Dr. Kevin Patterson- The Article

[Blackadder1916]

...  And, it is not privelaged information to say which patient is under your care. 

Actually it is.  Common principles in all (Canadian) personal info protection legislation are that personal information is to be collected only as necessary to accomplish a specific purpose,  that the person about whom the info is collected is aware of the purpose and that disclosure of the info only be made in order that the purpose be accomplished.

I am more familiar with Alberta's Health Information Act (and have had dealings with representatives of Alberta's Privacy Commissioner in regards to health information complaints) but as I cannot access their site for some reason today, I will quote from the guide to BC's Personal Information Protection Act (BC does not have specific health info legislation like Alberta).
http://www.oipc.bc.ca/pdfs/private/a-_GUIDE_TO_PIPA(3rd_ed).pdf

Personal information means information that can identify an individual (for example, name, home address, home phone number, ID numbers), and information about an identifiable individual (for example, physical description, educational qualifications, blood type). Personal information includes employee personal information but does not include business contact information or work product information.

BC regulations may be more appropriate as (from what I got from the news articles) Dr. Patterson practices in British Columbia, so he should be familiar with the specific requirements of his jurisdiction.

As for disclosing information that is already in the news, that doesn't matter.  If a physician acquires personal information about a patient in the course of his medical practice he is bound by confidentiality, regardless what others may know about the patient.  If he is unable to tell his story without identifying a patient (and he doesn't have express permission from that patient to do so), then he doesn't (or shouldn't) tell the story.

 

[Donut]

Not completely on topic here, but an excellent clearinghouse of information on the various pieces of privacy legislation is Privacylawyer.ca

I know he's done a fair amout of work with the CMA, CMPA and various provincial bodies, as well as international privacy law.

PMT

 

[Blackadder1916]

My above post dealt primarily with privacy legislation as regards a physician's practice, but what about his ethical obligations.  However, ethics (or more so the practice of ethical behaviour) are a personal thing and difficult to enforce (thus we have legislation).  When privacy legislation was being proposed in Canada, the medical community did make many proposals that they should be exempt from some of the legislative mandates as they could meet the requirements due to their ethical obligations in the practice of medicine.  The Canadian Medical Association has compiled a Code of Ethics for use by Canadian physicians from which the following section is excerpted:

Privacy and Confidentiality

31.  Protect the personal health information of your patients.
32.  Provide information reasonable in the circumstances to patients about the reasons for the collection, use and disclosure of their personal health information.
33.  Be aware of your patient’s rights with respect to the collection, use, disclosure and access to their personal health information; ensure that such information is recorded accurately.
34.  Avoid public discussions or comments about patients that could reasonably be seen as revealing confidential or identifying information.
35.  Disclose your patients' personal health information to third parties only with their consent, or as provided for by law, such as when the maintenance of confidentiality would result in a significant risk of substantial harm to others or, in the case of incompetent patients, to the patients themselves. In such cases take all reasonable steps to inform the patients that the usual requirements for confidentiality will be breached.
36.  When acting on behalf of a third party, take reasonable steps to ensure that the patient understands the nature and extent of your responsibility to the third party.
37.  Upon a patient’s request, provide the patient or a third party with a copy of his or her medical record, unless there is a compelling reason to believe that information contained in the record will result in substantial harm to the patient or others.


I suggest that Dr. Patterson failed to meet the ethical obligations of his profession.  Hopefully it can be be shown that he failed to meet 'legal' obligations as well.

 

[geo]

Meanwhile this is happening in the states...
The plastic surgeon who did Boob enhancements for Anna Nicole Smith is releasing (selling) the video to the public of the surgical procedure.  While the executor of her estate (Stern) is complaining & threatening, the MD is claiming that, once the patient is deceased, the caregiver confidentiality obligation ends.....

Without being the same situation.... similar ethical issues.

 

[RHFC_piper]

once the patient is deceased, the caregiver confidentiality obligation ends.....

I have actually heard this before, many times and in many contexts (including the death of a close friend), as well as in movies and TV shows (I know.. not a good point of ref), but is this actually legal in Canada, is it a US thing, or is it just a steaming pile of movie magic?
I've been trying to find some kind of legal precedence or reference to this, in Canadian legal terms, and have been unsuccessful, especially since I don't know even whete to start looking.

Can anyone shed some light on this... 'cause if this is the case here in Canada, than this Doc is in the clear for sure.

 

[geo]

well... you could consider the boob job as a test case - stay tuned, do not adjust your set

 

[RHFC_piper]

well... you could consider the boob job as a test case - stay tuned, do not adjust your set

Heh... that whole case is about the adjustment of a set.  > (I know, bad joke.)


All joking aside, is there any legal precedence in Canada WRT caregiver / patient confidentiality being lost at time of death?  And would precedence set in the US hold water here?

 

[Blackadder1916]

Perhaps one of the shysters lawyers who post on these means may have a more current "legalistic" answer.  My frame of reference is in health administration.

The following is probably a good answer, though there has been changes in Canadian info privacy legislation since it was written. 

