Disclosure of Patient Information in Drug Rehab Treatment

When a drug rehab treatment program begins assessing and treating a new client, the clinical staff often seeks information from third parties, such as relatives and friends, coworkers and employers, law enforcement personnel, school officials, and other medical professionals. However, how is it possible to gather the type and scope of background information necessary to properly treat a patient suffering from alcoholism or drug abuse while at the same time protecting his or her private and health-related information?

Further, is it ever proper for a drug treatment rehab to communicate with an employer, law enforcement agency, or parent without the patient’s consent? How do drug rehab programs handle situations where the patient may be an imminent threat to herself or others?

Drug rehab treatment centers are not operating in a vacuum when it comes to determining the best course of action in the above situations. In many cases, federal or state law dictates both the level of confidentiality and disclosure required of a treatment center.

When a patient has entered drug rehab treatment as a result of a court proceeding, there are special rules that must be followed with regard to patient confidentiality and disclosure. If participation in treatment has been made part of the defendant’s probation, sentence, dismissal, release or other official disposition, a patient consent or court order is still need before a drug rehab treatment program can release any information about the mandated assessment or treatment. However, any information gleaned from substance abuse treatment providers can only be used in the current criminal proceeding.

It is important to note, however, that disclosure consent pursuant to a criminal proceeding cannot be revoked by the patient, especially if the agreement to voluntarily enter treatment has resulted in more favorable treatment for the patient in the criminal case. Further, federal regulations require that certain factors be considered before a particular expiration date or condition is set for a criminal justice consent, including the anticipated length of treatment, type of judicial proceeding, need for treatment information during the proceeding, and anticipated date of final case disposition. By following these guidelines, drug rehab treatment programs can opt to use an expiration condition that reflects a substantial change in the defendant’s criminal case status. For instance, when a patient is on probation there would only be a substantial change in status only when the probation ends or is revoked. Setting this type of expiration condition allows program staff to disclose information to the probation officer throughout the period of probation.

When a patient in a drug rehab treatment program is a minor, the facility cannot provide private information to parents unless the minor consents to the disclosure in writing. If the minor refuses to consent to disclosure of information to the parents, the program cannot reveal any information, even if only to confirm that the minor is still receiving treatment.

An exemption does exist, however, if the minor seeks drug rehab treatment in one of the several states that requires parental consent for treatment. In that situation, the program can contact the parents without consent if the program believes that the child lacks the capacity to decide rationally about parental consent or if the program believes that there is an immediate threat to the well-being of the patient or somebody else. If neither of these two exceptions exists, a program in a parental consent state must explain to the minor that no drug rehab treatment can be given without parental consent. Even in states where parental consent for treatment is not required, a program might be able to insist on consent to communicate with parents if necessary to ensure payment for services and might be permitted to refuse to treat any minor who does not freely give the consent.

Like practitioners in other mental health fields, addiction professionals may have a duty to warn of a patient’s threat to harm herself or others. This would include a patient who intends to drive while impaired. Many practitioners feel that it is their moral, professional or ethical duty to stop a crime from happening when they can, especially if the crime would be serious.

Some states already require mental health professionals to take reasonable steps to protect the intended victim, if the professional believes that the patient poses a serious threat. For instance, in Tarasoff v. Regents, the California Supreme Court found a counselor liable to a woman’s estate for monetary damages because he did not warn the woman that his patient intended to kill her. Thus, in California, if a mental health professional knows his patient poses a threat of harm to a particular person, the professional has a duty to warn.

When a particular program is faced with a potential duty-to-warn situation, clinicians must first determine whether a duty to warn exists under current state law and, if no such law exists, do they feel a moral obligation to do so regardless?

However, does the duty to warn, either under state law or moral conscious, violate federal confidentiality regulations? In some situations, the answer is “yes”. Federal confidentiality laws prohibit these particular disclosures unless they meet one of the few exceptions. First, the drug rehab treatment program is permitted to seek a court order authorizing disclosure of the information. Second, the program can disclose the threat if it can do so without disclosing that the potential bad actor is a patient in a drug rehab treatment facility. This usually requires the threat to be disclosed anonymously. The final exception allows program staff to report the threat to medical personnel if there is an immediate threat to the health of someone that will require medical intervention. If a drug rehab treatment program is faced with a situation that does not meet one of the exceptions, it may elect to make the disclosure and face the consequences.