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Parent authorizes treatment of a minor. When does s/he have access to treatment records

- therapist anticipates detrimental effect on therapy
- therapist anticipates detrimental effect on child's physical or emotional well being
What did the Tarasoft Statute add to previous Tarasoft practice?
It restricted Tarasoft duties to threats made directly by the patient.
CA record retention
7 years after termination
APA record retention
3 years after termination

a record summary for 12 addtional years
Process when ethics and law conflict
Make known commitment to Ethics
Try to resolve conflict
If that doesn't work, obey the law
Psychologist reporting responsibility for spousal abuse
Neither mandated nor permitted
Relationshp between supervisor and Psych Assistant
Employer and employee
Response to 3rd party phone calls
May listen

May acknowledge that patient is in therapy only in extenuating circumstances

May breach confidentiality only in extenuating circumstances
Timing of child abuse reports (phone, written)
By phone immediately
Written within 36 hrs
Examples of breach of duty
Patient sues for malpractice
Therapist sues for non-payment
What is the status of privilege in breach of duty suits?
There is no privilege
Process when a multiple relationship is discovered
Try to resolve the conflict in the patient's best interest and maximal compliance with the Ethics Code
When is sex permisible with former patients?
After 2 years and
Only in most unusual circumstances
Def: grave disability
Inability to provide one's own food, shelter and clothing
HIPAA requirement for privacy notice document
It must be separate from other signed forms, such as a general consent form
Meaning of availability of supervisor to supervisee
Can be contacted by any means
Conditions for elder abuse reporting
Any reasonable suspicion of abuse including, but not limited to:

Direct evidence of abuse
Elder reports abuse
Types of elder abuse
Physical abuse
Financial abuse
When can a psychologist do a custody review of a family s/he is treating?
Almost never

It would be an insurmountable threat to objectivity
When do you get assent instead of consent?
When the patient does not have legal capacity (eg a minor or dependent adult)

Consent is procured from his/her guardian

Note: informed consent is required for court mandated treatment
When would a temporary suspension of a licence be issued?
When you are possibly a danger to the public (eg for an untreated addiction) and before the problem has been resolved with the Board
What happens when a license revocation is stayed?
Therapist is put on probation
Def: multiple role
Being in more than one role with the same person
or in a role with someone close or related, now or in the future
Requirements for documentation of treatment
Ethically mandated

And includes progress notes
In a legal proceeding when is privilege inapplicable to a minor?
Patient is <16 and victim of a crime

Therapist believes that disclosure is in the best interest of the child
Who is responsible for posting the notice to consumers about how to make complaints to the Board?
All licensees and registrants
What is the disciplinary action for incarceration for a felony?
License suspension
What is the best defense for breaching confidentiality to prevent a suicide?
A safety emergency occured
What are the general conditions for an exception to privilege?
When a judge has legal authority to order disclosure in the course of a legal proceeding (eg court, deposition, administrative hearing)
What is the appropriate course of action when you learn that goods received in barter were stolen?
Maintain confidentiality
Who is authorized to provide consent for HIV testing to an 11 year old living in a county facility? *
The responsible county official
Who are emancipated minors?
Legally married
Enlisted in the military
By court declaration
What are the enabling conditions for the Court to declare a minor emancipated? *
Minor >= 14 yo
Living apart from parents with consent
Management of finances with legal income
In the best interest of the minor
Obligation to provide records to a patient with an outstanding bill
Respond within 15 days
Records may not be withheld for non-payment
If a patient requests a copy of his / her records and you believe there may be adverse consequences if you do, you must:
1. Make a note in the record as to why
2. Permit inspection of records and note by another licensed health care professional

Summary optional
Conditions of Tarasoft duty
Direct communication by patient
Threat of violence against an identifiable victim
Tarasoft duty
Notify victim
Notify police

(But not attempt to prevent potential violence)
Detention schedule for a gravely disabled person
03 days - 72 hours
14 days
30 days

47 days max
Detention schedule for someone who is a threat to self
03 days - 72 hours
14 days
14 days

31 days max
Detention schedule for some who is a threat to others
03 days - 72 hours
14 days
180 days, renewable

197 days max
Criteria to be met for a 14 day hold
Completion of 72 hour hold
Still a danger to self or others, or gravely disabled
Refuses voluntary treatment
When is a report of sexual assault required for lewd or lascivious contact?
Child is under 14
Child is 14 or 15 and perp is 10 years older
When is a report of sexual assault required for intercourse, even if voluntary
Child is under 16 and perp is 21 or older
When is a report of sexual assault required for rape, incest or sodomy?
Child is under 18
When is a report of sexual assault not required?
When both participants are 16 or older and it is voluntary
Types of child abuse
Sexual assault or exploitation
Willful cruelty or unjustifiable punishment
Unlawful corporal punishment or injury
To whom are child abuse reports made?
Police department
Sheriff's department
County welfare department
Recommendations for informed consent
Written informed consent to treatment (written standard of care, but oral legal)
Written privacy policy
2 separate documents
Who are the third parties to whom confidential information may not be released?
Anyone outside the professional relationship
Retention period for HIPAA documentation
6 yrs
Ethical obligation in face of a colleague's ethical violation *
Depending on severity:
Attempt informal resolution
Report to Ethics committee or Board
How long may someone with an out-of-state license practice in CA without applying for a CA license?
180 da
How long may someone with a foreign license (eg Canadian) practice in CA
Up to 30 days in the calendar year
Continuing Ed requirements in first renewal cycle
Spousal abuse
Aging and long term care

