Breaking confidentiality to meet legal obligations

Breaking patient confidentiality may be legally permissible in specific circumstances where statutory or legal obligations override the duty of confidentiality. These instances are typically regulated to ensure that confidentiality is breached only when necessary to protect public interest, legal mandates, or the patient's well-being.

The importance of patient confidentiality

Patient confidentiality is vital for several reasons. An article by Charter College list the following as key benefits of maintaining confidentiality in healthcare:

• Protects patients from harm and stigma: Prevents sensitive health information (e.g., diagnoses) from being shared publicly and potentially harming a person’s reputation or social standing.
• Encourages honest communication: When patients trust that their information is secure, they are more likely to disclose full and accurate details to healthcare providers, which supports better care.
• Prevents discrimination: Keeping health information private ensures that individuals are judged by their abilities and character, not by illnesses or chronic conditions.
• Builds trust in healthcare relationships: Confidentiality creates a safe environment where patients feel comfortable seeking care, being open about their symptoms, and participating in research or public health efforts.
• Preserves the reputation of healthcare providers: Providers who respect confidentiality are more likely to earn patient recommendations and uphold a positive professional reputation.
• Is required by law: Laws such as the Health Insurance Portability and Accountability Act (HIPAA) legally bind healthcare workers to protect patient information and prohibit unauthorized disclosure.

However, there are exceptional situations where the need for confidentiality is outweighed by legal or ethical obligations to disclose patient information.

See also: Safeguarding patient confidentiality during information requests

When can confidentiality be legally broken?

Mandatory reporting of infectious diseases

One of the most common situations where confidentiality may be breached is when healthcare providers are legally required to report specific infectious diseases. As the HHS states, “A covered entity may disclose protected health information to a person who is at risk of contracting or spreading a disease or condition if other law authorizes the covered entity to notify such individuals as necessary to carry out public health interventions or investigations.”

Many countries maintain a list of diseases that must be reported to public health authorities. This ensures that the spread of contagious diseases can be monitored and controlled.

Examples of reportable diseases, as listed by the CDC, include:

• Tuberculosis (TB)
• Human Immunodeficiency Virus (HIV)
• Sexually transmitted infections (STIs) like syphilis and gonorrhea
• Viral hemorrhagic fever
• Measles

“The county or state health department will try to find the source of many of these illnesses, such as food poisoning. In the case of sexually transmitted diseases (STDs), the county or state will try to locate sexual contacts of infected people to make sure they are disease-free or are treated if they are already infected,” writes MedlinePlus.

In such cases, the disclosure of patient information is necessary to protect public health. For instance, during the COVID-19 pandemic, healthcare providers were required to report positive cases to public health authorities to facilitate contact tracing and containment efforts. Although this involves breaking patient confidentiality, it is legally justified by the need to prevent a wider health crisis.

Reporting abuse or neglect

Another exception to confidentiality occurs in situations of suspected abuse or neglect. Healthcare providers are legally required to report cases where they suspect a patient, especially vulnerable individuals like children or the elderly, is being abused or neglected. As per the HHS, “Covered entities may disclose protected health information to report known or suspected child abuse or neglect, if the report is made to a public health authority or other appropriate government authority that is authorized by law to receive such reports.”

For example, if a healthcare provider suspects that a child is being physically, emotionally, or sexually abused, they are obligated to report this to child protective services or law enforcement. Similarly, elder abuse or neglect in nursing homes must be reported.

This obligation is in place to protect individuals who may not be able to protect themselves. Although it involves breaching patient confidentiality, the primary aim is to safeguard the individual's well-being.

See also: How HIPAA compliant emails can help survivors of abuse

Duty to warn and protect

Healthcare providers may also have a legal obligation to break confidentiality if they believe a patient poses a serious and imminent threat to another person or the public. This is known as the “duty to warn and protect.”

