2. What is Confidentiality?
• Right of an individual to keep his
or her medical information
private.
• Fundamental to any therapeutic
relationship.
• Every client expects it.
• Health Insurance Portability and
Accountability Act of 1996 and
California's Confidentiality of
Medical Information Act.
• Patients should provide written
consent to release any medical
information.
3. When Can you Break
Confidentiality?
• When physicians release information
about the patient without the consent of
the patient.
• When physicians discuss about the
patient's condition to third party.
• When health insurance employees
distribute or access unauthorized medical
records.
• Medical Laboratories and public health
employees who distribute medical records.
• This wide involvement of different parties
erodes privacy (Landrum, 2003).
4. How does Confidentiality Differ
With Minors?
• Minors are unable to give informed voluntary consent
(Gustafson & McNamara, 1987).
• Some adolescents will enter a therapeutic treatment only
when confidentiality is guaranteed.
• Responsibility of healthcare professional to identify the best
interest of minors.
• Juvenile crime and substance abuse among minors has
created thes need to share information to law enforcement
authorities (Isaacs and Stone, 2001).
• There is little guidance from laws to protect minors' rights
and provide information to legitimate third parties.
5. Minor's Confidentiality Laws
• Court allows minors who are aged 15 and above to give consent
because of the higher mental maturity.
• Minors can pursue treatment without parental knowledge. This legal
right to pursue treatment is given in cases where parental
intervention may jeopardize the needed treatment.
• Parents should sign authorization for minors or minors should sign
when they consent to healthcare voluntarily or by law.
• California Civil, Penal and Family Code lay down rules regarding
what information should be shared with others and the
circumstances in which it can be shared.
• Healthcare providers who violate California's CIMA can be held
criminally and civilly liable.
6. Different kinds of Minor Consent
• Literature identifies four kinds of consent (Isaac and Stone,
2001).
• Complete Confidentiality – No disclosure to parents or
others.
• Limited Confidentiality – Minors waive the right to know
what will be disclosed.
• Informed Forced Consent – Minors are given advance notice
that information will be disclosed to parents and other
legitimate agencies.
• No Confidentiality – No guarantees are made about
confidentiality.
7. Exceptions to Confidentiality Laws
• In the case of an emancipated minor, the healthcare provider cannot
share information to the parents without the minor's written consent.
• The healthcare provider can inform the parents with or without the
minor's consent if the minor is living separate from the parents. Code
6922(c).
• When a minor undergoes abortion, the records should not be shared
with anyone without the prior consent of the minor.
• Family planning including contraception, rape, sexually transmitted
diseases and pregnancy should not be disclosed. -Code 123110(a) and
123115(a)(1).
• Sharing is permitted without minor's consent when certain diseases
have to be reported to authority, sharing for treatment or payment
purposes and reporting child abuse. California Civil Code 56.13
8. Conclusion
• Confidentiality is essential .
• Laws are different for minors.
• California's CIMA and the
Federal HIPAA protect privacy.
• There are certain exceptions
to sharing information based
on the situation involved.
• In all other cases, written
permission is required.
• Healthcare provider can face
legal action for violations.
9. References
Landrum, S. E.(2003).
"Patients' rights and
responsibilities." Journal of
the Arkansas Medical
Society Vol 99. p 222–223.
Gustafson, Kathryn;
McNamara, Regis. (1987).
Confidentiality with Minor
Clients: Issues and
Guidelines for Therapists.
Professional Psychology,
Research and Practice. Vol
18(5). p 503-508.
10. References
Isaac, Madelyn; Stone, Carolyn.
(2001). Confidentiality with
Minors: Mental Health
Counselors' Attitudes toward
breaching or preserving
confidentiality. Journal of
Mental Health Counseling.
Vol 23(4). p 1-342.
Goodman, Rebeca. (October
2006). Minor Consent,
Confidentiality and Child
Abuse Reporting in
California. National Center
for Youth Law. Retrieved
from:
Editor's Notes
Confidentiality is the right of a patient to have his or her medical records kept as private. All medical records and other related information should not be disclosed to others by the healthcare provider unless the patient has provided written authorization for consent. This confidentiality is fundamental for the therapeutic relationship between the healthcare provider and the patient. It helps to build trust with the provider and for this reason, it is implicitly expected by every patient. Federal and state laws also understand the importance of this privacy and this is why the federal government and every state has their own laws pertaining to it. The HIPAA Act was passed by the federal government in 1996 while California passed CMIA to ensure privacy is maintained.
Healthcare providers break confidentiality agreement when they discuss about a patient's condition to others or release medical information pertaining to the employee without their knowledge or consent. Other than healthcare providers, a patient's records are routinely viewed by insurance company employees and public health departments. If the employer provides health insurance, then the records may also be viewed by some authorized employees. When any of these people distribute records or access unauthorized information, it amounts to breaking the confidentiality. The fact that information is so widely disseminated makes it difficult to maintain privacy.
Minors are not in a position to give written consent because they do not have the mental maturity. So, the healthcare provider should do what is right in the best interest of the minor. Adolescents who are facing serious problems such as rape, abuse or abortion will agree for treatment only when confidentiality is ensured. So, this makes it important for minors too. However, many crimes and substance abuse forces healthcare providers to share information with enforcement authorities and others and this puts the physicians in a difficult position. Also the fact that state laws vary and have little guidance or precedents for dealing with minors makes it more difficult for healthcare providers.
The laws give certain rights to minors. Anyone who is above the age of 15 in California can give consent because they are considered to have the maturity to understand their actions. Minors can undergo treatment without parental consent if the court determines that intervention by one or both the parents can have negative result for the minor and the treatment process. If there is no problem with parental intervention, then the parents should sign the consent or release form. When minors consent to a treatment voluntarily or by law, they can sign it themselves. Laws related to privacy are found in California's civil and family codes and healthcare providers who violate them can be held liable criminally and civilly.
There are four prominent kinds of consent put forth by researchers to address the problems that come with minor consent and the release of information to parents and enforcement officials. None of these has been legislated yet and it is hoped that the future lawmakers will take into consideration the challenges that come with minor confidentiality.
Codes Code 123110(a) and 123115(a)(1) relate to the laws that talk about exceptions to confidentiality and it applies to certain situations such as an emancipated minor, rape, child abuse, family planning, abortion and sexually transmitted diseases. An emancipated minor is someone who has entered into a marriage or is on active duty or has got a letter of emancipation from a court. In these cases, no information is shared with anyone including the parents. The only exception is when this information has to be shared with authorities.
