1. Salladay, Susan A. RN, PhD

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Recently, a 22-year-old man with paranoid schizophrenia was admitted to the mental health unit where I work. He was too ill to consent to or refuse the release of information to his family. When he needed to be restrained for his safety, the nurses wanted to contact his family, per hospital policy. But his physician refused, saying that the patient hadn't given permission for us to notify his family. Fortunately, he rapidly improved with treatment and was released within a week.

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Now his family is threatening to sue the hospital and staff for failing to notify them about their son's condition. My manager says the hospital is legally protected by the privacy provisions in the Health Insurance Portability and Accountability Act (HIPAA). Putting myself in the parents' shoes, I wonder about the ethics of withholding information in this case. What's your opinion?- H.F., TEX.


I think this is an example of well-meaning caregivers overzealously guarding patient privacy based on a misunderstanding of HIPAA provisions. Under HIPAA, facilities are required to have written privacy procedures, educate employees about them, and designate an individual to oversee compliance. The hospital's legal counsel and risk manager need to be involved in preparing policies and procedures and educating staff in accordance with HIPAA guidelines.


In general, HIPAA allows health care providers to share information with those who have a need to know unless the patient objects. The law isn't intended to isolate patients from their families, and it expects professional caregivers to exercise good judgment when a patient is incapacitated. This and other issues are addressed on the U.S. Department of Health and Human Services Web site, which states that even when it's "impractical because of an emergency or incapacity to ask the patient about notifying someone, a covered entity [a hospital or health care provider] can still notify family[horizontal ellipsis]when in exercising professional judgment, it determines that doing so would be in the best interest of the patient. See 45CFR 164.510(b)." For more information, visit


Another issue to consider is the relationship between patient confidentiality and informed consent. When this patient came to your facility, who signed the consent form approving his treatment? Under the circumstances you describe, I suspect that a signature was "deferred." Typically, consent is obtained as soon as possible from next-of-kin or a legal guardian when a patient can't speak for himself. The person asked to give consent must be fully informed of the risks, benefits, and alternatives to treatment (just as the patient would be), so this is a good time to bring the family into the treatment process.