Gun Control and Mental Health in the News

There has been a flurry of news affecting psychiatrists recently, including, but not limited to:

– President Obama’s list “Gun Violence Reduction Executive Actions” which includes, among 21 others, these actions:

– “Clarify that the Affordable Care Act does not prohibit doctors from asking their patients about guns in their homes.”

– “Release a letter to health care providers clarifying that no federal law prohibits them from reporting threats of violence to law enforcement authorities.”

– The White House plan is available here (.pdf).

– The Department of Health and Human Services released the letter referenced-above to the nation’s health care providers clarifying that the HIPAA Privacy Rule “does not prevent your ability to disclose necessary information about a patient to law enforcement, family members of the patient, or other persons, when you believe the patient presents a serious danger to himself or other people.”

I thought this would be a good time to remind psychiatrists that confidentiality is not (and has never been) absolute.  There are exceptions to confidentiality, such as state laws requiring the release of confidential information.  Just since the first of this month, our risk management team has assisted Program participants through our Risk Management Consultation Service (RMCS) with three questions about abuse reporting (child and elder), one question about reporting an impaired practitioner/patient, and two concerns about the duty to warn/protect third party potential victims. 

Patient safety is another exception to confidentiality.  Communication with family members/significant others can be very important when treating a patient at risk of suicide as an outpatient.  In such situations, if the patient will allow you to communicate with family you should certainly do so – inform of the potential for suicide, risk factors, signs and symptoms to watch for, what to do if they see these signs and symptoms, ensure no access to weapons, etc.  Even if the patient prohibits you from communicating with others, consider alerting family members to the risk of outpatient suicide if the risk is significant, family members do not seem to be aware of the risk, and the family might contribute to the patient’s safety.

Final reminders:

– When releasing patient information under an exception to confidentiality, disclose only the minimum of confidential information necessary for the purpose.

– Call your risk management team with any questions or concerns.  As noted above, PRMS’ risk managers frequently assist our insureds with these, and other complicated concerns.

By Guest Blogger: Donna Vanderpool, MBA, JD – Vice President
As Vice President of Risk Management, Ms. Vanderpool is responsible for the development and implementation of PRMS’s risk management services for both The Psychiatrists’ Program and The Neurologists’ Program. Ms. Vanderpool has developed expertise in the areas of HIPAA and forensic practice, and has consulted, written and spoken nationally on these and other healthcare law and risk management topics. She most recently wrote a chapter concerning the risks of harm to forensic experts for Robert L. Sadoff, MD’s book Ethical Issues in Forensic Psychiatry: Minimizing Harm, (Feb. 2011/Wiley). Ms. Vanderpool received her undergraduate degree from James Madison University, and her MBA and JD from George Mason University. Prior to joining PRMS in 2000, Ms. Vanderpool practiced criminal defense law, taught business and legal courses as an adjunct faculty member at a community college and spent eight years managing a general surgical practice.