Disclosing Information

Thank you for your MedicASK regarding navigating this convoluted, difficult, and ethical dilemma.

Currently, under the Personal Health Information Protection Act, 2004 (PHIPA) and Health Care Consent Act, 1996 (HCCA) that regulate paramedics, we cannot disclose information if the patient has asked us not to. The exception to this is if the paramedic:

• Is subpoenaed by court
• Reporting suspected child abuse
• To warn intended victims (e.g., if plans to hurt another person are described)
• The paramedic can also release confidential information to the young person’s substitute decision-maker, if the young person has been judged incapable.

There are other situations discussed below, and the references attached speak to what physicians follow which can mostly be applied to you in your practice. That said, a good place to start looking would be your service's internal policies and what their requirements for mandatory reporting are. Typically, most if not all paramedic services require an incident report (IR) for any criminal/suspected criminal activity. That said, in this situation you describe, you would be quoting what the patient disclosed to you if it is criminal in nature in your IR, which can later be subpoenaed by the police/court should they request it. In brief, confidential information should only be disclosed if the rigid legal test for requiring/permitting this is met. Also, if confidential information is disclosed, limit the information by only disclosing what fulfills the minimum mandatory reporting requirements (be objective and accurate).

• "When you are required by law to disclose the information – for example, when you have a statutory duty to report. In this case, you must disclose the information."
• "When you are permitted by law to disclose the information – for example, when a privacy law exemption allows doctors to disclose personal health information without consent. In this case, you may lawfully disclose the information." (CMPA - When to disclose confidential information)

While it is natural to want to cooperate with police, you also have a legal duty to keep patient health information confidential unless they have given consent to disclose this. There are few exceptions when the disclosure of patient information is permitted without express patient consent for example, when the paramedic/service receives a subpoena or court order. An example of mandatory reporting would be when a child is in need of protection (CAS). You can find this in the Child, Youth, and Family Services Act (paramedics would be considered a service provider under professionals and officials in Ontario). There is also the duty to report to the police when physicians must report directly to the police immediately in situations such as gunshot wounds (in some provinces this includes stab wounds), child abuse, and certain deaths (i.e. violent, suspicious, unexplained). All provinces and territories have legislation that requires ANYONE (including physicians) to report violent, suspicious, or unexplained deaths. You may have encountered certain calls where you have spoken with a coroner on scene around a suspicious death, which is considered acceptable. Again, your service may have a specific internal policy on reporting these types of deaths to police.

"Treating a patient who is under arrest or the subject of a police investigation can be challenging. The Supreme Court of Canada has confirmed that confidentiality obligations apply even when a patient is under arrest or otherwise being detained. Without this protection, these individuals may be deterred from seeking necessary medical care if they perceive healthcare providers as agents of the police." (https://www.cmpa-acpm.ca/en/advice-publications/browse-articles/2015/when-to-disclose-confidential-information) For example, a patient in custody who has just intentionally harmed others who is also injured themselves, you still have a duty to provide medical care as you would to anyone else.

When required by law to disclose confidential patient information generally, you will not be faulted for a breach if you make a report in good faith. That said, if you fail to disclose information when required to do so, you may be subject to an investigation/complaint. For example, you may be liable if you do not report a child in need to CAS. If you are ever in a situation and are unsure, it is best to err on the side of caution and discuss your intentions to disclose with your Superintendent/Service on proper steps to be taken.