Can my therapist speak to my Dr. without my permission?

February 10, 2009 12:55 PM

Can my therapist speak with my medical doctors without my permission?

My therapist and I just ended our relationship because I had (what I believe to be) 3 seizures. I saw a neurologist but have chosen not to seek more medical treatment at this time. My therapist said she wanted to be able to speak with my regular doctor about this, and I told her I did not want her to.

She informed me that, as my therapist, she has the right to speak with my doctors, with or without my permission. Can this really be legal?! I've never talked about hurting or killing myself--why would she have the right to speak to my medical doctor and inform them that I've had seizures (my regular doctor does not know about the neurologist I saw)? Why would my doctor release medical information without my consent? (my therapist also wants to see the results of a bloodtest I took)

My therapist said that all therapists have this right. I never signed anything giving her that right, and I don't remember signing anything saying my medical doctor would be able to release my medical information to a therapist.

Is my therapist full of it?

posted by secretsecret to Health & Fitness (25 answers total)

You should let us know what country you're in, so that we can provide you with an accurate answer.
posted by bshort at 12:58 PM on February 10, 2009

Response by poster: I'm in the USA, specifically California.
posted by secretsecret at 12:59 PM on February 10, 2009

IANAL, but you may want to google "HIPAA privacy rights" and read through them.
posted by roomthreeseventeen at 1:05 PM on February 10, 2009

According to HIPPA your doctors have the right to consult with other doctors that are managing your care. Did your primary care send you to the therapist? I must say that I am wondering just why you would not want your pcp to know about the seizures. When your doctors communicate with each other, it should insure that you are getting the very best medical care you can get. The other issue is that only when they can communicate with each other can you be sure that you are not getting a medication from one doctor that might conflict with medication from another.
posted by JAD'E at 1:11 PM on February 10, 2009

It would be helpful also to know whether the therapist is an MD or what her credentials are -- that might help determine whether she's considered a doctor under HIPAA or not.
posted by chesty_a_arthur at 1:16 PM on February 10, 2009

Response by poster: Thanks, JAD'E. I found the therapist on my own. I've only gone to that medical doctor twice (for something nonrelated), and had them run some bloodwork because my therapist recommended I have a physical (haven't had one in years).

Seizures can't be corrected, and mine are far enough apart that medication would not be necessary. California has very strict DMV laws regarding seizures.
posted by secretsecret at 1:17 PM on February 10, 2009

Medical professionals, and your therapist probably counts as one, generally have the right to speak with other medical professionals about your condition without your express permission. You actually want them to be able to do this, as most of the time it's simply consults, i.e. your primary care physician might call up a cardiologist on a different floor and say "Hey, could you look at this file for me?" Your primary doctor doesn't need to ask your permission to do this, he just does it, and you want him to be able to do it, because this drastically improves your quality of care.

When you started your relationship with your therapist you signed a document indicating you were aware of your rights under HIPAA and the procedures your therapist would be using regarding them. This almost certainly involved granting permission for your therapist to share your information with other medical professionals, and the form you signed for your other doctors would have included this same waiver. So in essence, you already gave your permission for your therapist to gather relevant medical information and for your other physicians to provide it. This is entirely above board.

My question is why you don't want your therapist to know what seem like significantly relevant details about your medical history. Why are you trying to keep your medical information compartmentalized? This is just a bad idea all 'round.
posted by valkyryn at 1:19 PM on February 10, 2009

There's a reason California has strict licensing issues regarding seizures: it's because they can be dangerous not only to you, but as the driver of a vehicle potentially to dozens of others.

Don't try to skirt the law here.
posted by valkyryn at 1:21 PM on February 10, 2009 [11 favorites]

The seizures can't be corrected because of a verified medical condition, or because they are caused by drugs you are doing, that you don't intend to stop doing?

If it's the latter, your therapist has an ethical duty to try to prevent you from harming yourself, and others, which overrides your privacy rights, IIRC, IANAL, IANAD, IANAME (medical ethicist).