Legal: Does confidentiality continue after death?
http://www.parkhurstexchange.com/qa/A.php?q=/qa/Legal/1998-08-07.qa

"Do you need authorization for release of medical information if the patient has died, and if so, who authorizes this?" wonders GREG KARAGUESIAN, MD, of Haliburton, Ont. 
   
I presume you are asking this question as an individual and not as a representative of an institution, in which case the Freedom of Information Act would apply. Although you don't say why the information is needed (for example -- research, study, statistics, court action, potential serious harm to a third party), I would suggest that you not release any information until you are ordered to do so by a court of law. The only explicit reference of which I am aware with regard to the continuance of patient privilege after death is in the World Health Organization's International Code of Medical Ethics which states that the physician must keep secret all he or she knows about the patient, even after the patient's death. The right to privacy is of fundamental importance, and the law is designed to protect us against the loss of dignity that may result from exposure of intimate details of our private lives. That protection doesn't simply evaporate with death. Only the patient has the power to release the physician from his duty of secrecy. Even under the Freedom of Information Act, the powers of a deceased individual may be exercised by his personal representative (executor or heir) only if the exercise of the power relates to the administration of the individual's estate. The other side of that coin is that the representative of the deceased can also act on his behalf where his rights have been breached; the release of privileged medical information might be considered such an instance, and therefore the heirs could sue. Information given to a physician in confidence is not always protected from disclosure in the courts. The Supreme Court of Canada held in 1992 that in the exercise of its discretionary power, the Court must balance the individual's claim to privacy against the interest of justice. In avoiding a miscarriage of justice, the public interest is more important than doctor-patient privilege. Consequently, under certain circumstances, a court of law can order medical records or physician testimony to be produced. To protect yourself from possible court action, wait for a court order before releasing confidential information, or get a legal opinion if you think there may be overriding public interest or danger to a third party. JF

The following from the American Medical Association Code of Ethics
http://www.ama-assn.org/ama/pub/category/8354.html

E-5.051 Confidentiality of Medical Information Postmortem

All medically related confidences disclosed by a patient to a physician and information contained within a deceased patient's medical record, including information entered postmortem, should be kept confidential to the greatest possible degree. However, the obligation to safeguard patient confidences is subject to certain exceptions that are ethically and legally justifiable because of overriding societal considerations (Opinion 5.05, "Confidentiality"). At their strongest, confidentiality protections after death would be equal to those in force during a patient's life. Thus, if information about a patient may be ethically disclosed during life, it likewise may be disclosed after the patient has died.

Disclosure of medical information postmortem for research and educational purposes is appropriate as long as confidentiality is maintained to the greatest possible degree by removing any individual identifiers. Otherwise, in determining whether to disclose identified information after the death of a patient, physicians should consider the following factors:

(1) The imminence of harm to identifiable individuals or the public health

(2) The potential benefit to at-risk individuals or the public health (eg, if a communicable or inherited disease is preventable or treatable)

(3) Any statement or directive made by the patient regarding postmortem disclosure

(4) The impact disclosure may have on the reputation of the deceased patient

(5) Personal gain for the physician that may unduly influence professional obligations of confidentiality

When a family member or other decision maker has given consent to an autopsy, physicians may disclose the results of the autopsy to the individual(s) that granted consent to the procedure. (IV)


Issued December 2000 based on the report "Confidentiality of Medical Information Postmortem," adopted June 2000. Updated December 2001 (Arch Pathol Lab Med. 2001; 125:1189-92).

In the USA there's probably not as much legislative protection of personal/medical information as in Canada, so I won't speculate on the 'legal position' of a plastic surgeon releasing a video of a patient's procedure, but I would consider him an unethical turd.

 

[geo]

yup.... but a rich unethical turd.....

 

[Danjanou]

And to toss another can of naptha on the fire, here’s our national moonbat collectives take on the whole thing. http://www.rabble.ca/babble/ultimatebb.php?ubb=get_topic&f=2&t=009492

I particularly like the second post on why we shut down outgoing comms after and incident.

 

[Greymatters]

'Like' in a negative or positive way?

 

[Danjanou]

'Like' in a negative or positive way?

One of these days we need to get that sarcasm smiley for here

 

[Greymatters]

One of these days we need to get that sarcasm smiley for here

I thought it was this one?  :

 

[3rd Herd]

Further from the Globe and Mail:
"Ms. McKennitt lashed out at Kevin Patterson, the B.C. doctor and author who used the death of Corporal Kevin Megeney, a Nova Scotia reservist, on the operating table as the climax of a 7,000-word memoir he penned for Mother Jones magazine about his month working at the base hospital in Kandahar."

"Dr. Patterson has conceded he never asked permission from the Megeney family before writing the account. His actions are currently the subject of two separate investigations by the Department of National Defence, which had hired him as a civilian internist to work at the military hospital because of a shortage of military doctors."

"Medical ethicists and doctors say that Dr. Patterson may find himself under investigation for breaching his responsibilities as a physician by the B.C. College of Physicians and Surgeons, which is responsible for his medical licence."

"Ms. McKennitt is honorary colonel of 435 Squadron, a search-and-rescue squadron based in Winnipeg."

