Exceptions to the "personal rep" rule

Q: I have reason to believe that the personal representative of one of my elderly patients may not have her best interests at heart. Under these circumstances, does HIPAA make any exceptions for how I must treat this representative?

A: Yes. Generally, you can't refuse a patient's personal representative access to restricted information, but you can if you reasonably believe that he or she may be subjecting your patient to violence, abuse, or neglect. You can also deny access if, in your professional judgment, it isn't in the best interests of your patient if you treat the person in question as her personal representative-because, for instance, you believe the person is a potential thief. But, in such circumstances, be prepared to defend your decision in the event that it's challenged.