Oregon Jurisprudence Exam July 2013 Flashcards
Privilege
The legal right to confidentiality
Privilege is claimed by… (p.1)
- Patient
- Guardian or Conservator
- Personal Representative of the Deceased
- Therapist on Behalf of the Patient
PGRT (Mnemonic)
Limits to Privilege (p. 1)
- Judge ordered exam or evaluation
- Mental condition is part of a defense
- Mental condition is part of a defense after DEATH
- Communication is needed for involuntary commitment
- HIPAA
- 179505 (Section 12)
- Intent Crime Law 40.252
Confidential Communications (p. 1)
- Made for the purposes of Dx or Tx of mental or emotional condition.
- Not intended to be disclosed to 3rd person.
- Privileged under Oregon Law.
Holder of Privilege
Patient
Disclosure of Written Accounts by Health Care Services Provider-**ORS 179.505-Section 12 **(p. 17)
- Information obtained in the course of Dx, evaluation, or Tx, which in the professional judgment of provider indicates a CLEAR AND IMMEDIATE DANGER TO OTHERS OR TO SOCIETY may be reported to the appropriate authority.
- Decision NOT to disclose information shall not subject the provider to civil liability.
- Provider = a provider in a public agency.
Decision NOT to Disclose (p. 17)
Decision not to disclose information shall NOT subject the provider to civil liability.
Provider - ORS 179.505 - Section 12 (p. 15)
- Public Agency
- Publicly Operated Institution
- Private Organization that operates as a Community Mental Health (CMH) provider
- Contracter of the DHS
In short, “public provider or therapist”
3.04 Avoiding Harm (APA, 2002, p. 58)
Psychologists take reasonable steps to avoid harming their patients or clients, research participants, students, and others with whom they work, and to minimize harm where it is foreseeable and unavoidable.
4.05 Disclosures (APA, 2002, p. 61)
Psychologists disclose confidential information without the consent of the individual only as mandated by law, or where permitted by law for valid purposes, such as:
- Provide needed professional service to patient, individual, or organizational client.
- Obtain professional consultations.
- Protect patient or others from harm.
- Obtain payment for services (limited to the minimum that is necessary to achieve that purpose).
Patient Records (Release of Information) - 179.505 Section 3 (p. 15)
- Patient MUST give WRITTEN informed consent for records to be released.
- Consent must be:
- Written
- Signed
- Dated
Release of Information Includes… (p. 15)
- Name of provider who this information is going to.
- Name of patient.
- Extent and nature of information to be disclosed.
- Statement that consent can be revoked at any time.
- Expiration data of consent.
- Signature of patient or representative.
- Date of signature.
Release of Information without Consent-179.505 Section 4 (p. 16)
- Medical emergency (SI, HI, Involuntary hospitalization).
- Peer review, research, or fiscal audits.
- Governmental agencies to secure payment.
- Within a department.
- HIPAA related disclosures (Tx, Payment, & Health Care Operations)
Limitations of Record Release
Confidentiality limited by Oregon Law 179.505:
- Information obtained in the course of Dx, evaluation, or Tx, which in the professional judgment of provider indicates a CLEAR AND IMMEDIATE DANGER TO OTHERS OR TO SOCIETY may be reported to the appropriate authority.
- Can apply to patient records.
Refusal to Release Patient Records (p. 17)
Provider can refuse to release information if it would constitute an immediate and grave detriment to the Tx of the patient.
Access to Records-ORS 179.505 Section 14 (p. 17)
Persons granted access to written records of a patient shall not disclose the contents of those records to any other person except as allowed by law.
4.06 Consultations (APA, 2002, p. 61)
When consulting with colleagues:
- Do not disclose confidential information that reasonably could lead to the ID of the client/patient, research participant unless they have obtained prior consent or the disclosure cannot be avoided, and;
- Disclose information only to the extent necessary.
Rights of Individual & Person Wanting to Review Records
- Must be weighed between both parties.
- Both rights may be limited, but ONLY to the BENEFIT OF THE CLIENT.
Record Keeping (Private Practitioners)
Encouraged to:
- Adopt voluntary guidelines that will grant patients access to own medical records.
