Twyla Roberts works at Marion Home Care Agency as a physical therapist. She offers physical therapy primarily to the elders but will treat children as well. Twyla does a big majority of her work in a home setting. She does treatments throughout the community, and the agency is interconnected with two area hospitals and several outpatient clinics. This type of system allows Twyla to be able to enter patient information into the hospital’s database as well as being able to obtain more information on other activities her patients may have in a larger healthcare system.

Twyla has a patient named, Mary Louis, who is in the system as well as her progress notes being noted after a fall. Mary had released from the hospital after her fall at home. She has seen a surgeon, several nurses, a physical therapist, an occupational therapist, as well as a social worker. After being discharged from the hospital Mary was referred to a home care agency to do a home safety evaluation and ongoing physical therapy to regain strength in her right knee.

Twyla was trained to document all relevant information about the patient; which was a surprise to her own reluctance to record the information her and Mary had talked about that day. While Twyla was doing her treatment session with Mary, she had yelled out that she did not get her injury from a fall. Turned out her injury was from a domestic dispute with her husband who has the middle-stages of Alzheimer’s disease. Mary mentioned that her husband was starting to show more signs of agitation. Mary also mentioned that she done her best to manage is aggressive behavior, but she was unable to. That’s when the incident had happened between Mary and her husband. She mentioned to Twyla that her husband pushed her down the stairs.

Mary was never asked specific questions on how she fell, so when she was placed in the ambulance, she just told them that she had tripped. After talking to Twyla about the incident during their therapy session, Mary had realized that maybe she shouldn’t have told Ms. Roberts what happened. Mary had asked Twyla not to mention anything to anybody because she was ashamed of her husband. She feared that if anyone else found out about the incident it would affect the ability of him staying at home. Despite the abuse she was enduring, she did not want her daughter finding out because she knew that she would put him in a nursing home. She didn’t want to dwell on that situation because she would die if they weren’t together even though he was getting worse.

While Ms. Roberts was completing the treatment, she signs in on her laptop computer and begins to type in her clinical information. When she opened Mary’s EHR (Electronic Health Record), she had seen the social worker Michael White had concerns about her home situation. He had noted that he found Mary’s husband as being quite irritable during hospital visits. Mary was interviewed without her husband by the social worker many times, but she didn’t draw out any information that would classify her husband as being an overt safety risk.

At this point Twyla realizes that if she was to document the conversation, she had with Mary that everyone who can get in the system will know the real reason as to how Mary had fallen. To this point Ms. Roberts wished that Mary wouldn’t have shared that information with her. Twyla had wished that she would have stopped Mary at that point and let her know that she can’t promise to keep the information confidential.

`One ethical standard to the scenario such as this one is

Making Decisions

. For example, After Ms. Roberts had that conversation with Mary, she was left to decide whether she wanted to document the confidential information. Another ethical standard would be

Respect privacy and maintain confidentiality.

An example, the information Mary had shared with Twyla should be confidential, however, because Mary was pushed down the stairs during a domestic dispute with her husband, that labels as serious harm and should be reported.

One regulation that pertains to this scenario is the HIPAA Privacy Rule. Although the incident with Mary’s husband had got out of hand; she still has a right for her medical information to be private. However, if Mary continues to go without saying something or letting someone help her with her situation, she will continue to suffer from elder abuse from her husband.

An ethical solution to this scenario would be exploring the practical alternatives. Twyla could talk to the other interprofessional care team who has also worked with Mary. She should tell Mary that she would keep the conversation they had confidential, but she would like to share it with a trusted colleague. Twyla could also let Mary know that she will not document in the system but give her information to the social worker and go from there.

References:

• American Society for Bioethics and Humanities. (2011). Core Competencies for Healthcare Ethics Consultation (2nd ed.). Glenview, IL: Author.
• Bluestein J.T. The weight of shared lives: truth telling and family caregiving. In: Levine C., Murray T.H., eds.
  
  The cultures of caregiving: conflict and common ground among families, health professionals and policy makers.
  
  Baltimore: The Johns Hopkins Press; 2004:47–55.
• National Center on Elder Abuse. Elder Abuse: Questions and Answers. Washington, DC: National Center on Elder Abuse; 1996
• Tracy C.S., Drummond N., Ferris L.E., et al. To tell or not to tell? Professional and lay perspectives on the disclosure of personal health information in community-based dementia care.
  
  Can J Aging.
  
  2004;23(3):203–215.