A Request from a Lawyer
I have received a request from a lawyer:
Please provide copies of all notes, records , email correspondence , letters, etc. and other documents of any nature that are in your file, whether in English or any other language, at your earliest convenience.
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My understanding is that I should write a Report and then include the notes. correspondence, etc. Or I can just send the raw verbal material and let them figure out what they need?
Are there any guidelines?
This question is about informed consent. In fact, the insurance companies do obtain a signature that allows them to have the entire chart in a time period. The question is, is this informed consent? Sigh. I don't know how to get at that part of the puzzle.
I often write a quick note back to the insurance company, saying,
"Please provide a more specific request for the claim you are processing, for the chart request is more costly than the patient can afford." (Of course, if the insurance company is paying, this is moot.)
Nancy
If the chart in question is CBT clinic notes, do not include it. In US, CBT notes has not been part of medical chart for years. Some major Ontario hospital has separated such notes from medical chart system (since now it's in electronic form). In Canada this separation has not been advocated enough.
I have found that patients really don't understand what the consent they signed in the lawyer's office means - for example - do they want the results of STD testing given to the lawyer when it has absolutely nothing to do with what the lawyer wants the chart for. I also ask for payment first as I have been burned in the past and if it is a lawyer's office then the patient is paying and often cannot afford the whole chart. i also have not included counselling notes unless absolutely specified and I am sure that the patient knows this is being asked for.
Typically, I call the patient: do they want “the whole chart” or the parts that are relevant?. I also make the patient review what is going out before I send it.
Do not write a report unless it is specifically requested. It rarely is.
Charge the same rates for copying the chart as for WSIB.
I'm assuming this is the patient's lawyer? I usually call the lawyer to clarify exactly what it is that they are looking for to ensure that I am sending everything that they need and nothing that they don't. That being said, lawyers have very high confidentiality requirements, in some ways stricter than ours, and I'm sure they just skim over everything that isn't relevant. As long as the patient signed a consent to release information, I don't think that it should be a problem to send what has been requested.
I would want to make sure I understand precisely what the issue is: the requested information will be used...for what? What is the purpose of the litigation? Is this cause about your client? Why has it been initiated? Read the consent form carefully and ask these questions of the lawyer doing the requesting. Sometimes, these are "fishing expeditions"... Again, it depends entirely who is asking and for what purpose. If in doubt, call your regulatory body (CRPO) and ask to speak to the Director of Practice for guidance.
I would definitely clarify who the lawyer is representing and what the information is required for. I would then consult your regulatory body for specific guidance before you provide any verbal or written information.
It is completely reasonable to ask for context, time period of incident etc.. As a litigation matter, criminal or civil, is the client the defendant or plaintiff. If your notes would only be understood by another trained caseworker / Physician etc. then a report is appropriate to accompany the notes. There is nothing wrong with explaining the request to your client as part of the consent giving process.
A very good question!
To share information about clients, I ensure clients have signed a form in my presence giving consent for information to be shared. This form includes the date this sharing can begin, and the date it is to end, if any. The person(s) or organization(s) receiving this information are identified, and the reason for this information to be shared will have been ascertained and written on the form they have to sign. The form also includes the nature and content of information to be shared.
A request from a lawyer should include a form containing all of the above and the client's signature authorizing its enactment. The client has to confirm this as being valid before I will act on it. If I am not satisfied with the lawyer's form, I may ask the client to fill out my form after I have contacted the lawyer.
Where a court subpoena is received, no client signature is needed since the courts have the authority to order provision of information, but I will let the client know about what is happening if they have not already alerted me to events requiring this. Again, where material is not specifically identified, I would ask the person sending me the subpoena to clarify exactly what is needed.
If a client is incapable of communicating with me, I would ask for a doctor's certificate verifying the client's inability to communicate before responding to a request from a lawyer. Where a court has issued a subpoena, I would at least try to contact the client. Their inability or unwillingness to respond would be established and specified subpoenaed documents would be submitted.
Any thoughts on this, and/or corrections, are most welcome.
David