Q&A: Protecting patient privacy vs. a mandatory duty to warn

Q: I know that there is a mandatory duty to report abuse, neglect, and exploitation to law enforcement, but where is line between protecting patient privacy and a case manager's duty to warn when a patient is in danger of harming themselves? 

A: HIPAA was never intended to prevent professionals from disclosing pertinent information about a client to law enforcement, family members of the client, or others if there is a belief that the client presents a serious danger to himself or other individuals. However, this fact continues to pose confusion for the interprofessional workforce. Most, if not all, case managers are aware of their mandated duty to report child and adult abuse, neglect, and/or exploitation to law enforcement or appropriate authorities. However, the mandated duty to warn for those in danger of harming themselves or others is different. The concept refers to how clients communicate an explicit threat of imminent serious physical harm or death to a clearly identified or identifiable victim or victims, with the client having the intent and ability to carry out the threat (National Conference of State Legislatures, 2018). This area is a complex and often confusing concept for many case managers.

Case managers are challenged by inconsistent mandatory duty-to-warn legislation across different states. Some states have mandatory laws (you must report), wheras others have permissive laws (you can report but don’t have to). The laws of several states apply to particular professional disciplines or groups only (e.g., mental health practitioners, psychiatrists). A current table of regulations by state appears on the National Conference of State Legislatures website, listed in the chapter resource list.

Food for thought: Case managers who reside in states with either permissive or no mandatory duty-to-warn legislation often defer to the language of their professional standards, which all speak to a primary responsibility to protect clients, patients, members, consumers, and the public.

For more information, see The Essential Guide to Interprofessional Ethics in Healthcare Case Management . Need expert advice? Email your questions for consideration in the Revenue Cycle Daily Advisor. Note: We do not guarantee that all questions will be answered.