Practice Management Q&A

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Fire a staffer; releasing psychiatric records

Can you fire a staffer returning from leave?

Shortly after I bought a practice from a retiring physician, one of his staffers asked for a leave of absence for medical reasons. Now, after five months, she says she's ready to come back. We're managing fine without her. Can I terminate her?

Maybe. Ask your attorney first. If you or your predecessor did anything to give her a reasonable expectation of reinstatement, you could be bound to take her back under state contract law.


Releasing psychiatric records

We've recently added a licensed psychologist to our practice. To safeguard our patients' protected health information we keep separate charts for psychotherapy visits under lock and key. Now our workers' comp carriers claim that, by law, they're entitled to all medical records, including psychotherapy notes, without a written consent from the patient. Should we release them?

It depends. The HIPAA Privacy Rule recognizes that insurers and other entities involved in the workers' compensation system need access to protected health information to resolve claims. It permits you to disclose such information without written consent from the patient.

However, under the Privacy Rule, you may disclose only the minimum amount of protected health information necessary to resolve the workers' compensation issues. So if your patient has filed a workers' comp claim for a straightforward injury he sustained on the job (e.g., his foot was injured when a machine jammed), there's probably no reason to hand over the portion of his records concerning his psychotherapy visits for help dealing with his divorce.

You don't have to make this call, however, under certain conditions: when the patient authorizes the release, when the disclosure is required by law, or when the information has been requested by a state agency which administers a workers' compensation program or a state official who works for that program. In those cases, the law allows you to rely on the assumption that the information requested is the minimum necessary for the intended purpose.

In this issue, the answers to our readers' questions were provided by: Barbara Fick, Assoc. Professor, Notre Dame Law School, Notre Dame, IN; Mark D. Nelson Esq., Drinker Biddle Gardner Carton, Chicago; Michael J. Wiley, CHBC, Healthcare Management and Consulting Services, Bay Shore, NY.

Do you have a practice management question that may be stumping other doctors, too? Write: PMQA Editor, Medical Economics, 123 Tice Blvd., Suite 300, Woodcliff Lake, NJ 07677-7664, or send an e-mail to (please include your regular postal address). Sorry, but we're not able to answer readers individually.