Department of Health Services Logo

 

Wisconsin Department of Health Services

Client Rights Home

Intro to Client Rights

Client Rights Office

Client Rights Training Opportunities

Client Rights Limitation or Denial

Community Grievance Decision Digest

Confidentiality of Treatment Records

Guardianship

Minors

Informed consent

Centers for the Develop- mentally Disabled

Mental Health Institutes

Secure Treatment Centers

Outpatient treatment

Inpatient treatment

Model Grievance Procedure

Forms, publications and posters

Non-Wisconsin residents who are emergency detained

Community Grievance Decision Digest

RECORDS, CONFIDENTIALITY OF TREATMENT

The Laws; Previous Decisions 1-10

DECISIONS

  1. A patient’s mother complained that her daughter’s doctor violated her daughter’s confidentiality. The Level I Client Rights Specialist did not address this issue in his written response. The failure to address this issue was a violation of the right to have the grievance fully investigated. (Level III decision in Case No. 01-SGE-02 on 12/10/01.)

  2. A patient’s mother complained that her daughter’s doctor violated her daughter’s confidentiality by reading things from her records during a meeting between the doctor, the patient and her parents. The parents had the same right of access to her records as the daughter had under §51.30(5)(b), Stats. Therefore there was no violation of confidentiality. (Level III decision in Case No. 01-SGE-02 on 12/10/01.)

  3. The law states that, "A patient or a person acting on behalf of a patient" may file a complaint. It was a violation of the complainant’s rights when a Level I Client Rights Specialist refused to investigate her allegation that her ex-husband’s right to confidentiality had been violated. (Level III decision in Case No. 01-SGE-02 on 12/10/01.)

  4. A therapist informed a woman that her former husband was in counseling. She had been unaware of that. The disclosure violated her ex-husband’s right to confidentiality. (Level III decision in Case No. 01-SGE-02 on 12/10/01.)

  5. Patients have the right to involve their spouses in their home-visit treatment sessions unless their participation is contraindicated for treatment reasons. The service provider should either allow such participation or explain to the patient why it is contraindicated. The patient would have to sign a release of information to allow the spouse to be present during treatment sessions. (Level III decision in Case No. 01-SGE-09 on 3/27/02.)

  6. Sec. 51.30(4)(e), Stats., requires that, when records are released, "a notation shall be made in the records by the custodian thereof that includes the following: the name of the person to whom the information is released; the identification of the information released; the purpose of the release; and the date of the release". Handwritten notes in the margin of records request documents, due to their brief nature, are unlikely to satisfy all the requirements of this statute. Subsequent to April 14, 2003, entities releasing records must also comply with the even more stringent federal Health Information Portability and Accountability Act (HIPAA). (Level IV decision in Case No. 02-SGE-04 on 9/19/03, overturning the Level III.)

  7. A mother believed a therapist acted unprofessionally in working with her daughter by not reporting various risky behaviors in which her daughter was engaged. The therapist was aware that her daughter tried to commit suicide, purposely cut herself many times, used illegal drugs, and engaged in underage sex with multiple partners. The mother thought the therapist should have reported all these incidents to proper authorities. She requested disciplining the therapist – including possible license revocation. The records indicated that the suicidal ideation expressed by the daughter was taken seriously. Appropriate referral resources were immediately offered to her parents. The daughter was also placed on a medication for depression. For the next seven subsequent sessions the therapist inquired about and documented the daughter’s present mental status and thoughts of suicide or dying. Each entry includes some statement indicating that she was asked if she was seriously contemplating suicide or hurting herself. She responded that she was not having thoughts about suicide or hurting herself over the following months. Therefore, her right to prompt and adequate treatment was met. The therapist was not obligated to initiate social services intervention into her family life, or to notify any other authorities. (Level III Decision in Case No. 03-SGE-02 on 12/26/03.)

  8. A mother complained that her daughter’s therapist reported sexual abuse to the county social worker. The therapist learned that a teacher at her daughter’s home school had touched the young woman inappropriately. The therapist reported the allegations to the county social worker. The county Social Services department then got the police involved. The police came to the home school to arrest the teacher. This situation was stressful for both mother and daughter. The incident met the legal definition of sexual abuse. Since she was a minor, law mandates the reporting of the allegation. The therapist’s actions were professional and appropriate. (Level III Decision in Case No. 03-SGE-02 on 12/26/03.)