Source:
ALAN FREEMAN,  "Canadian singer enters the fray over MD's story of soldier's death", August 9, 2007
http://www.theglobeandmail.com/servlet/story/LAC.20070809.DOCTOR09/TPStory/TPInternational/Asia/

 

[Scotian]

Lots of good points here.  I confess that, after reading the entire article, the idea of the deceased soldier's family being upset at the gruesome depiction of his death didn't cross my mind at all.  What caught me was the concept of troops from so many different countries, in the same war, same wounds, same hospital . . . but, despite that, different care, different habits, etc.

I think that many of the people who responded so negatively to that article were the victiams of massive email forwardings, and I doubt many of them took the time to read the whole article.  Now, if the immediate family of the soldier was so absolutely outraged at the description of their son's death, they had the right to be (not that it would have made a huge difference).  However, they were not.

This was a -good- article.  It was real, touched on human issues, and I would like to see more like it.

 

[Blackadder1916]

Something about closing the barn door comes to mind, but I suppose when the original contract was drafted the expectation was that a physician would adhere to his ethical obligations.

Department of Defence muzzles civilian MDs http://www.theglobeandmail.com//servlet/story/RTGAM.20070816.wmotherjones16/BNStory/Afghanistan/home

Publication of article describing soldier's death in Afghanistan prompts DND to warn physicians not to release sensitive information
ALAN FREEMAN From Thursday's Globe and MailAugust 16, 2007 at 4:28 AM EDT

OTTAWA — Stung by the publication of a magazine article by one of its doctors that includes the graphic description of the death of a Canadian soldier in Afghanistan, the Department of National Defence has changed its contracts with civilian physicians, warning them not to release sensitive information and to respect patient confidentiality.

The changes to contract wording were ordered on July 30, coinciding with the appearance in Mother Jones, a U.S. magazine, of a memoir by Kevin Patterson, a B.C. physician, describing the month he spent working on contract to DND at a coalition military hospital in Kandahar.

The article includes several passages describing, in excruciating detail, the death on the operating table of Nova Scotia Corporal Kevin Megeney. Family members and friends have objected to the portrayal as a breach of the doctor's responsibility to keep patient dealings confidential. The department has launched two inquiries into the incident.

Lieutenant-Commander Pierre Babinsky, a DND spokesman on justice issues, insisted the new contract wording was not changed because of the Mother Jones controversy, but conceded they could be seen as linked. "This is not directly in response to the article, but it does cover some of the issues that raised concern from the article," he said.

The new contract wording deals with the need for confidentiality, not just in the case of patients but for operational security reasons as well. A fellow Canadian doctor said he was surprised by the detailed description of the Kandahar base included in the Mother Jones account.

According to the new contract wording, "It is critical to the safety of personnel, as well as the potential success of an operation, that sensitive information not be discussed or released outside the Department/Canadian Forces."

The document goes on to say that "every contractor with access to any information dealing with personnel, equipment or operations has the potential to intentionally or unintentionally provide information that may result in compromise of an operation and/or increase the risk to our people.

"Therefore, it is requested that all contractors refrain from discussing or writing about their deployments except with those personnel who have a need to know."

On the issue of patient confidentiality, the new contract language reminds doctors that they must follow the Privacy Act and rules set by provincial medical licensing authorities, noting that "personal health information will not be disclosed without the consent of the individual to whom it relates or their next of kin, as the case may be."

DND has been hiring civilian doctors to augment its own full-time physicians because of a shortage of personnel, especially doctors experienced in trauma treatment.

 

[geo]

Interesting....
Guess that, because the event took place in a foreign country, the rules & regs of a licencing authority might not have come into force... unless it was stipulated in the contract.

Drat & double drat!

 

[Blackadder1916]

Guess that, because the event took place in a foreign country, the rules & regs of a licencing authority might not have come into force...

Not necessarily.  The conduct/actions of a physician are usually judged by his licensing body (College of Physicians and Surgeons of British Columbia in Dr Patterson's case) in their totality and not always specific to activities that occur only in that jurisdiction.  Dr. Patterson gets to practice medicine (in parts of Canada and overseas with the CF) because the CPSBC says he is competent to do so.  Any action of his part (done anywhere) that brings into question his competency or ethical behaviour or may bring discredit to his profession could be subject to sanctions by his college.  (It was interesting to read some of the discpilinary actions taken against doctors by the CPSBC.)

DND may not have a good case to take legal action against Dr. Patterson because of the wording of his contract.  Based on experience, that does not surprise me in the least.  Additionally, it would be a PR nightmare.  But it does not rule out action by the CPSBC if the doctor's conduct is the subject of a complaint from DND or the patient's family.

 

[Greymatters]

Would there be a time restriction in this clause, i.e. not allowed to speak on the subject for x number of years, or are they talking silence in perpetuity?

 

[geo]

naming names?... probably in perpetuity.
that having been said, the Doc could probably discuss the case, in general terms without naming names.
In this case, Dr Patterson was about as subtle as a blunt pick-axe AND he may yet feel some pain for having been too free wth discussing some of his "life events".