- Preserve them from unnecessary disclosure.
Covered Entities (HIPAA)
- Must abide by HIPAA regulations.
- Covered entities include:
- Health Plans
- Health Care Clearinghouses
- Health Care Providers
…that transmit health information in electronic form in connection with a HIPAA standardized transaction.
Disclosures Injurious to the Patient
Provider can withhold records or provide a summary.
Confidential Information in Databases (APA, 2002, p. 62)
6.02 Maintenance, Dissemination, and Disposal of Confidential Records of Professional and Scientific Work
- Information in databases or record systems should be coded to avoid personal identifiers.
- If research protocol requires the use of personal identifiers, these labels should be removed before information is made accessible to outside people.
- If deletion is not possible, consent from patient is sought.
Preserving Records and Data (OAR 858.010.0060, p. 35)
- Psychologist arranges in advance for the protection of confidential records and data in the event of their death, incapacity, or withdrawal from practice.
- Records are double-locked, or protected with a password on a computer.
- Records kept for 7 years in OAR 858.010.0060.
Preserving Records (APA, 2002)
In the absence of a superseding requirement, psychologists may consider retaining full records until:
- 7 years after the last date of service delivery for adults, OR
- 3 years after a minor reaches the age of majority, whichever is later.
Ownership of Records and Data
Psychologists take reasonable and lawful steps so that records and data remain available to the extent needed to serve the best interest of patients.
6.03 Withholding Records for Nonpayment (APA, 2002; p. 63)
Psychologists may not withhold records requested and imminently needed for a patient’s Tx solely because of nonpayment, except as provided by law.
Health Insurance Portability and Accountability Act (HIPAA) - ORS 192.518-192.524
- Passed in Oregon in 2003.
- Oregon is a HIPAA compliant state.
HIPAA Background
- Designed to improve efficiency and effectiveness of the health care system by encouraging the development of standards for the electronic transmission, privacy and security of certain health information.
- Oregon must comply with HIPAA.
HIPAA (Best Practice & Statutes re: PHI, p. 21)
- Obtain written consent (one-time at intake) and understand when additional authorization is required.
- Patients will be informed of the relevant HIPAA regulations in written form at onset of Tx.
- Patients asked to sign a form and a copy will be kept in the medical record.
- Relevant HIPAA rules are posted.
- Applies to PHI.
- Oregon HIPAA compliant state.
- Psychologists maintain HIPAA consistent security.
Communications Revealing Intent to Commit Certain Crimes Law ORS 40.252 (p. 2)
There is NO privilege if, in the professional judgment of the person receiving the communications, THE COMMUNICATIONS REVEAL A CLEAR AND SERIOUS INTENT at the time of the communications are made to COMMIT A CRIME involving:
- P=Physical Injury
- T=Threat to Physical Safety of Any Person
- S=Sexual Abuse
- D=Death
PTSD (mnemonic)
If Intent to Commit Certain Crimes are Perceived… (ORS 40.252, p. 2)
- Person receiving the communications makes a report.
- Issues Include:
- This is NOT a Duty to Report, NOR a Duty to Warn.
- The person who discloses (psychologist) is immune from civil liability, if
- S/he reports, OR
- S/he does NOT report
- It is NOT stated to whom one reports.
- It need not be due to mental illness.
Tarasoff Standard (Definition)
Where there is a clear and immediate threat of serious harm to an IDENTIFIABLE victim, a therapist has a DUTY TO WARN the intended victim.
Tarasoff Standard (Oregon)
Oregon has neither ADOPTED NOR REJECTED the Tarasoff Standard.
Tarasoff Standard and Relationship to Oregon Law - ORS 179.505
For public providers, Oregon statute ORS 179.505 (section 12) ALLOWS therapists to report to appropriate authorities:
- Information obtained in the course of Dx, evaluation, or Tx, which in the professional judgment of provider indicates a CLEAR AND IMMEDIATE DANGER TO OTHERS OR TO SOCIETY may be reported to the appropriate authority.
- Decision not to disclose information shall not subject the provider to civil liablity.