Confidentialty Issues

[Gerry Clinchy]

I participated in a local phone conference call-town hall meeting last night. It was a county-level group, which also include Charles Dent our local US Representative.

A county social worker called in. She brought out two issues.

1) As a field worker, she was visiting a family. It appears that she was also accompanied on that visit by at least one other agency colleague. She felt "uncomfortable" in the home, but could not pinpoint the reason. The other co-worker expressed the same feeling. To satisfy her curiosity, she did an internet search and found that the man in the family had been convicted in another state for disseminating child pornography and had also been arrested for murder (she did not have further info on the latter).

Her concern was that county workers would be sent into such situations with no knowledge of this "history". She presumed that there were other agencies in the county that would have had this information, but it was not conveyed to her department. She had to research the information independently. She actually questioned whether, she as a middle-aged woman might actually have been placed in a dangerous situation by not having this knowledge. Sounds reasonable to me that she should be able to prevent herself from being put in a dangerous situation. She's not getting "combat pay" to be a social worker.

2) In visiting families she has seen evidence of drug abuse and dealing, as well as seeing other violations of agency rules, such as people living in the home who are not authorized to be living there; and illegal aliens receiving these county benefits. County policy prevents her from breaching confidentiality by reporting any illegal activities that she may find in a client home. Does this make any sense?

Is there no law that REQUIRES one to report a law being broken?

[dnf777]

Wow. Tough questions. At least for a free society to answer. Recall the legal hurdles the "registered sex offender" laws faced. Only after showing that sex offenders continue to pose a real threat to society, even after "paying their debt", did the courts allow those requirements. Invasion of privacy was the main argument. There's nothing stopping a SW from checking public databases prior to visits, and it sounds like she would have know about this before hand if she did. (what to do with that knowledge?)

Question two reminds me of the herion-high pregnant ladies that would deliver babies in Philly, that would scream and wail in high-pitched tones in the nursery at 2-3 days old as they went through heroin withdrawl. I always said they should drug test, and slap cuffs on mothers who endangered the lives of their babies. If she had injected her newborn with herion, we would arrest her. Giving it to them trans-placentally warrants no consequence. The logic here is that you would only arrest ONE, and word would get on the street, then those babies would still get heroin, but would be delivered in alleys and have NO medical care or chance. The same logic applies to the SW visits. Usually, there's concern for the welfare of children that prevents law enforcement from occuring. (how's THAT for paradox?)

Also, many confidentiality policies are not so much designed to prevent reporting, but rather to prevent being COMPELLED to report, for various reasons. Few rules have been subjected to more twisting of the original intent than privacy laws.

Not sayin' I agree or disagree.... just what I've seen in the healthcare field.

[Gerry Clinchy]

You are correct that the SW could check the public databases ... however, her point was that some other department probably had the information already.

The implication was that she did this checking on paid time, that she should not have to do this, but, rather, some other department that already had the information should alert a social worker.

Since the SW must maintain confidentiality, wouldn't that be like a doctor transmitting records of a patient to another doctor? Both must maintain confidentiality except to help the patient. Knowing that information could actually help the SW in her goal of working with her clients.

Perhaps the drug usage is "private", but drug dealing is a crime.

The other issue is the agency qualification based on who is living in the household. Do you continue to provide agency services for those who are not qualified? How do you know that if the SW providing the services; the only person able to verify the information cannot disclose that?

[dnf777]

Since the SW must maintain confidentiality, wouldn't that be like a doctor transmitting records of a patient to another doctor? Both must maintain confidentiality except to help the patient. Knowing that information could actually help the SW in her goal of working with her clients.

Yes, but you'll find nobody is interested in protecting or helping those who help others! :(

Perhaps the drug usage is "private", but drug dealing is a crime.

Drug usasge is a crime as well. The frustrating point however is that ANY reporting of any crime will deter those people from seeking help, and that may put children at risk. Again, I don't necessarily agree, but thats what seems to hold up every day! Like I said, there's more interest in helping and protecting those people, than the ones helping them!

Believe me, it's frustrating as hell. I remember as a medical student, my truck was stolen from the ghetto apartment I lived in. Couple days later I remember a SW giving cab fare to a vagrant in the ER so he could get a ride home. I had to walk. I remember asking her if putting needle marks on my arms would get me a ride home?

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