Q.

The largest of our programs is a school program.  Recently we had a discussion regarding school students and/or parents who reveal to our staff, especially nurses and physicians that the student is pregnant, has Hepatitis B or is HIV positive.  The student/parent then goes on to tell staff that they refuse to consent to the sharing of this information with other staff who work with the adolescent. Our biggest concern is around pregnancy and all of the ramifications in the classroom, during physical activity, and general safety. Our children suffer serious emotional and behavioral disorders.  A student who acts out may need to have a therapeutic hold applied.  Other children in the classroom need to be protected while a student is out of control.  There are multiple concerns both in the classroom and in terms of ordering and administering psychiatric medication. We are looking for legal guidance on our ability to limit confidentiality based on a "risk-benefit analysis" specific to each situation.  While we always counsel the individual on the need for other staff to have this information, we are not always successful in our attempts to obtain consent.
 

A.

Your patients are asking you to take a course of action which could place them in danger.  For instance, your physicians need to know the patient's health status as part of the decision making process in prescribing medication. This puts you at considerable legal risk.

Thus, I suggest that you disclose to all the students and their families that information provided by the student or family will be shared with all staff who have a need to know. You can explain that all of your staff are required to abide by confidentiality regulations. The disclosure should be contained in a form signed by the responsible party at the beginning of treatment or for current patients as treatment continues.

The possible legal risks of not complying with a request not to disclose information necessary for treatment are far outweighed by the potential danger of your staff taking action without necessary information.