Introduction
In the 2019 legislative session, the upper house of the Legislature, the Florida Senate, passes Senate Bill 1418 (SB1418) concerning the disclosure of patient information from clinical records to law enforcement agencies by health care professionals. The SB1418 took effect on July 1, 2019, shortly after being passed (Florida Legislature, 2019). Overall, the Senate Bill under consideration is in force throughout the state of Florida.
Summarized Legislation
Summary
The SB1418 concerns the disclosure of information shared by patients to law enforcement. It requires mental health and psychiatric care service providers to relate information communicated to them by their patients if it concerns “threats to cause serious bodily injury or death” (Florida Legislature, 2019, p. 1). Under the term “service provider,” the bill lists clinical social workers, mental health counselors, marriage or family therapists, clinical psychologists, physicians, and psychiatric advanced practice registered nurses (APRNs) (Florida Legislature, 2019). Service providers are expected to reveal declarations of intended harm to others regardless of whether the identification of the potential victim was made. In addition, the communication of the patient relating threats of harm to others can serve as a basis for involuntary psychiatric examination (Florida Legislature, 2019). Thus, SB1418 obliges service providers to disclose information related to patients if there is a clear intent to harm unidentified or identified persons.
Relevant Facts
Disclosure of patient communications that may concern third parties is a serious ethical issue. The Health Insurance Portability and Accountability Act (HIPAA) prohibits health care workers from relating patients’ private information, including their communications with their service care providers, to third parties (Edemekong et al., 2022). Furthermore, divulging patients’ statements may threaten the therapeutic alliance and adversely impact the clients’ progress (Holland et al., 2021). Nevertheless, it should be noted that mental illness and criminality are closely linked, and persons with diagnosed mental health problems are at a higher risk of committing violent acts (Hall et al., 2019; Whiting et al., 2021). Considering these facts, health care professionals should comply with SB1418.
Role of APNs
Advanced practice nurses (APNs) working with patients with diagnosed mental health issues are mandated by the SB1418 to share with law enforcement agencies if their clients made statements of intent to harm others. In addition, if the case is severe, APNs can execute a certificate of observation to support the need for involuntary observation of a patient (Florida Legislature, 2019). Thus, APNs are expected to play a critical role in reporting threats of harm to law enforcement made by their patients.
Strengths and Weaknesses of the Legislation
Strength: Law Enforcement Involvement
The main strength of the legislation under consideration is the inclusion of health care workers and law enforcement officers in the bill’s text. The SB1418 requires reporting from all care providers who learned from their patients about the potential harm they might cause to other persons. Moreover, it dictates that law enforcement agencies investigate such claims seriously, with potential victims being warned if named.
Strength: Victim Identification and Involuntary Examination
Another strength of the bill is its consideration of vague threats made by patients with mental health issues. The bill requires law enforcement to be informed regardless of whether the clients named the victim they want to harm. In addition, the legislation allows for the observed behavior and verbal communications of threats to serve as grounds for involuntary psychiatric examination. It allows to better address the statements made and decide on the course of treatment if needed.
Weakness: Lack of Training
Although the presented bill is vital for the patient and potential victims’ protection, it does not outline any training that can help service providers recognize whether threats made are genuine or not. The bill would benefit from amendments concerning continuing education programs or in-service training for health care workers working with patients with mental health problems to recognize genuine threats of harm or mass harm to third parties.
Impact of the Legislation
Impact on Consumer Stakeholders
As the legislation is relatively new, having been enacted in 2019, no research has been conducted on its impact on different stakeholders, including consumers. Nevertheless, it can be argued that SB1418 can positively impact patients. Disclosure of intended violent crimes can potentially prevent the offense from taking place. Subsequently, crime prevention translates into the prevention of client incarceration. This is for the benefit of patients as their revelation of the intent to harm others can lead to a more appropriate course of treatment being offered.
Impact on Provider Stakeholders
The SB 1418 has a meaningful impact on the provider stakeholders. The bill mandates the health care facilities in Florida to educate all medical employees and service providers on proper reporting procedures to law enforcement. In addition, health care facilities should establish closer connections with local enforcement agencies to ease reporting (Holland et al., 2021). Overall, the bill under consideration gives additional responsibilities of care for patients and potential victims to health care institutions.
Impact on APRN Practice
As frontline workers in health care, APRNs working with patients with mental health issues are greatly affected by the bill. In particular, they are tasked with reporting to law enforcement the threats of physical harm or death to named or unnamed persons made by their patients in the course of their established professional relationship. Thus, the bill put additional care and harm prevention responsibility onto APRNs.
Conclusion
In summary, the SB1418 enacted by the Florida legislature at the end of the 2019 legislative session requires health care workers, including registered nurses, to disclose any patient communication regarding intended harm to their parties. Any information obtained by service providers in the course of their professional relationship with the patient should be disclosed to protect potential victims and provide better care to the client.
References
Edemekong, P. F., Annamaraju, P., & Haydel, M. J. (2022). Health Insurance Portability and Accountability Act. StatPearls. Web.
Florida Legislature. (2019). Senate Bill 1418. Web.
Hall, D., Lee, L., Manseau, M. W., Pope, L., Watson, A. C., & Compton, M. T. (2019). Major mental illness as a risk factor for incarceration. Psychiatric Services, 70(12), 1088–1093. Web.
Holland, D. C., Newmeyer, M., Holland, J. A., & Quaranta-Leech, A. (2021). Tarasoff vs threat: Considerations for mental health providers navigating legal, ethical and practical variables associated with preventing mass acts of violence. International Journal of Emergency Mental Health and Human Resilience, 23(6), 86–92.
Whiting, D., Lichtenstein, P., & Fazel, S. (2021). Violence and mental disorders: A structured review of associations by individual diagnoses, risk factors, and risk assessment. The Lancet Psychiatry, 8(2), 150–161. Web.