When does HIPAA allow a hospital to notify an individual’s family, friends, or caregivers that a patient who has been hospitalized for a psychiatric hold has been admitted or discharged?
Hospitals may notify family, friends, or caregivers of a patient in several circumstances:
- When the patient has a personal representative
A hospital may notify a patient’s personal representative about their admission or discharge and share other PHI with the personal representative without limitation. However, a hospital is permitted to refuse to treat a person as a personal representative if there are safety concerns associated with providing the information to the person, or if a health care professional determines that disclosure is not in the patient’s best interest.
- When the patient agrees or does not object to family involvement
A hospital may notify a patient’s family, friends, or caregivers if the patient agrees, or doesn’t object, or if a health care professional is able to infer from the surrounding circumstances, using professional judgment that the patient does not object. This includes when a patient’s family, friends, or caregivers have been involved in the patient’s health care in the past, and the individual did not object.
- When the patient becomes unable to agree or object and there has already been family involvement
When a patient is not present or cannot agree or object because of some incapacity or emergency, a health care provider may share relevant information about the patient with family, friends, or others involved in the patient’s care or payment for care if the health care provider determines, based on professional judgment, that doing so is in the best interest of the patient.
For example, a psychiatric hospital may determine that it is in the best interests of an incapacitated patient to initially notify a member of their household, such as a parent, roommate, sibling, partner, or spouse, and inform them about the patient’s location and general condition. This may include, for example, notifying a patient’s spouse that the patient has been admitted to the hospital.
If the health care provider determines that it is in the patient’s interest, the provider may share additional information that is directly related to the family member’s or friend’s involvement with the patient’s care or payment for care, after they clarify the person’s level of involvement. For example, a nurse treating a patient may determine that it is in the patient’s best interest to discuss with the patient’s adult child, who is the patient’s primary caregiver, the medications found in a patient’s backpack and ask about any other medications the patient may have at home.
Decision-making incapacity may be temporary or long-term. Upon a patient’s regaining decision-making capacity, health providers should offer the patient the opportunity to agree or object to sharing their health information with involved family, friends, or caregivers.
- When notification is needed to lessen a serious and imminent threat of harm to the health or safety of the patient or others
A hospital may disclose the necessary protected health information to anyone who is in a position to prevent or lessen the threatened harm, including family, friends, and caregivers, without a patient’s agreement. 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. For example, a health care provider may determine that a patient experiencing a mental health crisis has ingested an unidentified substance and that the provider needs to contact the patient’s roommate to help identify the substance and provide the proper treatment, or the patient may have made a credible threat to harm a family member, who needs to be notified so he or she can take steps to avoid harm. OCR would not second guess a health care professional’s judgment in determining that a patient presents a serious and imminent threat to their own, or others’, health or safety.