Do Advocates Have a Duty to Report Dangerous Patients?

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Warning! This will be one of those posts you think back to from time to time, because the answers aren’t clear or easy, and the stakes are so high.

danger

A few weeks ago we all watched the news about 150 people who lost their lives as their plane crashed into the French Alps; a tragic loss of life which we learned later was caused by the co-pilot, who had intentionally crashed the plane – suicide by one – mass murder of 149 others.  Horrible, tragic, and just so very, very sad.

It’s easy, of course, to dismiss the young pilot as crazy – depressed, suicidal, truly an example of mental health gone awry.  But if you’re like me, the next thought that pops into your head is a question, “Could it have been prevented?”

Once I learned of the pilot’s mental health issues, and the fact that his doctor had written a note to keep him from working, I wondered how exactly that had taken place. Writing a note isn’t the same as actively reporting to the authorities (whoever those authorities might be) unless a copy of the note was delivered to those authorities… (And as an aside, I wonder if the doctor stopped at handing the patient-pilot a note telling him not to fly, and didn’t report it to the right authorities, and if so, how does he sleep at night?)

But even more importantly, what are the rules or laws in the US? Is there any responsibility to report a patient who is dangerous to himself, or certainly others? Could a provider be held legally responsible if he did – or didn’t – report?  How does HIPAA affect the assignment of responsibility? If there is a duty to report such a patient, where is the line drawn? How does that reporting take place?  And how does one decide whether a patient is truly dangerous to someone else, or just him/herself – or even truly dangerous at all?

…..(sidebar)

I’ve been there. I’ve reported.

When I was a first grade teacher, many (many!) moons ago, teachers were mandated to report suspicion of child abuse among our students. One of my students, David, repeatedly came to school with black and blue marks, or a sore arm…. I would ask him how he got hurt and he had a new story every time — including the day he came to school with a black eye. When I asked him how he had gotten a black eye, he responded, “My mother said I fell down the stairs.”

And then I knew I had no choice but to report David’s situation. I was so upset to be put in that position! I was in my mid-20s at the time; still wet behind the ears. My hesitancy was a fear that when I reported it, David’s life would become even more difficult for him. Would he be taken away from his mother, perhaps thrown into foster care? If so, would that be a good thing in the long run? Or?

But none of those questions were mine to ask or answer. The law was the law. And I reported David’s injuries to state authorities.*

…..(end of sidebar)

Healthcare Professionals and the Duty to Report

So out of curiosity, I went looking for answers to my questions about providers and dangerous patients, and I learned something I had never known before, even after ten years of helping patients become smarter about navigating their care.

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Helping Your Clients Deduct Your Services From Their Income Taxes (IRS and CRA)

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It’s a good year to revisit patient advocacy services and income taxes. Our first review came in 2010. We looked again in 2013.  While little (maybe nothing) has changed, this year I have a new suggestion for you – a bit of a twist.

In question is whether or not your patient advocacy services should be included in the list of medical expenses that allow them to be deducted from your clients’ income taxes;  whether they can be used to reach that 10% or 7.5% threshold that allows them to be deductible (for the IRS).  This is all not-so-clearly spelled out in Publication 502 from the IRS and on this list of eligible medical expenses from the CRA.

If your services ARE deductible, that’s a huge WIN-WIN – for you and your client. It makes your services more affordable.

But “not-so-clearly” is still a problem in 2015. As mentioned in previous years, patient advocates or navigators or health advocates or coaches – none of these are specifically included in the list of what can be deducted. Many forms of advocacy are covered – but not using any of the terms we use for our work. We just don’t call ourselves the same names as those services that are listed.

Until the deductibility of patient advocacy services either shows up on the list all on its own, or is tested during an audit, we can only guess that they will be, some day, a bona fide, deductible expense.

But it is most certainly an educated guess. Within the existing list, we have plenty of evidence that the services we provide as advocates are/will be eligible expenses, as follows:

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Has Your Work Been Plagiarized?

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computerthiefThey say that imitation is the highest form of flattery.  While there may be some truth to that, there is no truth to the idea that plagiarism is a form of flattery at all.

In my last post I shared with you my excitement at the advent of some new competition in the advocacy space, and gave you a list of six reasons why competition is a good thing, something to celebrate.

But sometimes there’s a downside to competition, too. 

One such competitor to AdvoConnection, a new directory being set up in hopes of taking your money to match you with patients who need you, makes a mockery of the professionalism of advocates, as if we are the used car salespeople of health care.

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Remembering the Mean Girls

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In Fall 2010, about 150 health advocates, many of whom were just considering entering the profession, convened in Washington DC for the Second Annual NAHAC Conference. I was there at the invitation of NAHAC, to both be a vendor, and to give a presentation about marketing for advocates. The conference was a resounding success in my estimation, using my two conference-success measuring sticks: 1. I met so many smart, wonderful, passionate people and 2. I learned so much more than I imparted.

But there was one aspect to the conference that left a bad taste in my mouth, marring the experiences of too many, and lighting a fire under me.

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The Two Pieces of Advice You Will Ignore – Until You Are Burned

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charredConsider these scenarios:

  • Scenario #1. Jane calls you, in a panic. Her mother, age 88, who lives in your city, has fallen at her nursing home. Mother Frederick has been hospitalized, but Jane can’t get there until late tomorrow and wonders if you would be willing to help her mother until Jane can get there. Of course you can! This is the very reason you are an advocate.
    (Alternatively, Jane asks you to review her mother’s medical bills because she’s afraid her mother’s insurance isn’t covering everything it needs to cover. You, as a medical billing specialist, agree eagerly to help out.)
  • Scenario #2. You’re so excited!  You’ve just learned about patient advocacy as a profession and you know it’s a perfect way for you to make some extra money.  So you start asking your friends if they like the idea – they all do – they think it’s a great idea!  You sit down and do the math…  and decide that yup – let’s go – I’m going to be a patient advocate!  You find your first client, Mr. Howard, and you help him to the max! He is thrilled with the work you did for him.  You know you’ve made the right choice. Patient advocacy is for you.
  • Question #1:  Do you see yourself in either scenario?

So let’s continue….

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