The aftermath of tragedy

When a patient becomes the perpetrator or the victim of murder, it is shocking and stressful for everyone involved.
 
A recent homicide case in Victoria highlights the need for the police and the courts to establish whether the perpetrator is clinically or mentally fit to instruct lawyers and stand trial.
 
Criminal investigations can be time-sensitive, so doctors and practice staff should be aware of the rights and responsibilities of the police before releasing the personal health information of patients involved in a serious crime.
 
Case study
Liz and John Allen were a loving elderly couple who had been patients of the practice for more than 30 years.
 
John had recently been diagnosed with terminal bowel cancer and opted for palliative treatment only. Liz was diagnosed with dementia three years prior, and John voiced his concerns about what might happen to Liz when he was gone.

Their only son, Bryce, lived in London and they had no other family in Australia.
 
Too close to home
Dr Jackson was watching the late news when he saw a breaking story about an attempted murder–suicide. He put it out of his mind until his practice manager came into his consulting room early the next morning.

‘Two detectives from Major Crimes are waiting in reception,’ the practice manager said. ‘They have demanded a copy of Liz and John Allen’s medical records. They say John murdered his wife, and he is in a coma following an overdose.
 
‘What should I do?’
 
Dr Jackson asked the practice manager if the police had produced any paperwork.
 
‘No,’ the practice manager said. ‘They just said it was urgent and to hand the notes over immediately.’
 
Dr Jackson advised the practice manager to do nothing until he sought advice.
 
When in doubt, call your MDO
After calling his medical defence organisation (MDO), Dr Jackson was reassured that in the absence of patient consent, the police would need to provide a legal authority, such as a search warrant or a notice to produce, before the notes could be released.
 
Dr Jackson relayed this information to the practice manager and the detectives left shortly after.
 
Don’t gossip about your patients
Later that morning, Dr Jackson overhead the receptionist talking to a patient.
 
‘Yes, they were both patients of the practice,’ Dr Jackson heard the receptionist say. ‘It was John Allen – you know, the retired teacher – he murdered his wife Liz.’
 
Dr Jackson interrupted the conversation and took the receptionist aside.
 
‘I know everyone is talking about the sad situation which unfolded yesterday, but the police haven’t released any details yet,’ the GP said. ‘It’s not appropriate to disclose confidential information you have gained through working at the practice.’
 
He also noted that it was insensitive to discuss patients in reception where friends of the family may overhear the discussion.
 
Medico-legal discussion
Privacy and confidentiality are vital when building trust in the therapeutic relationship. There are limited exceptions that allow for disclosure, but these exceptions can be complex and advice should be sought before complying with a request for medical records without patient consent.
 
The Office of the Australian Information Commissioner’s (OAIC’)s Guide to health privacy is an excellent resource and offers practical scenarios to assist doctors in navigating the principles of patient privacy.
 
The outcome
Bryce contacted Dr Jackson to say he didn’t consent to his parents’ personal health information being released to the police. Dr Jackson expressed his sympathy but explained that the police attended the practice later in the day, and medical records were provided following receipt of a signed search warrant.
 
John passed away shortly after, and the case became a matter for the State Coroner.
 
This article is provided by MDA National. They recommend that you contact your indemnity provider if you need specific advice in relation to your insurance policy or medico-legal matters.
 
The case history used is based on actual requests for medico-legal advice; however, certain facts have been omitted or changed by the author to ensure the anonymity of the parties involved.

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