1. Should the MD contact the FBI for a wanted criminal under his care? Confidentiality vs. NonMalificience

2. What is wrong with the picture? There is a potential that a wanted criminal will seek care by a dermatologist or optometrist The doctor has a responsibility to the patient to keep his/her personal health information confidential The potential patient is a fugitive and considered dangerous The FBI are requesting that anyone with information please assist with capturing the fugitive Confidentiality vs. NonMaleficence Justice vs. Veracity

3. Confidentiality vs. Nonmaleficence Confidentiality—MD has an accountability to the patient to hold their information in strictest confidence If he notifies the FBI, he will be breaching the confidentiality of his patient Nonmaleficence—MD has a duty that requires “no harm done” And if he does not notify the FBI….. He may have a part in harming many others, which is against the AMA Code of Ethics

4. Veracity vs. Justice Veracity is simply telling the truth. The MD will not uphold the standard of veracity if he does not abide by the law and assist the FBI He has the knowledge that this patient is dangerous. Justice requires that all be treated equal regardless of gender, sexual orientation, religion, ethnicity, disease or social standing. If the MD refuses the fugitive treatment, then, he will be going against the ethical principle of justice.

5. Whichever MD the fugitive chooses, they have an obligation to provide nonbiased care to her However, they also have an obligation to society and must choose what is ethically right according to the Principle of Beneficence—to do good for the benefit of others. How many would be benefited by reporting the patient?

6. The MD has to choose: According to HIPPA, “Law Enforcement Purposes. Covered entities may disclose protected health information to law enforcement officials for law enforcement purposes under the following six circumstances, and subject to specified conditions: (1) as required by law (including court orders, court-ordered warrants, subpoenas) and administrative requests; (2) to identify or locate a suspect, fugitive, material witness, or missing person; (3) in response to a law enforcement official’s request for information about a victim or suspected victim of a crime; (4) to alert law enforcement of a person’s death, if the covered entity suspects that criminal activity caused the death; (5) when a covered entity believes that protected health information is evidence of a crime that occurred on its premises; and (6) by a covered health care provider in a medical emergency not occurring on its premises, when necessary to inform law enforcement about the commission and nature of a crime, the location of the crime or crime victims, and the perpetrator of the crime.34 (U.S Dept. of Health and Human Services) What would happen if the FBI found out that the fugitive was indeed seen by the MD and no report was made, and others were harmed? Would the MD be an adjunct to a crime? This could go public and his practice possibly ruined, right?

7. Because of this exception to disclose PHI, can the MD not act on justice, and treat the fugitive, even though he reports her to the FBI? Is that not his duty? The confidentiality may be breached, but her acne vulgaris and/or vision can be treated, while waiting on the FBI to arrive. And, many lives will be kept out of harms way….

8. What else can the local MDs do to prepare after reading the FBI article? This is a potential situation, so the MD has a chance to research the situation and collaborate with his/the hospitals ethical committee to prepare themselves for the “What Ifs” Hopefully, I’m not put in that situation, but if I am, what would I do?