  9. There is legal precedence for the "duty to warn or protect," though in Wisconsin it is not defined by statute. The precedent is from the courts, and is outlined in the 1988 Wisconsin Supreme Court case Schuster v. Altenberg, and in subsequent literature. This case, similar to many that preceded it, establishes a duty on the part of psychotherapists to take "some reasonable" action to prevent foreseeable harm to third parties who are injured by those being treated by the psychotherapists. This state precedent parallels federal precedent, Tarasoff v. Regents of the University of California, which was a 1976 California case decided by the U.S. Supreme Court. (Level III Decision in Case No. 03-SGE-02 on 12/26/03.)

  10. A mother was concerned about the way her daughter’s underage sexual activity was handled in treatment. The therapist learned she had engaged in sexual activity with multiple partners. While it is true that a minor cannot legally consent to sexual activity, the relationships the minor was engaged in were not against her will, the relationships were with other minors who she was dating, and thus were not considered to be abuse. There was thus no cause to violate the daughter’s confidentiality by reporting this matter to outside authorities. (Level III Decision in Case No. 03-SGE-02 on 12/26/03.)

  11. A form called "Consent for Release of Information – Patient Assistance Program" is used by a service provider and is presented to all patients who receive medications through the Patient Assistance Program. This form is to aid patients in filling out the paperwork necessary to receive medications through the Patient Assistance Programs offered by pharmaceutical companies. The release allows service provider staff to help patients fill out all the information required on the application, and it allows staff to send the applications to the pharmaceutical companies (or their contracted agencies) for the patients. Without this consent, patients would need to fill out and mail the application form themselves. This is not possible in its entirety, as their physicians prescribing number is not available to be known by patients and must come from the service provider. If a patient refuses to sign this consent form, the individual may not be denied services by the provider, and patients may elect to fill out and send the application to the Patient Assistance Program on their own. In this case, the service recipient chose not to sign the release, and this did not negatively effect his treatment because he was able to handle the paperwork himself. This resolved the concern as it applied to him. However, he expressed concern about the form for other patients’ confidentiality. Over 700 patients receive medications from this provider and approximately 75% of those patients receive their medications through a Patient Assistance Program, which resulted in over $300,000 worth of medications being disbursed to patients at no cost to them in the last year through that agency. Many of these clients do need assistance in filling out the paperwork to maintain these free medication services. It was determined that the consent form in question is a useful and important tool for those individuals to maintain their psychiatric treatment services. While this person’s concern for their confidentiality is admirable, the allegation that this form violates their confidentiality is unfounded, and the limitations on the types of information that can be released does protect patients’ confidentiality and allows the provider to facilitate their clients’ participation in the PAP. (Level III Decision in Case No. 03-SGE-08 on 7/14/04.)

  12. The confidentiality rights of a client at a methadone clinic were violated when she was called by her first and last name in the waiting room. The appropriate and professional way to address her would be to only use her first name when other clients are present. The clinic remedied this confidentiality breach by conducting a staff In-service on confidentiality. (Level III decision in Case No. 04-SGE-02 on 12/20/04)

  13. In order to protect a client’s confidentiality, it is not appropriate to discuss confidential or personal matters on a speakerphone in a cubicle workplace environment.  Speakerphone use during conference calls should be restricted to constructed office space or conference rooms that offer reasonable degrees of privacy. Here, the speakerphone use in question was appropriately conducted in a constructed office with a closed door. (Level III Grievance Decision in Case No. 04-SGE-07, affirmed at Level IV on 8/15/05)

  14. If a county is contracting with a mental health center to provide inpatient treatment for a client, they can share confidential client information they have with the center without the client’s consent. It did not violate the client’s confidentiality here where the information shared was something the client had objected to as being inaccurate.  The client had other means of trying to correct the information at issue.  (Level III Grievance Decision in Case No. 04-SGE-07, affirmed at Level IV on 8/15/05)

Last Updated: October 24, 2008