Privileged Communications in Missouri

The state of Missouri recognizes that a fiduciary duty exists on behalf of the physician or another medical professional, including psychologists, to maintain confidentiality of the patient’s records. However, as with all jurisdictions, Missouri recognizes a common law exception to the presumption that all communications are privileged when the privilege holder, that is the patient, presents a serious danger or threat of violence as judged by the standards of the profession. A breach of that fiduciary duty exposes a physician or another medical professional who is duty-bound under Missouri law to maintain a patient-treatment provider privilege exposes the professional to civil liability and professional licensing discipline as well.

There are of course times when a psychologist or other professional bound to maintain confidences must disclose the communication. A general alarm that a person might be a threat is insufficient. Instead, the psychologist, doctor, or mental health professional must believe that there is a potential victim who is readily identifiable and, in that case may warn the potential victim or law enforcement authorities to prevent the harm from occurring.

The recognized exception to presumption that communications are  privileged illustrates how important the rule is in Missouri. Even in circumstances in which a woman expressed a suicidal threat and sped on the wrong side of the highway, the psychologist was justified in not disclosing the patient’s wishes because there was no specific target without the written consent of the privilege holder.

Before treatment may begin, Missouri law requires treatment providers to obtain the informed consent of their patients to begin therapy. The informed consent of the patient must be recorded by the treatment provider. The informed consent of the patient sets the limits of treatment to be provided and delineates the boundaries of the patient-provider relationship. A discussion of those boundaries must include information about patient confidentiality and the legal limitations of patient confidentiality.

Patients must be informed that Missouri law resumes communications between therapists and patients are privileged. Moreover, the patient must understand that information may be disclosed if the provider receives the informed consent of the patient. The presumption has its limitations. The first limitation, as discussed above, pertains to an emergency situation in which the patient’s life or the life of an identifiable person is in imminent danger. In this circumstance, the psychologist “shall” disclose only necessary information to prevent harm.

Interpreters present a unique problem relative to privileged communications. The client or patient must give informed consent to use an interpreter and the provider must take all steps necessary to prevent disclosure of reports and diagnostic test results.

The treatment provider must also take special care to carefully explain the limitations of the privilege when treating a minor. The limitations on the privilege for a minor are the same for an adult in Missouri.

Couples therapy presents another significant problem regarding confidentiality. Missouri law instructs a treatment provider to discuss the limitations of confidentiality with all people participating in therapy.

Treatment providers must also inform their clients that they might discuss their patients’ cases with other professionals for the express purpose of providing the appropriate treatment to the patient. The psychologist cannot simply blurt out the information. Instead, Missouri law requires the psychologist to inform his or her colleagues that the information provided is confidential to ensure further that the collaborators maintain confidentiality.

Avoid Disciplinary Action by Seeking Advice from an Experienced Missouri Professional Licensing Attorney

Missouri law treats violations of patient confidentiality seriously. Disclosure of patient confidences is unethical conduct, which is subject to disciplinary action pursuant to the Missouri Ethical Rules of Conduct. Anyone with a concern about the boundaries of the privilege or whether you are authorized to disclose confidences, you need to consult with Missouri Professional Licensing Attorney Danielle Sanger. Attorney Sanger will provide you with the legal advice you need to avoid allegations of unprofessional conduct. Contact Attorney Sanger today at 785-989-4353 today to learn more.

Privileged Communications in Kansas

Patients expect that their conversations with psychologists, psychiatrists, and doctors would be privileged, and not merely confidential. A privileged communication in Kansas is one in which the psychologist cannot disclose except in very limited circumstances under Kansas law. Disclosure of privileged communication is grounds for disciplinary action. Therefore, the psychologist must understand the nature of the privilege and when communications may be .

Kansas statute 74-5323 indicates that the communications and relationship between a psychologist and a patient are privileged in the same manner in which the attorney-client relationship is privileged. Therefore, a psychologist cannot testify in court about anything a patient told him or her and cannot disclose statements to police or another person unless there is an imminent threat of harm to oneself or another, or in another circumstance which Kansas law requires disclosure as provided in Kansas statutes 60-426.

Notwithstanding the prohibition against disclosure of communications from a patient to a psychologist, 74-5323 allows the psychologist to testify about several matters wherein privileged communications might be disclosed. Subsection b of 74-5323 allows the psychologist to testify in matters concerning adult abuse, neglect, adoption, matters concerning the welfare of children, or when the psychologist seeks advice from professional colleagues or superiors when acting on behalf of the patient.

