Abuse or Neglect of a Child or the Elderly or Disabled
The Texas 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 professional 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. 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.
In this Closed Case Study, TMLT explains Suspected child abuse and neglect - reporting requirements for health care professionals (The Reporter, Volume 2 2014).
How to report - child abuse/neglect or of the elderly or disabled living at home:
How to report - abuse/neglect of the elderly or disabled in facilities:
- When an emergency response is needed, dial 911 or contact local law enforcement.
- The Texas Department of Family and Protective Services (DFPS) has a central place to report - child abuse and neglect; abuse, neglect, self-neglect and exploitation of the elderly or adults with disabilities living at home; and abuse of children in child-care facilities or treatment centers.
- In a case that does not require an emergency response and the alleged or suspected abuse involves a person responsible for their care, custody, or welfare contact DFPS. 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 registers, licenses, or certifies that facility.
- Texas Health and Human Services (HHS) - Complaint and Incident Intake - 1-800-458-9858 - to report suspected abuse or neglect of the elderly or people with disabilities and the abuse occurs in nursing homes, assisted living facilities, or day activity and health services, as well as reporting concerns about home health and hospice agencies and intermediate care facilities.
Texas Family Code Chapter 261 Investigation of Report of Child Abuse or Neglect
Section 261.101 Persons Required to Report, Time to Report
Section 261.201 Confidentiality and Disclosure of Information
Section 261.401 Agency Investigation
Texas Family Code Chapter 91 Reporting Family Violence-Notice to Adult Victims of Family Violence
Section 91.003 Information Provided By Medical Professionals
Texas 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.
The following statutes address releasing records for investigation into child, elderly, disabled person abuse:
Texas Family Code Section 261.303
- Investigation of Report of Child Abuse or Neglect - Interference with Investigation, Court Order
Texas Human Resources Code Section 48.154
- Investigations and Protective Services for Elderly and Disabled - Access to Records or Documents
U.S Dept. of Health and Human Services-Office of Civil Rights (HIPAA)
- When the privacy rule allows disclosure of PHI to law enforcement officials.
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 reporting information and resources.
Houston - Disease Reporting phone number: 832-393-5080
City of Houston - Health Department - Epidemiology and disease information and reporting forms
Harris County - Disease Reporting (for areas outside Houston) phone number: 713-439-6000, and after hours 713-755-5050.
Harris County Public Health - Main page
Harris County Public Health epidemiology program - Reporting information page
Harris County Public Health epidemiology resources - Resources page
State - Department of State Health Services (DSHS) - Infectious Disease Control Unit, Phone: 512-776-7676, Fax: 512-776-7616
Main page for information and topics - TX DSHS Infectious Disease Control Unit
Lists of notifiable conditions, instructions - TX DSHS - Notifiable Conditions
Forms for reporting communicable diseases - TX DSHS - Reporting Forms
Main newborn page for information and updates - TX DSHS - Newborn Screening
List of newborn conditions - TX DSHS - Newborn Screening List of Disorders
Federal - Centers for Disease Control and Prevention (CDC) Phone: 1-800-232-4636 (800-CDC-INFO) (Disease)
CDC - Centers for Disease Control and Prevention
For statutes on reporting communicable diseases and some other conditions:
Communicable diseases - Texas Health and Safety Code Chapter 81
Occupational conditions -Texas Health and Safety Code Chapter 84
Injury prevention and control - Texas Health and Safety Code Chapter 92
Reports of childhood lead poisoning - Texas Health and Safety Code Chapter 88
Screening and treatment for tuberculosis in jails and other correctional facilities - Texas Health and Safety Code Chapter 89
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 Texas Health and Safety Code Section 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. The release of this information is an exception to the patient-physician confidentiality requirements. Section 12.098 Liability explains that a physician may not be held liable for a professional opinion, recommendation, or report.
When a report is received by DPS, the driver is notified in writing and is required to provide medical information 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 Medical Evaluation Process for Driver Licensing page.
- For additional info and resources for physicians, including a Physician Referral Form, 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.
Below is the TMA 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 and the Health of the Community Opinion 8.2 Impaired Drivers and Their Physicians.
Overdoses from Penalty Group 1 controlled substances such as opioids, cocaine, and methamphetamines are to be reported to the Texas Department of State Health Services (DSHS). Refer to a TMA article for more info. Penalty Group 1 drugs are listed under Texas Health and Safety Code Section 481.102.
How to report:
Texas Health and Safety Code Section 161.042 requires physicians or the person in charge of a facility in which an overdose occurs or is treated to report the overdose to DSHS via an electronic form.
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 medical, mental health, or law enforcement personnel of threats made by patients, but they are not required to do so. However, please note: there is NO exception in the statutes that provide for disclosure to third parties threatened by the patient.
Regarding mental health records, Texas Health and Safety Code 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, mental health, 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 information to law enforcement about a patient if the professional believes the patient is a danger to himself or others. TMLT has reprinted the letter (The Reporter, Volume 4 2013). The letter reminds professionals to follow the laws of the state where they practice.
AMA Code of Medical Ethics under Privacy, Confidentiality and 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 a 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.