Medical Confidentiality: Off-Duty Threats

I received an interesting question – for today’s burning question:  If an EMS crew is called to the home of an off-duty firefighter and she is drunk, suicidal and threatening to harm her husband, can the crew inform a supervisor? If she goes so far as to threaten the crew, can the crew disclose the threat to the police and a  supervisor?

Answer: wow… you guys are killing me.  The obvious issue that arises in this situation is that of medical confidentiality. There may also be a duty to report law for domestic abuse that may be triggered – based on state law.

Both HIPAA and state medical confidentiality laws apply to information that is exchanged between a provider and patient during the course of medical care and treatment. But not every piece of information that is exchanged between a provider and  a patient is confidential. As I watch the World Series – an example came to me:  if a medic asks a patient during the course of treatment for the score in the game, the answer is not confidential. It has nothing to do with medical treatment.

The problem is…. if a medic asks a patient a simple question such as what day is it…. for the purpose of assessing the patient’s orientation – the fact the patient knew (or did not know) the answer would be protected.

The observation of a patient’s overt behavior can be considered to be protected information, particularly when the behavior is embarrassing (loss of bladder control, bowel movement, etc.). When it comes to the observation of a patient making threats toward third parties, an argument can be made that the threats have nothing to do with medical treatment and thus are not protected. The argument can also be made that the medics have a “qualified privilege” to report their observations to law enforcement and their superiors that supersedes any rights to confidentiality the patient may otherwise have.

What makes this a VERY VERY close call… is that the patient’s behavior – including the threats – can be characterized as symptoms of  underlying psychotic issues.

On balance, I would think the medics would have a qualified privilege to inform the police and their supervisors. It would be a very narrow privilege – because certainly if one of the medics discussed what happened publically or on Facebook it would violate confidentiality.

I would also reach out to the other fire lawyers out there for their considered opinion.