That's just one example of a reason why it would be not just allowed, but required, for your doctors to communicate in direct contradiction to your wishes. There could be others. More information on why you think your seizures can't be treated, and why you don't want the best quality of care for yourself, by deliberately withholding information that could be vital to your health, from people you've asked for help, could provide additional insight.
posted by nomisxid at 2:09 PM on February 10, 2009

Response by poster: I know, Valkryryn. But my seizures are sleep associated and occur while my brain is trying to transfer from sleep to being fully awake after being asleep only a short time. This means that if I fall asleep on the couch watching tv for 45 minutes, by the time I wake up and go into another room, I seize.

California DMV automatically pulls your license without any regard to the situations in which your seizures occur.
posted by secretsecret at 2:11 PM on February 10, 2009

Response by poster: Nomisxid, I smoke marijuana, which is legally prescribed in the state of California to treat seizures (including seizures caused be epilepsy). Turns out to be ironic, as I already had a medical marijuana card for my stomach ulcers. I wasn't even aware that people treat seizures with pot. I don't think it controls my seizures in any way, because that would mean that I should have seized when I stopped smoking for a week or 2 in the past. That's the only drug I do, and I'm not on medication.
posted by secretsecret at 2:19 PM on February 10, 2009

I'm an epileptic. I'm also an attorney, but not your attorney. Nor am I barred in your jurisdicition. Those who purport to offer you legal advice on this thread should be ignored. We do not know what you signed and those so commenting have no actual evidence of any facts regarding your relationship with your doctor. Only an attorney in your jurisdiction can do so. A little knowledge is very dangerous.

I suggest you start by contacting the California Association of Mental Health Patient's Rights Advocates. They will probably refer you to a low-cost or no-cost alternative for advice.

Now, as an epileptic, I have to strongly tell you that you need to see a neurologist, immedately. There is a threshold level towards getting a seizure which goes down after you have one. This means it is easier to have another seizure. Three in a short time frame is really dangerous. If you are driving a vehicle, it is doubly the case, as you could put yourself or other, innocent persons at risk. You need to research the effect of these seizures with a medical professional and a lawyer regarding whether or not you are able to drive.

Seek assistance, legal and medical, immediately.
posted by Ironmouth at 2:20 PM on February 10, 2009 [8 favorites]

Can you talk to your therapist about your concerns?
posted by puckish at 2:21 PM on February 10, 2009

I'm reading your question as "How can I hide a medical condition my state considers to be a danger to other drivers?". Unless you are a physician, you can't know that they are far enough apart or not.

OTOH your physician may be able to categorize you as someone who has had seizures in the past but no longer has a chance of having one that should prevent you from obtaining a driver's license.

Please consider the results if you choose to keep your license and it happens again while driving. The laws were put in place for good reason.
posted by variella at 2:26 PM on February 10, 2009

I have a friend who is an epileptic, and who lives in California. The state has pulled her license twice because of seizures. It is not a permanent ban on driving; it is temporary (she got it back in six months, with a letter from her neurologist). There is much more information here about when or if the DMV will pull your license, since you seem to be under the impression (forgive me if I misread you) that if you've had a seizure you can never get a license, or it will be pulled permanently. Neither of these things is necessarily true.

And listen to Ironmouth about the legal stuff.
posted by rtha at 2:48 PM on February 10, 2009

> California DMV automatically pulls your license without any regard to the situations in which your seizures occur.

Yes and no -- considerable weight is put on the recommendation of the neurologist.

IANAD/IANAL, but my wife has some recent experience that may inform on this situation:

Last spring, my wife had a major seizure due to a previously undiagnosed congenital condition. Among other things, this resulted in the suspension of her driver's license for several months. She ended up having surgery to correct the underlying condition, and was prescribed Dilantin as an anti-convulsive. Following the surgery and followup exams, the neurologist rescinded his recommendation that her license be suspended, so she's now driving again. She also has a clean bill of health from the neurologist and has begun to taper off the Dilantin.

In total, her license was suspended from mid-April to late August.

