Psychiatric News June 6, 2003
Volume 38 Number 11
© 2003 American Psychiatric Association
p. 42
Confidentiality in Emergencies
Q. I recently received a call from an ER physician who was assessing a patient of mine who was having a medical crisis. The physician requested information about my patient and demanded an immediate response. I was reluctant to disclose any information, as it is my understanding that I would need a release from the patient or the patient’s representative to do so. Is this true?
A. Most, if not all, jurisdictions include either an exception to the statutory requirements of confidentiality or an immunity from liability for the release of relevant clinical information to another health care professional for the purposes of providing necessary emergency care for a patient, even when the patient has not authorized such a disclosure.
You should disclose any information that would assist the ER physician with preventing serious imminent harm to your patient or assessing the patient’s condition. This may include information about current and former medications (regardless of whether you prescribed the medication), allergies, lab work, vital signs, or the patient’s state of mind. When disclosing information, stay attuned to the issue of confidentiality and release only the information that is necessary. For example, information about a patient’s ongoing affair would probably not be considered pertinent in the above situation. In addition, information should not be shared with other, nontreating individuals, such as a spouse or parents. They may believe that they have a right or a need to know, but without proper authorization, you are prohibited from disclosing confidential information to them.
Q. What is "vicarious liability coverage," and why would I need it?
A. Vicarious liability coverage is an optional insurance coverage available to participants in the Psychiatrists’ Program (the Program), the APA-endorsed Psychiatrists’ Professional Liability Insurance Program. It is advisable for any participant who is incorporated or is a member of a partnership or employs or contracts with other health care providers such as psychologists, social workers, other physicians, etc., to obtain such additional coverage.
This coverage serves to protect you against negligence committed by your employee or contractor that may be imputed to you because of your legal classification as "employer." Health care employees or contractors of Program participants still need their own medical malpractice insurance because vicarious liability coverage offers them no protection.
This coverage is written as an endorsement to your individual coverage either as a combined single limit or as a separate limit of liability.
Q. I am purchasing medical malpractice insurance for the first time and am unsure of what information I should consider in the decision. Does the Program offer any educational materials that would assist me in this area?
A. The Program has developed an online presentation titled "Insurance 101" to help doctors in the purchase of a new policy. This multimedia presentation presents concepts such as the difference between claims-made and occurrence coverage, the "hammer clause," aggregate limits, and more. Just visit the Online Education Center at www.psychprogram.com.
Additionally, the Program has developed a comprehensive checklist, "Before You Sign," that presents key features and benefits to consider when choosing a medical malpractice insurance policy. After reviewing this checklist, you may be surprised to find that not all policies offer the comprehensive protection you need in today’s mental health care environment. To request your complimentary copy of "Before You Sign," please call (800) 245-3333, ext. 389, or e-mail TheProgram{at}prms.com.
This column is provided by PRMS, manager of the Psychiatrists’ Program, for the benefit of members. More information is available by visting the Program’s Web site at www.psychprogram.com; calling (800) 245-3333, ext. 389; or sending an e-mail to TheProgram{at}prms.com. 
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