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Difficulty: MediumConfidentiality and Privacy

An outpatient psychiatrist evaluates a patient who recently experienced a sudden job termination. During the clinical interview, the patient exhibits severe psychomotor agitation and states an unequivocal, detailed plan to shoot a specific former supervisor at the supervisor's home later that evening. Before the psychiatrist can initiate an involuntary psychiatric hold, the patient abruptly flees the clinic. The psychiatrist determines there is a credible, imminent risk of severe harm to the supervisor. Which of the following actions involving the disclosure of protected health information are legally permitted or mandated to protect the third party? (Select all that apply)

  1. Alerting local law enforcement agencies about the patient's identity and the specific threat.Answer
  2. Directly contacting the former supervisor to provide a warning about the impending harm.Answer
  3. C
    Contacting the patient's spouse to request that they intervene and secure any firearms.
  4. D
    Notifying the human resources department of the patient's former employer about the violent threats.
  5. E
    Forwarding the patient's complete psychiatric medical record to the police to assist their investigation.

Answer

The legally supported actions to protect the third party are alerting local law enforcement agencies and directly contacting the intended victim (the former supervisor) to warn them of the threat.
Under the legal principle often referred to as the Tarasoff ruling (duty to protect/warn), a physician is permitted and typically mandated to breach patient confidentiality when a patient presents a serious and imminent threat of physical violence to a specifically identifiable victim. To discharge this duty, the physician should take reasonable steps to protect the intended victim. This legally supports notifying local law enforcement about the threat and making a reasonable effort to directly contact and warn the intended victim. Both actions directly address the imminent danger while restricting the disclosure to those who absolutely need to know.

Step-by-Step Solution

1
Identify the ethical dilemma and legal precedent.
The patient presents an imminent, credible threat of severe harm to a specific, identifiable individual.
Physicians generally must maintain confidentiality, but there are specific legal exceptions for public safety.
2
Apply the 'Duty to Protect' (Tarasoff) principle.
The physician has an obligation to take reasonable steps to protect the intended victim from harm.
When a patient poses a serious danger of violence to others, the duty to protect overrides patient confidentiality.
3
Determine the legally permissible interventions.
Notifying law enforcement and warning the intended victim are the established methods to fulfill this duty.
These actions directly mitigate the threat while limiting the breach of confidentiality to the necessary parties.

Key Concept

Duty to Protect (Tarasoff Principle) and HIPAA Minimum Necessary Standard
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Topics

Confidentiality and Privacy

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