PROFESSIONAL ISSUES

Court says warning is OK, testifying is not

A split among federal appeals courts sends a mixed message on breach of confidentiality and leaves the government considering an appeal to the Supreme Court.

By Tanya Albert, AMNews staff. Sept. 15, 2003.

Physicians should break physician-patient confidentiality and come forward to police if they believe a patient is in danger of harming someone, but they shouldn't testify at a patient's trial, a federal appeals court has ruled.

The 9th U.S. Circuit Court of Appeals in California, in its Aug. 22 ruling, goes to great lengths to differentiate between the two actions, ultimately saying that a physician testifying against a patient in a courtroom would have a far more damaging impact on the physician-patient relationship than a physician going to authorities to report information.

"We know that the initial disclosure to the target or to the authorities can be damaging to the psychotherapist-patient relationship," the court said in its opinion in United States v. Chase. "But we think that a patient will retain significantly greater residual trust when the therapist can disclose only for protective, rather than punitive, purposes."

And the court worries that a patient who has seen a physician testify against him or her in court would be less likely to seek medical treatment later.

"A criminal conviction with the help of a psychotherapist's testimony is almost sure to spell the end of any patient's willingness to undergo further treatment for mental health problems," the court said.

Jeffrey L. Metzner, MD, chair of the American Psychiatric Assn.'s Council on Psychiatry and the Law, said the court's opinion draws a nice line between a duty to protect public safety and testifying in court when safety is not an issue anymore.

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