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Saturday, January 7, 2012

Ask the Ethics Committee: Releasing Third Party Reports

Dear Ethics Committee:

I have a question about the release of third party records.  I understood that we are NOT to release records from third parties that we have in our charts (e.g., from other medical providers).

A colleague recently told me that this has changed.  If 3rd-party information is in our charts, then the expectation is to release it when asked for records.

Can the committee offer some guidance on this?

Thank you.

Ethics Committee Response:

There is no absolute prohibition against sending records received from third parties in response to a signed patient release. However, this may not be a good practice.  In many cases, the psychologist cannot ensure that the third party records are the most recent or the most comprehensive set of records available.

For example, a psychologist receives a release of information from a patient that graduated from therapy about one year ago.  The release specifies that the psychologist send “all records.”  In file, there is a report from a physician in file that is now five years old. By sending the old report from the physician, the psychologist may be doing a disservice because the psychologist does not know if the patient has had more recent contact with the physician.  Additionally, the psychologist cannot be sure if the physician's report is now inaccurate or misleading.

Therefore, we suggest that it is preferable to have the patient get the information directly from the third party.

There are certain situations in which good clinical and ethical judgment may indicate a different course.  As stated above, there is no rule that prohibits a psychologist from sending out information generated from third parties, if legally compelled or clinically indicated.

For example, a psychologist receives a copy of a psychiatric evaluation in file from the outpatient clinic of a psychiatric hospital that had closed several years ago. The former patient is now working with a different psychiatrist.  An appropriately signed release asks for “all records” to be sent to the current treating psychiatrist.  In this situation, the patient’s current treatment may be enhanced with this longitudinal data.

In another situation, a former patient, who is applying for Social Security Disability, requests that “all records” be sent to a State Agency.  In file, there are old reports from several inpatient psychiatric interventions.  Instead of sending a seriously mentally ill, and perhaps disabled, patient on a long and potentially futile effort to find out what happened to those old records, the patient may benefit from releasing those older records directly to that State Agency so that the most accurate decision can be made.

In forensic cases, it is sometimes expected that psychologists will send information gained from third parties, especially if it was used as a basis to formulate their opinions.

There may be other situations where it is legally or clinically indicated to send out records from third parties that psychologists have in their charts. The examples provided are not meant to be exhaustive.

However, as noted above, it is usually better for patient records to come directly from the original source.

Thoughts and comments about this response are welcome.