’s immediate arrest for making a veiled threat in therapy.
a. Hospitalize the patient voluntarily.
What is the obligation of the psychiatrist to reveal information about patients to no one unless required to do so by law?
confidentiality
What is the fundamental right of people to control the acquisition and disclosure of their identifiable health data?
Privacy
What is the right to keep confidential information out of court unless privilege is waived it there is a legal exception?
Privilege
Confidentiality = clinician’s obligation
Privilege = Patient’s Right
What are the two major privacy laws?
- 42 CFR Part 2 - federal regulation that established stringent protection for treatment records of persons receiving services specifically for drug or alcohol use.
- HIPAA
What are the two circumstances under 42 CFR Part 2 in which substance use can be disclosed in court proceedings
- Subpoena
- Court order
What are the two general types of exceptions to confidentiality under HIPAA?
- Permitted circumstances for disclosure
- Mandated circumstances for disclosure
What are the examples of mandated breaches?
Abuse - child, adult, disabled
contagious diseases
reporting gunshot wounds
What are examples of permissive sharing under HIPAA?
- Sharing from one treatment provider to another
- When information is needed to lessen a serious and imminent threat to the health and safety of a person or the public.
What is “testimonial privilege?”
The right to bar another person from testifying based on information that person has gained from contacts with him applies only in a judicial setting.
Privilege belongs to the patient, not the psychiatrist
What are the exceptions to privilege?
- Patient-litigant exception - the patient is involved in litigation where the mental status is questioned
- court-ordered competency or sanity
- The therapist aids in a crime
- patient’s death
- danger
- Malpractice suit against the therapist
- Child custody
- The patient fails to pay their bill
- military courts
What was the issue and holding in In re Lifschutz (1970)?
The patient holds the privilege, not the doctor! The patient was suing for distress and waived privilege.
What was the issue and holding in Jaffee v. Redmond (USSC 1996)?
In federal cases, Federal Rule 501 under the Federal Rules of Evidence supported the psychotherapist-patient privilege for psychiatrists, psychologists, and licensed social workers in the course of psychotherapy.
What were the outcomes of Tarasoff I (1974)? Tarsoff II (1976)?
Tarasoff I: established a”duty to warn” in California
Tarasoff II: established a “duty to protect” in California
What was the issue and holding in Lipari v. Sears Roebuck (1980)?
Is there a duty to protect the “public at large” when they are the victims?
Yes.
What was the significance of Naidu v. Laird (1988)?
Negligence was found for failing to foresee potential violence 5.5 months post-discharge (Nadir of responsibility).
