I am a case manager for a home care company. I was contacted by the spouse of a patient regarding the many psychological/social issues they were experiencing. The spouse said the patient has a history of substance abuse and did not need the added tactile hallucinations from stopping his
I reported this to the physician. The spouse found out and denied ever stating her husband has a history of a substance abuse problems. The patient, too, denied this as well as a few other things we had discussed the prior week.
Was I out of line to inform the physician that the patient has a history of substance abuse? Can I be sued for slander even though it was the spouse who provided me with the information?
I am concerned I may have messed up on this case. I was looking out for the best interest of my patient; but maybe I should have handled it differently. The spouse and patient, of course, are very angry with me. They said because I reporting the issue, the patient may never be able to get another job because potential employers will think he is a crackhead.
Dear Nancy replies:
From what you reported in your question, it sounds as though your concern about the patient and the effects of any problems when stopping his pain medications was well-founded. You said you thought this might have been handled differently but did not elaborate. Some of the ways in which the information you obtained could have been handled include asking the spouse why she was telling you and no one else, what she expected you to do with the information she shared with you and encouraging her to speak to the physician.
Another thing to evaluate is whether the spouse may have told you this because they are having problems about the substance abuse issue and other issues too. Her statements that he might not get another job because he will be seen as a “crackhead” and that she is contemplating a suit for slander makes one wonder if money is not a major problem for this couple and you were seen as a potential solution due to the sharing of information you believed was essential to the patient’s well-being.
When it comes to patient confidentiality and privacy, the nurse has an obligation to protect both. However, the protection of privacy and confidentiality are not absolute. One of the things you may want to consider working into your practice is to discuss with the patient and family at the onset that there are some things that you cannot keep private and confidential and then give general examples (e.g., child abuse, criminal activity, communicable diseases, past medical history that may affect current treatment) and to whom that information would be shared. Then, if something is discussed with you that you indicated was not private or confidential, telling the patient/family that this information needs to be shared with the physician or others may help minimize the displeasure of the family or the patient.
For one resource, review Provision 3 of the Code of Ethics for Nurses With Interpretive Statements, ANA, 2001 (www.nursingworld.org).
You might want to consult with a nurse attorney or other attorney who is familiar with nursing practice and the duty to maintain confidentiality and privacy and its exceptions. The attorney also can advise you of how to defend against any employer adverse action, as well as any legal action that might be contemplated by the patient and the spouse.