• Reporting Duties

    Brief summaries and links for reporting abuse or neglect, communicable diseases, driving ability, or threats of violence.

    For more detailed information, as well as risk management considerations, please refer to the Texas Medical Liability (TMLT) The Reporter 2006 March-April issue Duty-Bound - physician reporting duties in Texas. 

     

    Abuse or Neglect of a Child or the Elderly or Disabled

    The Texas Statutes-Family Code Section 261.101 has rules and guidelines that address requirements for reporting child abuse or neglect. If a physician or other health care provider has cause to believe that a child is being subjected to abuse, then the physician shall make a report no later than 48 hours after he/she first suspects that the child has been or may be abused or neglected or is a victim of indecency with a child. Reports of abuse can be made anonymously.

    Unless waived in writing, the identity of the physician making a report is confidential, and may only be disclosed to a law enforcement officer for the purposes of conducting a criminal investigation or the report, or as defined by confidentiality provisions in Section 261.201 of the Family Code. In addition, the Family Code states that reporting requirements apply regardless of professional confidentiality and licensing laws and rules.

    Similar rules exist requiring professionals to report suspected abuse of elderly or disabled persons.

    The Texas Medical Association (TMA) discusses HIPAA privacy protections and child abuse reporting.

    The Texas Medical Liability Trust (TMLT) advises Suspected child abuse and neglect - reporting requirements for health care professionals from The Reporter 2014 Volume 2 Closed Case Study.

    How to report:

    • When an emergency response is needed, dial 911 or contact local law enforcement.
    • In a case that does not require an emergency response, contact the Texas Department of Family and Protective Services (DFPS) if the alleged or suspected abuse involves a person responsible for their care, custody, or welfare. The DFPS Texas Abuse Hotline is 1-800-252-5400 and operates 24/7.
    • If the alleged abuse or neglect occurred in a facility, contact the state agency that operates, licenses, certifies, or registers that facility.
    • If applicable, the agency designated by the court to be responsible for the protection of children.

     

    Texas Health & Human Services (HHS) - consumer rights and services page
    Texas Department of State Health Services (DSHS) - reporting abuse and neglect page

    Texas Statutes-Family Code Chapter 261 Investigation of Report of Child Abuse or Neglect
    261.101 Persons Required to Report, Time to Report  
    261.201 Confidentiality and Disclosure of Information  
    261.401 Agency Investigation

    Texas Statutes-Family Code Chapter 91 Reporting Family Violence-Notice to Adult Victims of Family Violence
    91.003 Information Provided By Medical Professionals

    Texas Statutes-Human Resources Code Chapter 48 Investigations and Protective Services for Elderly Persons and Persons With Disabilities
    Chapter 48 Definitions, Reports of Abuse or Neglect, Failure to Report, etc.

     

     

    Communicable Diseases and Other Conditions

    Physicians are required to report to health authorities certain communicable diseases and some other conditions. Below are links to local, state and federal websites for more info.

    Texas Statutes-Health and Safety Code Chapter 81 Communicable Diseases

    Houston - Disease Reporting Phone: 832-393-5080
    City of Houston-Health & Human Services Dept for info and a disease reporting packet

    Harris County - Disease Reporting (for areas outside Houston) Phone: 713-439-6000; after hours 713-755-5050
    Harris County Public Health - main page
    Harris County Public Health epidemiology program - reporting info page
    Harris County Public Health epidemiology resources - resources page 

    Texas - DSHS - Infectious Disease Control Unit Phone: 512-776-7676   Fax: 512-776-7616
    Texas Dept of State Health Services Infectious Control Unit - main page for info and topics
    Texas Dept of State Health Services - Notifiable Conditions - lists of notifiable conditions, instructions
    Texas Dept of State Health Services - Reporting Forms - forms for reporting communicable diseases
    Texas Dept of State Health Services - Newborn Screening - main page for info, updates
    Texas Dept of State Health Services - Newborn Screening List of Disorders - list of conditions

    Federal - CDC Phone: 1-800-232-4636 (800-CDC-INFO) (Disease)
    Centers for Disease Control and Prevention

    For statutes on reporting some other conditions:
    Texas Statutes-Health and Safety Code Chapter 84 - Occupational Conditions
    Texas Statutes-Health and Safety Code Chapter 88 - Reports of Childhood Lead Poisoning
    Texas Statutes-Health and Safety Code Chapter 89 - Screening/Trtmt for Tuberculosis (Jails/Correctional Facilities)
    Texas Statutes-Health and Safety Code Chapter 92 - Injury Prevention and Control

    The Texas Medical Liability Trust (TMLT) provides answers to risk management FAQs involving communicable diseases

     

     

    Impaired Drivers

    In Texas, physicians are not obligated to report medical conditions that could affect a patient's ability to drive. Such reporting is strictly voluntary.

