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Aspects of confidentiality: A request from SARS

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, at the heart of which lies a difficult dilemma around confidentiality.

Knowing when it is permitted to breach patient confidentiality is a classic dilemma faced by clinicians worldwide, and is a common source of queries to the MPS advice line. In this case, a member was approached by the South African Revenue Service (SARS) for extensive details about a patient. These details included the patient’s name and contact information.

The member contacted MPS’s helpline for advice on his obligations in this situation. Advice In terms of the South African income tax legislation, in particular the Tax Administration Act and the Income Tax Act, SARS is entitled to request (and receive) information in regard to any “taxable event”, in respect of an identified or “objectively identifiable” taxpayer. As SARS sent our member a formal request in terms of the relevant legislation, we advised him that he was, therefore, obliged to provide them with the name and contact details that were requested.

Further advice was that:

  • Failure to comply with a reasonable SARS request amounts to a criminal offence, with a sanction of up to two years’ imprisonment
  • Disclosure to anyone – especially the taxpayer in question – that one has received such a request for information from SARS is likewise criminally sanctionable, with a similar sanction.

Other situations

There are a number of other situations where patient information can be shared with third parties, sometimes without the patient’s consent. These include:

  • Whenever a disclosure is required by law
  • When a specific statutory requirement demands that you disclose information about a patient, such as providing details of a notifiable disease or reporting child or elder abuse. You must also disclose patient information if ordered to do so by a judge or presiding officer of a court. However, there is the opportunity to object if you consider there to be a compulsion to disclose information that is irrelevant – for example, details relating to relatives or partners of the patient, who are not involved in any proceedings.
  • Justifiable disclosures in the public interest
  • Disclosure to protect the patient or others from harm
  • After a patient has died. For specific advice and guidance on these situations, read our Confidentiality factsheets on the MPS website, or the HPCSA guidance Confidentiality: Protecting and Providing Information and Ethical Guidelines for Good Practice with Regard to HIV. Contact MPS if there is still any uncertainty over a particular situation or dilemma.
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