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New York State Supreme Court ruled that the photographs of all patients in the treatment program be made available to witnesses and legal authorities in a hunt for a suspected murderer. At last word, this was being requested for review by the New York State Supreme Court, with consideration of appealing to the United States Supreme Court if necessary.
Additional attention is needed to the problem of protecting patients in psychotherapy, not from the intent of the law, but from how it works out in actual practice.
Maurice Grossman, M.D.
Appendix H: Samples of Reports From Psychiatrists of Injuries to Patients Resulting From Breaches of Confidentiality Compiled by Maurice Grossman, M.D.
Chairman of the Task Force
In the following illustrations, distortions have been purposefully made to disguise identification and in some instances the essential facts are gleaned from multiple cases.
1. A 24 year old schizophrenic patient, receiving EST in hospital improved and was able to return to work. Patient not told actual diagnosis because of still fragile state. Insurance covered patients routinely are given forms to sign on hospital admission. Includes permission to give information to insurance company. Hospital sent a report of the hospitalization as routine matter to get payment for bill, including diagnosis and suicide attempt. On return to work, patient found that fellow employees knew of the hospitalization, the incidents. Insurance company sends report to employer on group contract coverage. Patient becomes paranoid toward her physician; expresses self about first learning about herself from fellow employees; terminates treatment.
2. Similar case, with patient learning of diagnosis with notice from insurance company reporting they had paid the bill. Patient paranoid about how insurance company, and "their clerks" knew all about it.
3. A very emotionally upset patient, first making inquiries from insurance company that no information would reach employer, was so assured. The entire therapy damaged, and patient worse when finds employer discloses knowledge of the treatment and other factors. Medical Director of the national company involved, and a high official in insurance organizations writes "we are obligated to tell the employer because he pays the premiums." (Note that such group contracts are fringe benefits paid for by employees labor, and are only administratively paid for by employer.)
4. Patient called in for questioning about insurance report of psychiatric illness relative to security clearance even though no interference with work. Incident to security investigation, neighbors were asked what they might know about any psychiatric problem about this patient.
5. Reports of employers looking for excuses to separate employees based either on prejudice about psychiatric illness or unwarranted concern they will add burden and increased
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insurance premiums on group policy.
6. One patient, spouse of employee covered by group contract, required intensive treatment because of extreme emotional decompensation, — barely holding together and very depressed. When husband filed claim for the costs of treatment covered by policy, he was told that employer would be told of his claim; that employer would be required to increase premium payments on all employees (declared not to be a fact by insurance industry representatives when discussed with them later); and intimidated him into dropping the claim out of fear of losing job. The physician was dissuaded from making follow-up inquiries both by husband and wife out of fear of losing job. Patient became worse.
7. School systems who routinely turn down applications for teaching positions on any history of psychiatric care, derived from insurance questionnaires, without investigating the nature of the condition or treatment to determine whether it would have a deleterious effect on their teaching or contact with children. Many in treatment are better teachers than those who avoid it.
8. Many government agencies routinely request information about psychiatric treatment. If ignored, and later insurance information based on group policies discloses it, they may be separated on that ground. If they admit that they had treatment, they do not get job in first place. No effort is made to have individual examined to see how relevant the history is to present condition or job. (Incidentally I have found that the Department of Defense Industrial Security Review Agencies is the most careful to protect the confidentiality of material from employers and to evaluate current condition in relation to the job. The one difficult problem still is that of those who admit to homosexuality. I understand the Civil Service Commission has just agreed to drop this section of the questionnaire for job applicants, and rely on current examinations.)
9. Two high officials in the Department of Defense, defending the practice of SPN identification on conditions of discharge that includes medical data, unequivocally declared before a Senate Committee that they feel obligated to tell employers of the reasons for his discharge, when the discharged military person, returned to civilian life, seeks employment. (Again, I understand that recently the use of SPN identifications have been dropped; but the question of attitude remains open.)
10. Records of a child's psychiatric condition and treatment made a permanent part of that child's school file when the treating psychiatrist has consultation with the current school teacher and parents, are often used in later years by others not having the benefit of the psychiatrist's help in understanding the information; nor allowing for changes as the child progresses; and has even been turned up in search for information in the adulthood of the patient long after school years.
11. Patients returned to stability and able to work, forced back into their psychotic state by misuse of material released from insurance files, security clearance files, that reaches other parts of employment situation. Undoing years of therapy is only part of the price. Suicide attempts; homicidal threats based on paranoid upheavals; all generated by real attitudes about them from fellow employees who repeat the information for either sadistic or thoughtless reasons.
12. Since spouses are often the ones covered by the group policy and many insurance reports are required to go through the plant's personnel office, even a diagnosis can cause trouble. Not infrequently there is already some trouble in the family. The "well" member is not above using the fact of treatment to blame the "patient" for all the difficulty merely because the "patient” has been the one to accept the treatment. There have been cases where the spouse has used the diagnosis to threaten the “patient” as a means of dominating the household situation, even after the "patient" has recovered and become constructively functioning.
13. A variation of this is where the insured spouse seeks divorce, and threatens or actually seeks custody of children. When the insurance report indicated merely that an emotional condition existed, but that the physician would discuss it directly with the medical director on condition that it would not be disclosed elsewhere, the insurance company refused to pay the claim. The husband kept threatening the wife, to get a report for him to turn in through employer channels. A "secret" insurance company memo about the treating physician went through channels to the employer, got to spouse, who showed it to patient, who showed it to M.D., example of how protected their records really are, even when it concerns themselves.
14. This last case represents another problem. When it was discussed with the insurance commissioner of that state, he
replied it was an individual matter and that payment would
15. There are many patients, covered by insurance, who will not use their benefits because it will get back to employer. We receive reports that there are many more, who need care, but cannot afford it unless paid for by the insurance they have, but forego treatment rather than take a chance.
16. We have other reports from reliable sources, but which cannot be documented for obvious reasons, of people greatly in need of treatment, but because of critical nature of their employment, avoid treatment out of fear of disclosure from any source. Such groups are commercial pilots, military officers, certain professional men and women, people in high executive positions or on their way up the executive ladder. They can point to instances of those they know who chanced treatment, only to have leakage of information from some source interrupt their career.
17. These are not restricted to psychiatric cases alone. A surgeon hospitalized for a coronary attack, learned shortly after he was home that his automobile insurance had been cancelled. His broker informed him that his automobile insurance carrier had gotten word of his coronary through means of his hospital insurance report.
18. One of the patients listed above told of a claim for corrective eye surgery on a child that was refused by the insurance company although supposedly covered; and the family dropping the claim fearing repercussions from the employer. This was at a critical employment crisis in the industry.
19. A patient applied to her physician for a physical examination for life insurance. When her application was turned down, her agent obtained a full report for her, and indicated that her physician was responsible. That terminated that relationship. The physician reports he couldn't understand the rejection on his report per se.
20. At the March 1974 C.M.A. Annual Meeting, at a reference committee hearing, a physician reported a case who died, and