The landmark case Tarasoff v. Regents of the University of California (1976) set the precedent for this exception. In this case, a patient disclosed to a therapist that they intended to harm a third party. The therapist did not warn the third party, who was later killed. The court ruled that healthcare providers have a duty to warn potential victims if they believe a patient poses a credible threat.

In practice, this means that if a patient expresses an intention to harm someone, the healthcare provider must notify the intended victim and law enforcement. While this breaks confidentiality, it is legally mandated to prevent harm.

Court orders and subpoenas

The HHS notes that “A HIPAA-covered health care provider or health plan may share your protected health information if it has a court order. This includes the order of an administrative tribunal.”

For example, in a lawsuit where medical records are relevant to the case, a court may order the healthcare provider to release the patient’s health information. In such cases, healthcare providers are legally obligated to comply with the court order, even if it involves breaking confidentiality. However, healthcare providers must only disclose the information specifically requested in the subpoena or court order to minimize the impact on the patient's privacy.

Read also: Can covered entities share patient information without a court order?

Worker’s compensation cases

The HHS states that disclosures of protected health information (PHI) without individual authorization are permitted under the Privacy Rule for workers’ compensation systems. This includes disclosure to insurers, employers, and state administrators as necessary to comply with laws for work-related injuries, such as the Black Lung Benefits Act and the Federal Employees’ Compensation Act. Any disclosure must adhere to the requirements set by state laws and is limited to what is legally mandated. Additionally, PHI can be disclosed for obtaining payments for healthcare services provided to the injured worker.

Public health investigations

Public health emergencies, such as bioterrorism or widespread disease outbreaks, may also justify the breach of patient confidentiality. In such situations, healthcare providers may need to share patient information with government authorities to manage the crisis.

For instance, during the anthrax attacks in the U.S. in 2001, healthcare providers were required to report suspected cases to the Centers for Disease Control and Prevention (CDC). This allowed public health authorities to track the spread of the disease and implement containment measures.

In these cases, the need to protect the public outweighs the duty to maintain patient confidentiality.

Read also: The role of HIPAA in shaping public health surveillance efforts

Preventing harm to the patient

In some cases, breaking confidentiality is necessary to prevent harm to the patient themselves. If a healthcare provider believes that a patient is at risk of self-harm, suicide, or engaging in dangerous behavior, they may need to disclose this information to family members, law enforcement, or mental health professionals to intervene.

Go deeper: When can confidentiality be broken?

Balancing legal obligations and ethical responsibilities

While these exceptions to confidentiality are legally mandated, healthcare providers must still handle such disclosures with care and respect for the patient's privacy. The following principles can help guide healthcare providers in balancing legal obligations with ethical responsibilities:

• Minimize disclosure: Only the necessary information should be disclosed. For instance, if a court orders the release of medical records, only the relevant portions of the records should be shared.
• Inform the patient: When possible, patients should be informed when their confidentiality is going to be breached. For example, a healthcare provider can explain to a patient why they are legally obligated to report an infectious disease to public health authorities.
• Document the disclosure: Healthcare providers should keep detailed records of any breach of confidentiality, including the reasons for the disclosure and the information that was shared. This documentation can protect the provider in case of legal disputes.

See also: HIPAA Compliant Email: The Definitive Guide

FAQs

What is patient confidentiality in healthcare?

Patient confidentiality refers to the ethical and legal obligation of healthcare providers to keep patient information private. This ensures that any personal health information shared by the patient during the course of treatment is protected from unauthorized disclosure.

Are there any protections for healthcare providers who break confidentiality?

Yes, healthcare providers who breach confidentiality to fulfill legal obligations, such as mandatory reporting or preventing harm, are generally protected from legal liability. However, they must ensure that they follow the appropriate legal and ethical procedures and document their actions.

What are the consequences of not complying with legal obligations to break confidentiality?

Failure to meet legal obligations, such as not reporting an infectious disease or not warning someone of imminent harm, can have serious consequences for healthcare providers. They could face legal action, fines, loss of licensure, or other penalties, depending on the jurisdiction and the severity of the case.