Serving Chiropractors and Their Patients

Addressing Patient Threats of Injury or Violence

Particularly at this time of tragic school shootings and heightened sensitivity for public safety,  chiropractors are interested in properly responding to patients who threaten injury to themselves or others.  There is currently no express legal duty on the part of chiropractors to report these patients to law enforcement or others.  Unfortunately, there is also very little other directive for the Wisconsin chiropractor on how to handle these situations.  This article offers some practical suggestions on how to deal  with this critical situation.

The doctor needs to initially take into consideration the important principal of patient confidentiality when facing this situation.  Chapter 6 of the Administrative code describes standards of professional conduct and notes in CHIR 6.02(10) that a doctor cannot reveal confidential patient information without the consent of the patient, EXCEPT  to address a Board investigation or “as otherwise authorized by law”.  Initially, a doctor should reveal all important  information to the parent of a minor or the guardian of an incompetent person.  Otherwise, a doctor could attempt to obtain a written authorization for the release of this information directly from the patient, but concerns should always remain as to whether the patient is mentally competent to freely and knowingly provide this authorization.

If the option of obtaining an authorization for release of information is not possible, doctors can obtain guidance from another section of the administrative code and  from another profession which places a priority on confidentiality – lawyers.  As it relates to the code, CHIR 6.02(26) goes onto state that a doctor cannot aid or abet “the violation of any law substantially related to the practice of chiropractic.”  Certainly, doctors do not want to face the potential monetary liability for  injury resulting to others; let alone the personal and professional humiliation of failing to protect the public.  With this in mind,  lawyers have adopted Rules of Professional Conduct which permits a lawyer to disclose confidential  information of potential criminal or fraudulent acts which the lawyer “reasonably believes is likely” to result in death or substantial bodily harm to another. Lawyers are encouraged to release “hypothetical” information about the situation, if possible, so as to minimize the likelihood that the clients identity can be determined.

With these additional considerations, a doctor should consider confidentially referring the patient who threatens themselves  with injury  to a competent mental health care provider.  When doing so, the doctor should avoid placing the facts of the referral in the patient’s main file since this type of information has little to do with the patients treatment plan and could have serious, detrimental financial consequences if revealed to certain parties, such as health and life insurance companies. Additionally, when the doctor  believes that the patient presents a reasonable likelihood of injury to others, he/she should carefully reveal appropriate information to law enforcement officials.  The doctor should also act with a sense of urgency in notifying any specific individuals who were directly threatened by the patient.  Again, doctors may wish to document the reasons for this action in a separate file or discuss matters in confidence with their office staff.  Overall, there should be little  concern for the appropriateness of the doctors conduct in these types of situations provided that these types of reasonable steps are taken to protect the well being of the patient and the public.