Confidentiality Issues When Minor Children Disclose

What is Confidentiality?• Right of an individual to keep his

or her medical information private.

• Fundamental to any therapeutic relationship.

• Every client expects it.

• Health Insurance Portability and Accountability Act of 1996 and California's Confidentiality of Medical Information Act.

• Patients should provide written consent to release any medical information.

When Can you Break Confidentiality?

• When physicians release information about the patient without the consent of the patient.

• When physicians discuss about the patient's condition to third party.

• When health insurance employees distribute or access unauthorized medical records.

• Medical Laboratories and public health employees who distribute medical records.

• This wide involvement of different parties erodes privacy (Landrum, 2003).

How does Confidentiality Differ With Minors?

• Minors are unable to give informed voluntary consent (Gustafson & McNamara, 1987).

• Some adolescents will enter a therapeutic treatment only when confidentiality is guaranteed.

• Responsibility of healthcare professional to identify the best interest of minors.

• Juvenile crime and substance abuse among minors has created thes need to share information to law enforcement authorities (Isaacs and Stone, 2001).

• There is little guidance from laws to protect minors' rights and provide information to legitimate third parties.

Minor's Confidentiality Laws

• Court allows minors who are aged 15 and above to give consent because of the higher mental maturity.

• Minors can pursue treatment without parental knowledge. This legal right to pursue treatment is given in cases where parental intervention may jeopardize the needed treatment.

• Parents should sign authorization for minors or minors should sign when they consent to healthcare voluntarily or by law.

• California Civil, Penal and Family Code lay down rules regarding what information should be shared with others and the circumstances in which it can be shared.

• Healthcare providers who violate California's CIMA can be held criminally and civilly liable.

Different kinds of Minor Consent

• Literature identifies four kinds of consent (Isaac and Stone, 2001).

• Complete Confidentiality – No disclosure to parents or others.

• Limited Confidentiality – Minors waive the right to know what will be disclosed.

• Informed Forced Consent – Minors are given advance notice that information will be disclosed to parents and other legitimate agencies.

• No Confidentiality – No guarantees are made about confidentiality.

Exceptions to Confidentiality Laws

• In the case of an emancipated minor, the healthcare provider cannot share information to the parents without the minor's written consent.

• The healthcare provider can inform the parents with or without the minor's consent if the minor is living separate from the parents. Code 6922(c).

• When a minor undergoes abortion, the records should not be shared with anyone without the prior consent of the minor.

• Family planning including contraception, rape, sexually transmitted diseases and pregnancy should not be disclosed. -Code 123110(a) and 123115(a)(1).

• Sharing is permitted without minor's consent when certain diseases have to be reported to authority, sharing for treatment or payment purposes and reporting child abuse. California Civil Code 56.13

Conclusion• Confidentiality is essential .

• Laws are different for minors.

• California's CIMA and the Federal HIPAA protect privacy.

• There are certain exceptions to sharing information based on the situation involved.

• In all other cases, written permission is required.

• Healthcare provider can face legal action for violations.

ReferencesLandrum, S. E.(2003).

"Patients' rights and responsibilities." Journal of the Arkansas Medical Society Vol 99. p 222–223.

Gustafson, Kathryn; McNamara, Regis. (1987). Confidentiality with Minor Clients: Issues and Guidelines for Therapists. Professional Psychology, Research and Practice. Vol 18(5). p 503-508.

References

Isaac, Madelyn; Stone, Carolyn. (2001). Confidentiality with Minors: Mental Health Counselors' Attitudes toward breaching or preserving confidentiality. Journal of Mental Health Counseling. Vol 23(4). p 1-342.

Goodman, Rebeca. (October 2006). Minor Consent, Confidentiality and Child Abuse Reporting in California. National Center for Youth Law. Retrieved from: www.youthlaw.org/fileadmin/ncyl/youthlaw/publications/minor_consent/Minor_Consent_Report_Download.pdf