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Aspects of confidentiality: High-profile patients

 
 

One of the most commonly recurring issues that feature on the MPS advice line is confidentiality. In each edition of Casebook we will highlight an unusual scenario around confidentiality.

Public and media interest in the health and wellbeing of high-profile figures is not surprising. In this article we look at the contrasting experiences of two South African health ministers when it came to the confidentiality of their medical conditions.

In 2007, the late health minister Dr Manto Tshabalala-Msimang was admitted to the Johannesburg Hospital, suffering from anaemia and pleural effusion. Dr Tshabalala-Msimang later underwent a liver transplant. The stated cause was autoimmune hepatitis with portal hypertension, but the transplant was surrounded by accusations of heavy drinking. That these details made it into the public domain meant Dr Tshabalala-Msimang’s right to confidentiality had been breached.

Fast forward to August 2013. Current health minister Dr Aaron Motsoaledi was admitted to Steve Biko Academic Hospital, Pretoria, for an undisclosed procedure. His spokesperson confirmed to the media that Dr Motsoaledi had been admitted, but declined to give the reason – citing doctor–patient confidentiality. 

The celebrity patient

The following examples from around the world highlight the damage that can be done when the security of computerised records is breached. In the United Kingdom, an audit carried out after a celebrity had been admitted to hospital in 2007 revealed that more than 50 staff who were not involved in his care had accessed his medical records. Media reports did not specify who the celebrity was, or which hospital it concerned, but the staff were presumably subjected to disciplinary proceedings.1

In the United States, the Hollywood actor George Clooney was admitted to the Palisades Medical Center following a motorbike accident. Subsequent to this, 27 staff who were not involved in his care were suspended without pay for accessing his medical records.2 In New Zealand, Auckland District Health Board fired one employee and disciplined 20 others “for examining the private medical records of celebrities”. The hospital routinely runs electronic audits after a celebrity has stayed in the hospital.3

Patient confidentiality is enshrined in law – the National Health Act 2003 makes it an offence to disclose patients’ information without their consent, except in certain circumstances

What the law says

Patient confidentiality is enshrined in law – the National Health Act 2003 makes it an offence to disclose patients’ information without their consent, except in certain circumstances. Sections 14, 15 and 16 of the Act are pertinent with regards to confidentiality. In particular, sections 15 and 16 describe how patient information may be disclosed by a healthcare worker “for any legitimate purpose within the ordinary course and scope of his or her duties where such access or disclosure is in the interests of the user”.

It is not just in law that confidentiality is delineated; the HPCSA views it as central to the doctor–patient relationship and a core aspect of the trust that holds the relationship together. The HPCSA’s official guidance, Confidentiality: Protecting and Providing Information (2008), lists the key principles:

  1. Patients have a right to expect that information about them will be held in confidence by health care practitioners. Confidentiality is central to trust between practitioners and patients. Without assurances about confidentiality, patients may be reluctant to give practitioners the information they need in order to provide good care.
  2. Where health care practitioners are asked to provide information about patients, they should:
    • Seek the consent of patients to disclosure of information wherever possible, whether or not the patients can be identified from the disclosure; Comprehensive information must be made available to patients with regard to the potential for a breach of confidentiality with ICD10 coding.
    • Anonymise data where unidentifiable data will serve the purpose;
    • Keep disclosures to the minimum necessary.
  3. Health care practitioners must always be prepared to justify their decisions in accordance with these guidelines.4

An embedded problem?

In Current Allergy & Clinical Immunology, the official journal of the Allergy Society of South Africa, Dr Sharon Kling writes: “Famously, medical information about the late Minister of Health, Dr Manto Tshabalala-Msimang, was leaked to the press. The perception is that public figures are not entitled to the same confidentiality and privacy rights that accrue to others.

“In academic teaching hospitals, the hospital folder is generally available to numerous staff and students, and discussions on ward rounds may inadvertently disclose confidential information in the presence of patients other than those being discussed. 

“Computerisation of laboratory and radiological investigations makes confidential information easily available, even to healthcare professionals not directly involved with the particular patient’s care. In private hospitals I have personally witnessed patient confidentiality being violated by both nursing and medical staff.”5

There are numerous situations where a doctor is permitted to disclose confidential patient data – many of which have been outlined in a previous Casebook article6 – but the public profile of the patient is not one; hospital staff – both clinical and adminstrative – should be appropriately warned of their responsibility.

Computerisation of laboratory and radiological investigations makes confidential information easily available, even to healthcare professionals not directly involved with the particular patient’s care

References

  1. Carvel J, Concern over NHS’s IT systems after 50 view celebrity’s details, The Guardian (19 September 2007)
  2. Alleged breach of George Clooney’s health information leads to suspension of 27 staffers at NJ Medical Center, AIS’s Health Business Daily (19 November 2007)
  3. Pizzi R, It’s not just George Clooney: celebrity health records breached in New Zealand, Healthcare IT News (21 November 2007)
  4. HPCSA, Confidentiality: Protecting and Providing Information (2008), para 4
  5. Kling S, Confidentiality in medicine, Current Allergy & Clinical Immunology, Vol 23 No 4 (November 2010)
  6. Gillespie G, Disclosing patient records, Casebook 20 (3) (September 2012)
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