From my perspective as the person who had to do all the driving while her license was suspended, I can say that the CA DMV process seemed fair, if a bit obscure. It leaned very heavily on the recommendation of the neurologist. The decision to reinstate her license was very nerve-wracking for her, but in the end was almost a bureaucratic formality: following the thumbs up from her neurologist, she had a brief phone interview with someone from the DMV, and received a letter a few weeks later that she could drive again.

My point is this: your neurologist has a significant amount of discretion in what he recommends to the DMV regarding your ability to drive. Driving is a privilege, not a right. If he deems that your seizure poses a threat to your ability to drive, it is his responsibility as a neurologist to ask the state to rescind your license. This is your neurologist's call, not your PCP's. So if you've already met with a neurologist regarding your seizures, the cat is out of the bag, and the process may have already been initiated. FWIW, we received the license suspension letter from the DMV approx. one month after the seizure/initial consultation with the neurologist took place.

Good luck to you, and please, take this situation seriously and do not try to prevent doctors from sharing your medical history amongst themselves. Some of us will be sharing the road with you.
posted by mosk at 2:55 PM on February 10, 2009 [3 favorites]

You're not this person over here are you? If so there's a few red flags in your current medical care, and more to the story than you're presenting here. If not then maybe give that thread a read because it's a very similar situation.
posted by shelleycat at 3:01 PM on February 10, 2009 [5 favorites]

You don't sound like you'll be swayed much by the "you're a danger to others" argument, so I'll appeal to your self-interest here.

Seizures are not to be taken lightly, and can be just the first sign of a more serious problem. Just because you've noticed a pattern in when you've had them, doesn't mean they'll stick to that pattern in the future. If you don't see a neurologist and figure out the underlying cause, you're turning what could be a minor issue, easily controlled by the proper meds, into something that quite literally could kill you.

Let's say the next time you have one, you're at home alone, and it's more severe than your last ones. You hit your head on your dresser, your tongue gets lodged in your throat, and you choke to death in your own bedroom, only to be discovered weeks later when the neighbor's dog notices the smell. Do you really want that to be you?

Please, for your own sake, get this taken care of.

(Though I wonder what you'd say if someone argued that he should be allowed to drive drunk because in his own expert opinion, he was a perfectly safe drunk driver. I mean, he'd know, right?)
posted by tomatofruit at 5:16 PM on February 10, 2009

Under certain circumstances, a therapist can talk to anyone, and may even legally be required to talk to someone, about you.

(the following is a derail from your question, my apologies)

What ever you do, please find a good neurologist to work with. You are attempting to self-diagnose on something that is very serious. It's fine to educate yourself about a disease, but you should be working together with a doc you have confidence in.
posted by zippy at 5:24 PM on February 10, 2009

"can talk to anyone other doctors and the state"
posted by zippy at 5:25 PM on February 10, 2009

You may have signed paperwork when you started with your therapist that explicitly gave them permission to speak to your primary care doctor about your treatment and/or condition.
posted by mrbill at 6:18 PM on February 10, 2009

I know every time I've been a doctor, I've signed something agreeing to let that provider talk to any of my other health care providers about my care. It may be something you signed permission for because you didn't read the fine print on your intake paperwork, like HIPAA notification for example.
posted by fructose at 8:12 PM on February 10, 2009

Oops, or what MrBill said.
posted by fructose at 8:13 PM on February 10, 2009

Of course, your local Epilepsy Foundation can also be a really good resource for dealing with seizure-related issues and whatnot. They're going to know more about local laws and whatnot than a bunch of random people on the internet.
posted by ph00dz at 5:42 AM on February 11, 2009

I know my therapist's initial paperwork says she will NOT share information except at my request, even with other professionals. How does your therapist know who your doctor is? And would a doctor be allowed to use information from a third party to turn you into to the DMV? If so, why couldn't the therapist do it herself? I don't know the answer to this- I think you'll have to find a lawyer to ask.

I'm disappointed this has turned into an epilepsy thread, though I shouldn't have been surprised. The OP isn't asking about epilepsy law- he's asking about what the limits of client confidentiality are. I'm sure he's already heard all the tut-tutting he wants from his therapist.
posted by small_ruminant at 11:40 AM on February 15, 2009