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.