Other professions such as professional counselors, social workers, marital therapists, addiction workers, and other professions in which members of the public disclose private thoughts, feelings, and ideas as part of mental or emotional therapy are bound by rules of confidentiality. The doctor-patient privilege in Kansas receives slightly different treatment.

Kansas statutes 60-427 is the rule of evidence that delineates when a physician or another practitioner of the healing arts in Kansas to testify in court about communications and other information gained from the doctor’s patient during medical treatment. Under Kansas law, communications between a patient and a physician are more aptly described as confidential rather than truly privileged.

Under 60-427, communications between patient and doctor are presumed confidential when made in confidence by the patient with the expectation that the communications are confidential. In other words, the doctor must hold the communications private unless an exception to the presumption applies.

In a court action, a person can claim a privilege and prevent a physician from testifying in certain circumstances. Thus, a person who is not a party to an action can object to a witness testifying about confidential communication in court if the judge rules that the communication was confidential between the patient and doctor, the communication was necessary for diagnosis or treatment, the witness holds the privilege, or that the person holding information obtained it through an intentional breach of confidence. If the judge rules that these conditions do not exist, then the person may disclose the communications and is protected by law for disclosing them.

Physicians may disclose confidential patient communications is other circumstances as well. The physician may testify about communications when the legal proceedings involve the commitment of the patient, guardianship, or conservatorship of the patient. Additionally, there is no privilege when the doctor testifies about diagnosis and treatment related to a claim that is part of the legal proceeding. The most common example of this exception is a medical malpractice lawsuit or a personal injury lawsuit.

There is no privilege for blood draws made pursuant to a warrant or by the request of a law enforcement officer or when the patient makes a disclosure to commit an unlawful act.

Understanding Privileges Helps Avoid Professional Discipline

Professional licensing defense attorney Danielle Sanger is available to consult with professional licensees regarding their legal obligations so they can avoid pitfalls that could lead to professional discipline. Call Kansas Professional Licensing Attorney Danielle Sanger today at 785-979-4353 to schedule a consultation.


The Suicide of Nurse Underscores Pressures of Nursing Profession

News that a 35-year-old nurse working in the United Kingdom (U.K.) died by her own hand after working twelve-hour shifts following a promotion shocked and dismayed her coworkers. Sadly, the state of muring in the U.S. is very similar. Nurses work extraordinarily hard and are taking on more and more stress as medical resources are stretched thin.  Long, grueling shifts leave little time for socialization, stress management, and self-care. As time wears on mistakes are made due to the stress. Additionally, stressed-out medical personnel, especially nurses can turn to excessive alcohol consumption or abusing drugs as a means to relieve the insurmountable strain taking long shifts without the opportunity to take time off can have an on individual.

Kansas and Missouri professional licensing attorney Danielle Sanger has represented numerous medical professionals, including registered nurses, licensed practical nurses, nurse assistants, and nurse practitioners who encountered the destructive effects stress causes to a person’s life. Mismanaged or unmanaged stress leads to errors of judgment and could lead to a failure to live up to the character expected of a nurse. Attorney Sanger works with nurses of all types who are facing professional discipline brought about by the damaging effects of stress. Attorney Sanger works closely with her clients to get them back on their career path and resolve professional disciplinary issues favorably for her client.

The 35-year-old nurse from the U.K. received a promotion to senior staff nurse a mere six months before she hanged herself in her family home. The nurse worked in a hospital located in Manchester, England according to the New York Post. The nurse who died reportedly left a two-page handwritten suicide note wherein she describes in vivid detail her collapse into self-hatred and negativity. She described her emotions as a “downward spiral.”

Friends of the nurse say that they could see the terrible toll the promotion took on the woman. According to the woman’s friends, the nurse had a difficult time juggling work and a social life. The promotion bestowed upon her new responsibilities with which she struggled. One of the nurse’s college friends told a court reviewing the matter that maintaining a social life after the promotion was hard for her friend.

