INFORMATION FROM THE PRACTICE ADVICE SERVICE
COVID-19
As might be expected, about half of the inquiries received from members over the past many months relate to practicing in the context of the COVID-19 pandemic. The evolving nature of these questions is reflected in the advice provided by the College in email messages to members. These can be accessed from the homepage of the College website or by clicking here. While areas of the province has been moving from Stage 2 to Stage 3 permitting the opening of more services and facilities, the information about ensuring appropriate infection control protocols, if one is providing in-person services, continues to be applicable.
RISK OF HARM TO SELF OR OTHERS
Some members have expressed concern regarding the use of 911 as the appropriate resource when faced with a client/patient believed to pose a risk of harm to themselves or others. For example consider the following question:
My colleagues and I have been discussing “duty to warn” and what is required if we are concerned that a client/ patient may pose a danger to themselves or others. There is disagreement about whether we must report this concern and, if so, whether we are obligated to contact 911.
MUST I REPORT SUSPECTED HARM TO SELF OR OTHERS?
In Ontario, there is no duty to warn, if one interprets “duty” to mean a mandatory requirement. That is, there is no obligation to report concerns that a client/patient may pose a danger to themselves or others. It is important to understand however, that this does not mean that one cannot, or should not, take some action in the face of such serious concerns. The Personal Health Information Protection Act, 2004 (PHIPA) sets out a member’s obligations with respect to maintaining the confidentiality and privacy of personal health information. The legislation does provide an exception to the duty of confidentiality where a member finds it necessary to notify someone of a serious risk to a person’s safety. PHIPA states:
40 (1) A health information custodian may disclose personal health information about an individual if the custodian believes on reasonable grounds that the disclosure is necessary for the purpose of eliminating or reducing a significant risk of serious bodily harm to a person or group of persons. 2004, c. 3, Sched. A, s. 40 (1).
A key concept within this section of PHIPA is contained
in the words “may disclose”. PHIPA does not oblige a member to make such disclosures, but it permits one to do so “for the purpose of eliminating or reducing a significant risk of serious bodily harm”. With this purpose in mind, PHIPA reinforces a member’s need to use their knowledge of the client/patient and their professional judgement to determine the best, most appropriate, action to take.
MUST I CALL 911 TO REPORT SUSPECTED HARM TO SELF OR OTHERS?
The legislation does not direct a member to contact any particular organization, institution or individual should it be determined there is a need to take some action. In considering a breach of confidentiality under section 40 of PHIPA, it is important that, in keeping with the stated purpose, the disclosure be made to someone who is in a position to ‘eliminate or reduce a significant risk of serious bodily harm’.
When faced with serious concern about a client’s/patient’s risk of harm to self or others, members have to make the difficult judgment about who to contact in this time of crisis. When initially reviewing the limits of confidentiality regarding risk of harm with a client/patient, members may wish to discuss this with the client/patient. That is, engage the client in a discussion of who they believe should be called in the event of a crisis. The client/patient may identify a family member, other health care provider, close friend, member of the clergy, a community worker, an organization with which they have been involved or some other individual. While the ultimate decision rests with each member based on their best clinical judgement, taking into account their understanding of the client/patient and the particular situation, this previous discussion may prove helpful in deciding upon the most appropriate action.
It is important to make a distinction between situations
of client/patient risk of harm to themselves or others, often referred to as “duty to warn” and other mandatory reporting obligations. Section 40 of PHIPA does not apply to situations where one has reasonable grounds to suspect that a child is in need of protection or one suspects abuse or neglect in a retirement or long-term care facility. In these situations, mandatory reporting to the appropriate authority is required.