Courses prior to licensing may count at the descretion of the Board
After license expiration, for how long may the license be renewed?
3 years
When may a license be surrendered?
Before the hearing
What happens to your license if you are incarcerated
It is suspended (at min)
What is covered by the evidence code
Exceptions to privilege
Under what condition may you not assert privilege?
If it has been waived by the patient
Who holds privilege?
Patient's guardian
Patient's representative
Who can claim privildege?
Holder of privilege
Person authorized by the holder
The therapist
Who can authorize a waiver of privilege?
Holder of privilege

If more than 1 then all holders

Anytime confidential communication is disclosed by the patient to a third party
Constraints on self-sufficient minors *
15 or older
Living apart from parents
Managing own finances

May consent to medical and dental treatment

Provider may contact parents with or without consent
Under what circumstances may a minor get outpatient or residential shelter treatment?
12 or older
Mature enough to participate
Cannot get ECT, psychosurgery or meds without parental consent
What are the parental contact requirements for outpatient or residential shelter treatment?
Outpatient: should attempt to contact unless inappropriate; document

Residential: MUST attempt to contact
Rule of thumb age constraints on treating a minor *
Generally must be 12 or older
Except for:
sexual assault (except rape)
Time frames for inspecting and copying records
Inspection - 5 working days
Copying - 15 days from receipt of written request
Treatment summary - 10 working days or 30 days with extenuating circustances
Time frames for abuse reporting
Child abuse
immediately by phone
written follow up in 36 hrs

Elder abuse
asap by phone
written follow up in 2 working days
Consequences of not filing an abuse report
Guilty of a misdemeanor

Possible jail up to 6 mo
Possible fine up to $1000
Elder abuse report recipients
In general: to adult protective services or police

In a long term care facility: ombudsman or police
Non-disciplinary actions by the Board
Education letter or review
Letter of warning
Citation and fine
Disciplinary actions by the Board
Letter of reprimand
Two-step agreement
Interim suspension order
License surrender
License revocation
Tarasoft with respect to confidentiality
Confidentiality must be considered even though it may be breached to provide the requisite information
Def in HIPAA: patient authorization
Written release of information beyond consent agreement
Hours of SPE a trainee may accrue under a single primary supervisor
When must you get a new license instead of a renewal?
3 years after expiration
Conditions under which graduate students must expose personal information
If requirement is clearly stated in admissions and program materials

If necessary to evaluate students for competence or threat to self or others
Def: sexual contact
Touching an intimate part, including intercourse
Ethics code on bartering
Permitted, as long as not clinically contraindicated or exploitive
Not encouraged or discouraged
Ethics on collection agency
Acceptable if:

Patient first given opportunity to settle accounts
Patient given advance notice
Contents of child abuse report
Reporter name and contact
Type of abuse
Narrative descripton

(But not risk of future abuse)
Requirements on professional initiating a 5150
Provide confining facility with a statement of probable cause
Responsibility to report to patients disciplinary actions by the Board
No requirement unless asked
Who may inspect patient records?
The patient or his/her representative and
One other person only
Requirements to reactivate inactive license
Application to the Board
Payment of fees
Completion of continuing ed prorated for time in active status
What is relevant to a patient threat against property?
Evidence Code 1024, stating
No privelege exists if the patient's mental state poses a risk to self, others or property and disclosure is necessary to prevent the threat
Ethics: handling of confidential information for didactic purposes
Must be disguised unless the person has consented in writing
Continuing education requirements
36 hours / renewal cycle
18 hours may be via distance learning
4 hour course in Law and Ethics
1 time course in spousal abuse
From whom must consent to treatment be secured?
Patient or legal guardian

Consent is not implicit in institutional consent
When is parental consent required for services to prevent or treat a pregnancy?
Contraception - no
Abortion - no
Sterilization - yes
What should be done in the event of the discovery of a harmful multiple relationship (APA)?
Take reasonable steps to resolve it with due regard for the best interests of the client and maximal compliance with the Ethical Code
Referral payments are
Examples of insurmountable conflicts of interest
Doing a custody evaluation for a family you have been treating

Using the wife as the translator for the husband in an assessment
What should you do if the police demand to see client records on the strength of a warrent for his/her arrest *
Inform them that any and all information regarding treatment is priviledged and confidential
When can a physician disclose HIV status to a partner w/o the patient's consent
Only after trying to secure consent
State law vs HIPAA
State law supersedes HIPAA unless HIPAA is more stringent or state and federal law are contradictory

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