family? The HIPAA Privacy Rule permits a health care provider to disclose information to the family members of an adult patient who has capacity and indicates that he or she does not want the disclosure made, only to the extent that the provider perceives a serious and imminent threat to the health or safety of the patient or others and the family members are able to lessen the threat. 7. Does HIPAA permit a doctor to contact a patient’s family or law enforcement if the doctor believes that the patient might hurt herself or someone else? Yes. Specifically, when a health care provider believes in good faith that such a warning is necessary to prevent or lessen a serious and imminent threat to the health or safety of the patient or others, the Privacy Rule allows the provider, consistent with applicable law and standards of ethical conduct, to alert those persons whom the provider believes are reasonably able to prevent or lessen the threat. These provisions may be found in the Privacy Rule at 45 CFR § 164.512(j). 8. Does having a health care power of attorney (POA) allow access to the patient’s medical and mental health records under HIPAA? Generally, yes. If a health care power of attorney is currently in effect, the named person would be the patient’s personal representative. “Personal representatives,” as defined by HIPAA, are those persons who have authority, under applicable law, to make health care decisions for a patient. 9. What constitutes a “serious and imminent” threat that would permit a health care provider to disclose PHI without the patient’s authorization or permission? HIPAA expressly defers to the professional judgment of health professionals in making determinations about the nature and severity of the threat to health or safety posed by a patient. Health care providers may disclose the necessary protected health information to anyone who is able to prevent or lessen the threatened harm, including family, friends, caregivers, and law enforcement, without a patient’s permission. 10. If an adult patient who may pose a danger to self, stops coming to psychotherapy sessions and does not respond to attempts to make contact, does HIPAA permit the therapist to contact a family member to check on the patient’s well-being even if the patient has told the Discussion The Texas Administrative Code 681.45, Subchapter B (Tex. reg, 2020b) references six different sections of the TAC related to confidentiality and required reporting. This section combines two important components, confidentiality and duty to report, into one subchapter, and it includes references from the Texas Family Code, Texas Occupational Code, Texas Health and Safety Code, Texas Behavioral Executive Council, Texas Civil Practice and Remedies Code, and Texas Human Resource code. The TAC sections are interrelated, and one informs the other as they outline what information is to be held confidential and define exceptions for disclosure when necessary for the administration of justice. Remember that the Texas statutes in the TAC are compiled by the TBHEC and presented in consolidated rulebooks for professional counseling and marriage and family therapy available for download in PDF format (TBHEC, 2023). The summaries in the previous section are provided for all the regulations mentioned in the TAC Rule 681.41 subchapter B (Tex.reg, 2021), but each chapter and referenced sections should be reviewed in their entirety. The practice of counseling is as diverse as the clients it
therapist that they do not want information shared with that person? Yes, under two possible circumstances: 1. Given that the patient is no longer present, if the therapist determines, based on professional judgment, that there may be an emergency and that contacting the family member of the absent patient is in the patient’s best interests; or 2. If the disclosure is needed to lessen a serious and imminent threat and the family member can avert or lessen the threat. *According to the Texas Health and Safety Code §611.004(Texas.gov,2021): A mental health professional may disclose information only to medical or law enforcement personnel if the professional determines that there is a probability of imminent physical injury by the patient to the patient or others or there is a probability of immediate mental or emotional injury to the patient. ** According to the Texas the Family Code the child is a minor until the age of 18 and would need the consent of a parent or guardian to receive counseling except in the following cases: 1. Texas Family Code Chapter 32(Texas.gov., 2015) Section 32.003 allows counseling without consent for individuals under 18: ● on active duty in the arm forces ● 16 years of age, emancipated, living apart from parents, guardians, or conservators, or financially independent. ● unmarried and pregnant and consents to treatment, other than abortion, or unmarried, parent of a child with actual custody ● confined in a facility operated by the Texas Department of Criminal Justice 2. Texas Family Code Section 32.004 allow persons under 18 to consent to counseling if they: ● are considering suicide. ● have drug or alcohol addiction or other chemical dependency issues. ● have been sexually, physically, or emotionally abused. The subchapter also requires information concerning any legal or disciplinary actions against a mental health care professional that must be disclosed. Failure to report this information may result in added sanctions or license revocation. serves, so some sections referenced in this TAC chapter apply to specialized practice. For example, certain sections contain specific regulations applicable to children, clients with physical or mental challenges, clients in hospital settings, those with competency issues requiring personal representatives, or counselling of couples or groups. Confidentiality and required reporting regulations are necessary for ethical practice regardless of the specialty area, but it is critical to revisit specific sections for in-depth study as applicable. Consent for treatment by a minor is discussed in Texas law that allows minors to receive counseling services in cases of chemical dependency or addiction, suicide prevention, and physical, emotional, or sexual abuse without parental consent. At the age of 16, a child may request inpatient or outpatient services without the consent of a parent or guardian and may provide a written form of consent for services. Children in foster care over the age of 16 may be allowed to give consent for healthcare services if they have been deemed to have the capacity to give consent by the court. In all cases, a child 16 or older is not allowed to consent to an abortion.
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Book Code: PCTX1325
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