A young woman, who states she has just been raped, comes into the emergency room requesting a pelvic examination and a morning-after pill, but she insists that the staff not call the police. The staff reports the incident.
The aforementioned scenario provides grounds for both ethical and legal debate. The description of the scenario does not completely fulfill the necessary information in order to make a definite ethical response. For instance, the woman’s age is not included; a ‘young woman’ may be 17 by some standards or may be 27 in others’ standards. The matter of specific age is of significance as the mandatory reporting for minors may differ from the mandatory reporting for competent adults. Additionally, the woman’s state of mind is not included. She may be of legal age yet may be considered a vulnerable adult due to extraneous conditions. In the event that the woman is legally considered a vulnerable adult, the emergency room staff may have greater ethical and legal obligations to report the rape to authorities.
If the woman is a competent, independent adult, there remain variations within state law that may or may not indicate the necessity of report (Scalzo, 2007). Also, there may be contributing factors, such as additional injuries caused by dangerous weapons that may affect the requirements that the hospital operates under (Scalzo, 2007). These must all be considered in order to appropriately address whether the hospital staff acted in an ethical fashion or not. While the staff has an ethical obligation to obey the autonomy of a competent adult, they must also obey, and submit to through the obligation garnered from their right to practice, the laws and regulations governing the area in which they provide care. Failure to do so may result in civil or criminal sanctions. The appropriateness of the disclosure is dependent on the state laws governing disclosure of such incidents; legally required disclosures do not constitute illegal or unethical disclosures; however legally required disclosures that are omitted constitute a breach of legal obligation and may result in the denial of the right to practice within the state.
A young woman brings her child into the emergency room for an arm injury. The family has brought the child in several times as of late for similar injuries with the excuse that the child is somewhat clumsy and is having difficulty learning to ride her bike. The child shows no fear of the parent, and upon questioning, she confirms the parent’s version of the events. The staff reports the injury as a possible child abuse case.
In this scenario, the greatest obligation is the safety of the patient; i.e., the child. While the abuse is not an obvious, definite case, the suspected abuse must be reported by law. State penal codes require that those who are mandatory reporters; physicians, child care providers and other as defined by law, must, when within the scope of his or her employment have reason to suspect child abuse, report thereof to a child protection agency (Stanford University Hospital, n.d.). In the aforementioned scenario, the suspected abuse should be reported as mandated by law, even in the event that the child is not fearful. Child protective services may further investigate the situation and disprove the provider’s concern; however an overly cautious report is of a lesser concern than the possibility of inadvertently dismissing a true child abuse case.
You are a medical records technician and are in the department when two men come in and flash badges indicating that they are from the FBI and need to see the Hiram Jones record as a matter of national security. You cooperate and allow them access to the files.
This scenario offers debate as to whether or not information may be disclosed to federal officials without a warrant. HIPAA allows for law enforcement to collect identifying health information without a warrant if the information is necessary to identify or locate a suspect (ACLU, 2003). “A covered entity may disclose protected health information to authorized federal officials for the conduct of lawful intelligence, counterintelligence, and other national security activities authorized by the National Security Act (50 U.S.C. 401, et seq.) and implementing authority” (Gostin, 2002, p. 9). In this event, pursuant 45 CFR 164.512, the disclosure of identifying health data: including a physical description, name and address, date and place of birth, social security number, and blood type (Gostin, 2002). This scenario does not specify whether the FBI agents supplied a warrant, so the amount of disclosure is subject to reconsideration. However, this law has not yet been tested in the courts and is still subject to interpretation until precedent is set (ACLU, 2003).
In each of these scenarios, it is important to gather additional information in order to make an appropriate legal and ethical judgment in the context of the state and federal laws regulating the practices of the healthcare organization.
American Civil Liberties Union (ACLU). (2003). FAQ on government access to medical records. Retrieved 27 November 2009 from http://www.aclu.org/technology-and-liberty/faq-government-access-medical-records.
Fremgen, B. (2009). Medical law and ethics (3rd ed.). Upper Saddle River, NJ: Prentice Hall Health.
Gostin, L. (2002). Public health law and ethics: a reader. Retrieved 27 November 2009 from http://www.publichealthlaw.net/Reader/docs/HIPAA.pdf.
Rodriguez, R., Ph.D. (2009, November 24). Chat posting. Retrieved from AIU Online Virtual Campus. Chat 1 week 3. The ethical and legal aspects of healthcare: HCM410-0904B-02 website.
Scalzo, T. (2007). Rape and sexual assault reporting requirements for competent adult victims. Retrieved 27 November 2009 from http://www.sapr.mil/contents/references/lawsummary.pdf.
Stanford University Hospital. (n.d.). Guidelines for managing child abuse and neglect cases at Stanford University Hospital. Retrieved 27 November 2009 from http://med.stanford.edu/gme/incoming_residents/documents/childAbuseReportingRequirements.pdf.