The nurse’s mother added another level of complexity to the situation in which the nurse found herself. The nurse’s mother told the court that the highly demanding job rendered her romantic life nearly impossible to maintain, Her mother said that the twelve-hours shift work thrust upon her subsequent to the promotion left her depressed and incapable of keeping a significant other in her life. The nurse experienced significant difficulty keeping a stable, long-term relationship. The nurse’s mother told the judicial tribunal that the nurse ended her most recent dating relationship simply by sending a text message.

Law enforcement authorities opened a coroner’s inquest into the nurse’s death. After a court hearing to determine the evidence surrounding the woman’s death, the court concluded that the nurse had killed herself by hanging and that the stress of her new job played a substantial role in the nurse’s decision to take her own life.

The coroner succinctly, albeit sadly, summed up the results of the inquest. The attending coroner said that the nurse experienced a substantial amount of stress that lasted for a very long time. The coroner added that the woman suffered from incredibly low self-esteem and, as a result, could not see herself as her family and friends saw her.

Help for Nurses Facing Professional Discipline

Contact Kansas and Missouri Professional Licensing Attorney Danielle Sanger today if you are a nurse, doctor, dentist, or another medical professional facing discipline due to stress. Attorney Sanger is ready to help. Call Attorney Danielle Sanger today at 785-979-4353 to schedule a consultation.

Unmanaged Stress Can Lead to Mistakes and Professional Discipline

Stress is a normal reaction to certain situations. Stress actually benefits us as humans in the long run. Our fight or flight stress response helps keep us alive. Additionally, experiencing stress in certain circumstances like when taking an exam in school, planning a wedding, or focusing on a project at work helps us focus and motivates us to get the job done. Some people relish in the pressure and rise to the occasion, whatever that might be. Stress befalls us when we make a change in our lives like when we change jobs, move to a new city, get divorced or, experience the loss of a loved one. In that sense, stress is a part of life and it is unavoidable. Handling stress depends on the individual.

While we cannot avoid stress, we must also learn to manage stress. Otherwise, we run the risk of experiencing bouts of depression, gaining weight, not sleeping, have family problems, and run the risk of poor job performance. Poor job performance for professional licensees such as medical doctors, nurses, and other medical professionals in addition to any other profession or occupational licensees, can lead to problems at work, culminating with professional discipline.

Kansas and Missouri professional and occupational disciplinary defense attorney Danielle Sanger understand how stress can affect people’s lives. She knows that stressful situations can put undue pressure on people to perform. Constant pressure and stress can break even the strongest person. If you find yourself in a situation as a professional or occupational licensee in Kansas or Missouri facing a disciplinary charge because of stress-induced incident, contact Attorney Danielle Sanger. Attorney Sanger has tremendous experience fighting for people who have succumbed to stressors in their professional and personal lives who face professional discipline.

The National Institute of Mental Health reported on the long-term impacts chronic stress has on a person. Persistent, long-term stress, which is different acute stress, takes a massive toll on the body’s systems until the stress level returns to normal functioning. Chronic stress can cause serious digestive problems, cardiovascular problems, sleep disruption, and reproductive issues. The body’s immune system can also be disrupted by stress in some people. In other people who suffer under chronically high stress, symptoms arise such as persistent headaches, sleeplessness, irritability, as well as sadness and anger.

The chronically high levels of the stress hormone cortisol coursing through a person’s body can cause chronic diseases. The National Institute for Mental Health indicated that people experiencing chronically high-stress levels could develop heart problems like high blood pressure, heart disease, mental disorders like anxiety and depression. Stressed out people can also develop diabetes and other metabolic illnesses.

Anyone who is suffering from chronically high stress must get their stress levels under control before experiencing the negative and potentially life-altering side effects discussed above. The National Institute for Mental Health suggests that people need to become aware of the stress they are under. Signs of increased stress include trouble sleeping, increased alcohol use or drug misuse, as well as other psychological signs like anxiety, depression, low energy levels, and becoming angry easily.

Anyone suffering from stress-related health problems must talk to their doctor about the problems. Mental health treatment might be necessary for additional to receiving medical treatment for the person’s acute health problems. Also, exercising regularly can help lower the body’s stress response and help relieve some of the symptoms of stress. Remaining a social person and partaking in fun activities can also help lower stress.

When Life and Work Becomes Too Much

Learning that you are under investigation for professional discipline will ratchet up the stress. You can fix this with Kansas Professional Licensing Attorney Danielle Sanger’s help. Call her today at 785-979-4353 today to learn more.