Wouldn’t life be easier if patients just did what they are told?

The claims solicitors at MIGA are often contacted for advice on whether to involve the police or someone else in circumstances where the doctor believes the patient’s health, or the health of a third party, is at serious risk.

Scenarios include:

  • Patient won’t take your advice that they need to be hospitalised
  • Patient cannot be contacted about concerning results because:
    • Phone number is incorrect
    • Phone is disconnected
    • Patient won’t answer phone
    • Patient address is incorrect.
  • Patient has not attended follow-up appointment and cannot be contacted
  • Patient has given a history of intent to do harm to self or others.

As you would appreciate, the decision about whether to involve the police or another third party to contact the patient in these circumstances will be based on the unique facts of the matter. The conundrum of:

  • Respecting patient wishes
  • Issues of confidentiality
  • Patient capacity to make their own decisions on healthcare
  • Patient best interests

are all matters for consideration when determining the next steps.

This can be challenging to navigate, sometimes the way forward is clear but more often it is not.

Recent findings by the Coroner in Victoria brings into focus some of the issues which must be considered when the safety of a third party is involved. The findings assist medical practitioners and provide some guidance.

Case study:-

The facts
Ms Donato was murdered by Mr Stoneham.

The Inquest into Ms Donato’s death included an investigation into the mental health care received by Mr Stoneham to seek to ascertain if Ms Donato’s death could have been prevented.

Mr Stoneham had been seen by a clinical psychologist and during therapy had expressed anger towards Ms Donato and declared an intent to harm an unnamed person.

One issue considered was whether the psychologist should have notified others, including the police.

There was an examination of the duty of confidentiality to a patient, balanced against a duty to protect the public. In Victoria, the Health Records Act 2001 has an exemption to that confidentiality in circumstances where there is a ‘serious and imminent threat’.

The Coroner found the psychologist should have questioned the patient further on his thoughts to identify whether there was a plan to act. Had the psychologist done so, then the psychologist would have been better informed on whether there was a serious and imminent threat and whether to notify the police.

Laws and professional codes which govern medical records and release of confidential information to others can vary.

In some circumstances, medical practitioners must base decisions to breach patient confidence on ethical considerations.

A decision to breach patient confidentiality should not be taken lightly and the balance between this duty and the duty to the community can be difficult to reconcile.

When in doubt, it may be beneficial to speak to a colleague to get another perspective, but the claim solicitors at MIGA are always available to assist. We will discuss the clinical scenario with you and be able to provide you with guidance. We are here to help.

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