Dilemma: Estranged parent's request for record access
A parent of one of your patients rings the surgery to ask for information about her. Under normal circumstances the request would seem reasonable but the daughter’s other parent has previously indicated that this person is estranged from the family, and receptionists say the daughter, a teenage girl, has previously seemed worried about whether her home address would be kept confidential.
I would not break the other parent’s confidentiality by alluding to the fact that there may have been a family break-up
I would explain to the person on the telephone that information about patients cannot be given over the telephone – regardless of him stating that he is the parent of a teenager patient. His or her identity cannot be confirmed over the telephone.
If the person is asking for routinely collected data (such as a home address) I would explain that this can never be given out. If the person is asking for clinical information (e.g. what were the recent results of his daughter’s full blood count test), I would advise that clinical information cannot be given out to third parties over the telephone. Instead he or she would need to gain consent from the teenage daughter and accompany her to a consultation in which the results are given.
If my actions were questioned by the person on the telephone, I would justify them by referring to data protection laws. I would state that in my opinion and experience many teenagers are of sufficient maturity to understand a health professional’s advice (as described in the Fraser Guidelines, also known as being Gillick competent) and so they are able to decide who they want accompanying them to a GP appointment or whether they would prefer to attend on their own. I would reassure the person on the telephone that when I see teenager patients on their own, I always encourage them to inform their parents or an adult that they trust (e.g. an older sibling) about their clinical care.
I would not break the other parent’s confidentiality by mentioning or alluding to the fact that I am aware that there may have been a family break-up, and neither would I break the daughter’s confidentiality by hinting at the fact that she was worried about the confidentiality of her home address.
Dr Alex Sohal is a GP in Whitechapel, London, and the RCGP’s clinical champion against domestic violence.
It may be in the child or resident parent’s interest, depending on the circumstances, to tell them that the other parent had called
My clear duty of care is to the resident parent and child. I need to act in their best interests. With the limited information given, I would take a very cautious approach. Even if the caller is a parent, he or she doesn’t necessarily have parental rights. We don’t know whether he/she might have called all the practices in the area asking for this information.
The resident parent has said that the absent parent is estranged from the family. At its most serious, this could be a safeguarding issue. There may be a history of domestic violence. It may be in the child or resident parent’s interest, depending on the circumstances, to tell them that the other parent had called and if there had been any unintentional disclosure.
The age of the teenager isn’t given. Of course, every teenager has a right to confidentiality provided she is Fraser-competent and there are no safeguarding concerns. This girl has raised unusual concerns about her home address being confidential. I would try to explore this with her and/or the resident parent to ascertain whether this was an unfounded anxiety, or if there was a genuine issue. The notes could then be flagged if there were any safeguarding concerns.
This would be a good subject for staff training for the whole practice. Giving out any patient-related data without permission is a breach of confidentiality. It isn’t clear how the receptionist responded to this request. Staff should just say that the practice does not give out any patient data to third parties.
Dr Marian Davis is a GP in Ludlow, Shropshire, and an advisory council member for the Association for Young People’s Health.
The child’s interest is always paramount
GP practices are increasingly caught in the middle of family disputes and having to mediate in highly emotive situations. Whilst you find yourself ‘piggy in the middle’, it is important to never lose sight of the fact that the child’s interest is always paramount. If you abide by that principle it is unlikely that you will be vulnerable to criticism.
It is important to establish at the outset the relationship of the person calling, and whether they have parental responsibility. Ultimately you need to be satisfied that they do retain PR and as such a legal right to request access to their child’s records. A home address may not be sensitive personal data, but it is still personal data governed by the Data Protection Act 1998.Whilst the other parent cannot overrule a request for information, you may wish to inform them of an application for access so that they may seek their own advice.
In this scenario the patient, a girl is a ‘teenager’ and would be presumed to have capacity to consent to disclosure of information. In respect of applications for access to records under the Data Protection Act, the Information Commissioner’s Office would expect anyone 12 or over to have capacity (though you will still need to exercise your own judgement), and you would therefore normally need their consent for a parent to be making such a request on their behalf. If the girl does have capacity she should be asked sensitively what her wishes are and this should be followed, unless in the unlikely situation this is not in her interest.
Dr Pallavi Bradshaw is a medico-legal adviser at the Medical Protection Society (MPS).
What would you have done in these circumstances? Do you agree with the panel’s advice?
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