Regulation and Law

Duty to Protect and Warn Laws

Duty to warn gives doctors, counselors and therapists the right and obligation to breach confidentiality if they believe a client poses a risk to another person.

Regulation

Regulrement To Report

Example: Wisconsin.51.17, Stats Warning of dangerousness. “(a) Any heal”. care provider that reasonably believes and individual has a substantial probability of harm to himself or herself or to another person…

  1. Contacting a law enforcement officer regarding the individual and disclosing knowledge ofpotential evidence of a substantial probability of harm…
  2. Contacting the country department that the health care provider  reasonably believes is responsible for approving the need for emergency detention of the individual

Which Staff have the Duty?

Healthcare Providers, Mental Health Professionals including General Physicians. MD’s. Psychsatnsts. Psychologists, Psychotherapists. Nurses, Social Workers, Marriage Counselors. data colectors, employees under supervision. and their secretaries, clerks. and stenographers.

This information does not constitute legal advice and should not be relied upon as a substitute for seeking legal counsel.

Patient Case

“this is an emergency, hang up and call 911”

Our primary care telehealth practice has been seeing a patient for the past year.  Late January she told her psychiatrist over telehealth she was going to kill herself.  The psychiatrist said this was an emergency and told the patient to “hang up and call 911” to receive in-patient care. They hung up and the patient did not call 911. A few days later she called her psychologist, said she was going to kill herself by taking pills, and again was told to “hang up and call 911.”   The patient hung up.  The patient didn’t call.

On Tuesday afternoon the next week, she took a whole bottle of hydroxyzine pills and OTC pills. A few minutes later she called our telehealth practice in Little Falls, NJ and told us she had “done something stupid.”  She is normally in Bergen county but this week she was in Toms River many hours south.  We have emergency telehealth protocols and were able to activate 911 in Toms River.  She became altered to the point she could not open the front door, so our providers coordinated with police and EMS to enter and identify the pills.  She made it to the emergency department and survived.

The psychologist and psychiatrist had no idea what happened until we called them a few days later.  The psychiatrist does not track how many patients she asks to go to the ER or call 911 and does not follow up to find out what happened.

Hand-Off Requirements

Requirements

Joint Commission recommends all hand-off procedures to have both written and verbal components for the critical hand-off information.

“2. Standardize critical content to be communicated by the sender during a handoff – both verbally (preferably face to face) and in written form. Make sure to cover everything needed to safely care for the patient in a timely fashion.
Standardize tools and methods (forms, templates, checklists, protocols, mnemonics, etc.) to communicate to receivers.”

Real Life Example

67 Lincoln Street vs 67 Lincoln Park

A 911 call was placed multiple times and the address was verbally stated and misinterpreted as street vs park. First responders showed up to the wrong address, no one was there, and they left as per standard EMS protocol. On the fifth try they realized they were going to the wrong address.

If a doctor or clinic calls 911 or the police administrative number, the doctor’s address shows up on the dispatch screens, not the patient’s address. If the doctor fails to explain that the address in the system is not the correct address, or the 911
dispatcher fails to further inform first responders that the forwarded address is not the correct address, first responders will go to the wrong address, not find any one, and leave. If the doctor does not follow up, no one will ever show up.

Sentinel Event Alert 58: Inadequate hand-off communication

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Homeless woman says plowed snow trapped her in van for 5 days, report says

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This information does not constitute legal advice and should not be relied upon as a substitute for

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