Q. One of my patients has died, and suicide is strongly suspected. I
have received verbal requests for information from family members, the medical
examiner, and a police detective. I know that confidentiality survives the
death of the patient, but I am having difficulty deciding what kind of
information I may divulge and to whom.
A. You are correct that patient confidentiality does indeed survive
death, and physicians are often torn between the legal and ethical duties to
protect information and the desire to be of assistance to grieving family
members and other entities like the coroner and the police. Fortunately, there
are some well-established, practical steps that physicians can take to make
this process more manageable.
In most states, it is the personal representative or the executor of the
estate who can authorize the release of medical records. That individual
should complete and sign an acceptable written authorization in his or her
capacity as personal representative or executor and provide official
documentation confirming his or her status.
The statutes vary from state to state in regard to releasing information to
the medical examiner or coroner. For example, some states require subpoenas,
while others allow a mere written request stating the applicable authorizing
statute. In any case, the request should be put in writing.
The same holds true for the police. It is not uncommon for law enforcement
officers to represent that their investigation requires the physician's urgent
response. The unhappy reality, however, is that there is no urgency if the
patient has already died. The appropriate response is to have the requesting
officer or investigator put his or her request in writing and cite his or her
authority to access the requested information (usually a statute or
Once a written request is received from a personal representative, a
medical examiner, or a law enforcement officer, Psychiatrists' Program
participants may want to contact the Risk Management Consultation Service
(RMCS) helpline for assistance with evaluating and responding to the request.
The RMCS is available between 8:30 a.m. and 5:30 p.m. ET Monday through Friday
at (800) 245-3333, option 2. Nonparticipants may want to contact their risk
manager or personal counsel for guidance.
Q. I have a psychiatric group practice that consists of 10 psychiatrists
and two nurse practitioners. I would like to know if you offer group coverage
for such a practice.
A. Yes. The Psychiatrists' Program offers professional liability
insurance coverage for multidisciplinary behavioral health care groups. All
practitioners—psychiatrists, psychologists, social workers, and other
behavioral health care providers practicing in a group—can be covered
under one policy, along with the group practice itself. All of the benefits
and features of the individual insurance program are available to members of
the group, including access to the toll-free Risk Management Consultation
Service. Furthermore, Groups may be eligible for up to an additional 5 percent
discount. Additional details about the group program are posted at<www.psychprogram.com/groups>.
For more information, please call (800) 245-3333, ext. 314, or e-mail
Q. I am a risk manager working at a psychiatric hospital and am looking
for risk management articles concerning the release of patient information. Do
you have materials that can assist me?
A. PRMS monographs are available on a variety of topics and are
designed specifically for anyone in the practice of behavioral health care:
psychiatrists, psychologists, nurse practitioners, social workers, and office
managers. In these materials, PRMS maps strategies and offers guidelines that
can be applied to your practice. All monographs are provided in a convenient
and easy-to-use CD-ROM format and can be purchased at<www.prms.com/store>.
Participants in the Psychiatrists' Program can access a library of
complimentary risk management tips and information in the online education
center by visiting the "For Participants Only" section at<www.psychprogram.com>.
For a nominal fee, participants can also purchase additional resources like
subject specific monographs on CD-ROMs and seminar material from past risk
This column is provided by PRMS, manager of the Psychiatrists'
Program, for the benefit of APA members. More information about the Program
can be obtained online at<www.psychprogram.com>;
by phone at (800) 245-3333, ext. 389; or by e-mail at