Medical Confidentiality: Breach Of Confidence Was Not Proximate Cause Of Damages

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Medical Confidentiality: Breach Of Confidence Was Not Proximate Cause Of Damages

Legal Eagle Eye Newsletter for the Nursing Profession

Quick Summary: The hospital's breach of confidence was wrong but it was not what sunk his career. The patient had to reveal his suicide attempt on his application for admission to the academy.

As with all wrongful conduct for which civil damages are sought, a breach of professional confidence must be a "proximate" cause of the victim’s damages. The applicant had to disclose the matter himself, and would have been refused admission. MICHIGAN COURT OF APPEALS, 1995.

A young man was taken to the emergency room for an apparent suicide attempt and then admitted to the psychiatric unit of the hospital. He was a senior in high school, who had already been selected for admission to the United States Air Force Academy. The suicide incident was apparently sparked by a rebuff from a young woman whom the young man considered his steady companion, who wished to see other people. When he arrived at school with a gun, threatening to harm himself, the young woman informed the principal. They then created a diversion to occupy his attention until the police arrived and took him to the hospital. He consented to a voluntary psychiatric admission.

His admitting history included his plans to enroll in the Air Force Academy. The hospital staff, upon learning of his plans, took it upon themselves to determine it was appropriate and necessary to inform the Air Force of this young man’s apparent suicide attempt. A complicated series of events ensued, which culminated in revocation of his admission to the Academy.

The young man filed suit. The suit in Circuit Court in Monroe County, Michigan resulted in a substantial verdict for breach of medical confidentiality against the individual who had phoned the Air Force with information concerning the suicide attempt. It was also determined in court that the hospital had committed breach of contract by failing to keep the patient’s condition in confidence.

The court looked to the state law which set out the rights of patients receiving health care. The law specifically required the hospital to adopt a policy describing the rights and responsibilities of patients and to treat patients in accord with that policy. Included in this policy is the patient’s right to confidential treatment of personal and medical records.

In addition, according to the court, the hospital was required by state law to maintain as confidential information acquired in the course of providing the patient with mental health treatment services.

The person who made contact with the Air Force to report the patient’s apparent suicide attempt claimed she was acting as the patient’s agent in doing so, and thus was not liable to the patient for breach of medical confidentiality. The court rejected this argument, in that there was no showing that the patient had ever extended any authority, expressed or implied, to his treatment team to report his mental health status to outside parties. Nor was there any proof that the hospital had extended any such authority to the individual. Absent an express grant of authority by the patient to reveal confidential information to outside parties, no such authority exists. The subjective belief by the party who reveals a patient’s confidential medical status without the patient’s authority, that such action is appropriate, is irrelevant.

The upshot of the case was that the Court of Appeals would throw out the verdict The court decided that the Air Force would have learned of the incident in some manner at some point. Thus the breach of confidentiality could not have been the actual legal cause of damage to the patient’s career prospects, as such damage was inevitable even without the actions of the hospital and its staff, according to the court. Alar vs. Hospital, 529 N.W. 2d 318 (Mich. App., 1995).