    According to the Texas Statutes-Health and Safety Code Chapter 12: 12.096 Physician Report, a physician may inform the Department of Public Safety (DPS) of a patient older than 15 years of age whom the physician has diagnosed as having a health condition that may interfere with the safe operation of a motor vehicle. This release of info is an exception to the patient-physician confidentiality requirements.

    Once a report is received by DPS, the driver is notified in writing and is required to provide medical info from his/her personal physician. When this info is received, the case is referred to the Medical Advisory Board whose members make recommendations or issue opinions to DPS. The final decision to issue, renew, restrict, or revoke a license rests entirely with DPS.

    How to report:

    • A Texas driver may be reported to DPS/Medical Advisory Board by physicians, family, friends, acquaintances, or anonymously. All records are kept confidential and are not included in public reports. For info and the current address to submit a report, refer to the Texas Department of Public Safety Driver License/Medical Revocation page.
    • For addt'l info and resources for physicians, refer to the Medical Advisory Board page under the Texas Department of State Health Services (DSHS). DSHS advises DPS in the licensing of persons having medical limitations that might adversely affect their driving.
    • Texas Medical Association (TMA) E-Tip Get Up to Speed on Driving Rules, Medical Restrictions

     

    Below is the Texas Medical Association Board of Councilors Current Opinion on Impaired Drivers:

    During the course of the patient-physician relationship, a physician may learn that the patient has a physical or mental impairment that might adversely affect the patient’s ability to drive. If the physician believes that the patient has such an impairment, the physician should discuss the risks of driving with the patient, and, with the consent of the patient, the patient’s family, if appropriate, and the means of reducing that risk.

    In situations which the physician believes that the patient’s physical or mental impairment poses an imminent threat to the safety of the patient or others, the physician should advise the patient to discontinue driving privileges. If the physician believes, however, that the patient will not follow his/her advice, it is desirable and ethically permissible that the physician notify the authorities.

    When advising the patient to discontinue driving privileges, the physician also should inform the patient that the physician will report him/her to the authorities as authorized by law if the physician believes that the patient will not follow the physician’s advice.

    The AMA Code of Medical Ethics also provides guidance under Physicians & the Health of the Community Opinion 8.2 Impaired Drivers & Their Physicians

     

     

    Threats of Violence

    Texas statutes allow for an exception to the rule of patient-physician confidentiality where there is a risk of harm to the patient or others. These statutes are permissive - physicians are allowed to inform law enforcement personnel of threats made by patients, but they are not required to do so. However, there is NO exception in the statutes that provide for disclosure to third parties threatened by the patient.

    Regarding mental health records, Texas Statutes-Health and Safety Code Chapter 611 Section 611.004 Authorized Disclosure of Confidential Information allows a permissive breach of patient confidentiality: "A professional may disclose confidential information ONLY...(2) to medical or law enforcement personnel if the professional determines that there is a probability of imminent physical injury by the patient to the patient or others or there is a probability of immediate mental or emotional injury to the patient..." 

    The same holds true for other medical records: Occupations Code (Medical Practice Act) Section 159.004

    In Jan 2013, the federal agency charged with enforcing HIPAA sent a letter to health care professionals clarifying that HIPAA does not prevent them from disclosing info about a patient if the professional believes the patient is a danger to himself or others. TMLT The Reporter 2013 Volume 4 has reprinted the letter

    AMA Code of Medical Ethics under Privacy, Confidentiality & Medical Records Opinion 3.2.1 Confidentiality.

    Risk management considerations from TMLT:

    – When an adult patient makes a threat against another adult, try to engage the patient in a discussion.
    – Ask the patient to check into the hospital or to consult a psychiatrist.
    – If the patient refuses and leaves the office, and the concern is valid, contact the police.
    – Another alternative is to consult with a psychiatrist and consider the option of civil commitment if the patient refuses to check into a hospital.
     If threats relate to a child, state law requires physicians to report the threat.(see Abuse/Neglect above)
    – Careful documentation is essential when dealing with a patient who exhibits signs of potential violence.
    – Document all assessments, evaluations, consultations, and actions taken (and why) and those rejected (and why).
    – Document instructions and info given to the patient and family. Also, note whether they agree with treatment decisions and any noncompliance.
    – It is worthwhile to maintain a list of contacts and resources. Doing so may save time when decisions need to be made and actions taken.