Weird legal situation-wife wants financial records

[whopper]

I got a patient who I saw for a few years, his diagnosis and most of the medical stuff is not relevant. He would do better with treatment but stayed in the mild to moderate range.

Getting to the point, the patient's wife several month's ago requested all of the patient's financial transactions with my office. So, the obvious out of the way, I told my assistant to tell her no. There's no HIPAA release. So okay fine. That settled the issue for several days.

I later see the patient and he gives me reason to believe his relationship with his wife is now possibly adversarial because divorce was discussed. So, and I have seen this before, I've seen patients sign releases, but when circumstances change want the release rescinded, but forgot they signed a release. IMHO it is unethical and wrong when doctors don't remind patients of signed HIPAA releases when circumstances change, and then the other person who's name is on the release exploits this issue.

So later on she provides us with a signed release (and I'm not handwriting expert but it does look like his signature within reason) for records. Cause I have reason to believe that the signature isn't his (signatures could be faked), cause he never contacted me once and told me he wanted the financial records, cause his relationship with is wife may be adversarial with evidence to back it up, I do the common sense thing. I call him to verify if he signed it and to ask if he himself actually wants the records.

I called over 10x and leave a message stating his wife wants information and I don't know what his opinion is. No answer. He never calls back.

So she again demands the financial records. So I ask, why isn't he asking for them? She won't answer. I did the nicey-nicey thing and called her up, but no answer. She refuses to talk to me except via e-mail, (Which IMHO only made the situation worse, kind of like a flame war on an social media forum where written words heighten tension where as actual discussion could be soothing). Then the last communication she gave out a very direct threat saying she will not communicate with me any further unless it's me giving her the records (tone of the communication was extremely upset and accusatory), and failure to provide her with the records within days will prompt her to seek legal action. Again the patient himself never once requested records nor have I noticed any signs of disability where the wife would have to step-in in a good faith manner if he needed her to do this for him.

So this is my reasoning.
1-I HAVE A FIDICIARY RESPONSIBIBILITY TO MY PATIENT, NOT HIS WIFE.
2-There's a release signed, but this does not entitle that person to the patient's records. HIPAA says a release allows me to share information but doesn't make it that I must share it. Only the patient is entitled to them. I have reasons to doubt the authenticity of the release and evidence to believe the wife has an adversarial relationship with the patient. I call the patient, and despite several calls he doesn't call back, so therefore while I do not believe I'm legally wrong if I give her records (signed release that looks like it's okay), I have good reason the dynamics in the marriage have changed and to believe it is against the patient's interests to give the records. The tension, anger, and lack of answers to questions beg the question that the spouse may have bad intent, and further I believe I don't have to give them to her. I only have to give them to THE PATIENT or his guardian or his estate.

So I get a letter from the wife stating if I don't send her the records "because my husband is entitled to them." (Remember she's not the patient, he is) if I don't send out the financial records she's taking legal action against me.

MY opinion-I don't have to give her the records. I'll be contacting my lawyer. I called the guy again 3x after I got the communication and NO ANSWER (I'm terminating him as a patient saying that this is a serious situation and his lack of communication is significantly contributing to this problem and a violation of our treatment relationship that he already violated in other regards), and see where it goes from there. I'm currently of the opinion I'm doing nothing wrong in a legal or ethical sense, but will possibly have to waste some time and money on lawyer's fees.

Thoughts?

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[splik]

You've done your due diligence. I would just ignore any further communication from the wife. If the patient wants the records he can request them himself. If the patient wants you to release the records to his wife he can tell you that (though typically I don't get involved in that - I will give the records to the patient who can give them to whomever they want).

 

[Crayola227]

Obviously legal counsel is where it is at, but I think you understand the issues and that is my understanding of HIPAA as well. And that even in death, only with the right paperwork can someone besides the patient access them.

 

[Stagg737]

Agree with the above. Unless either he contacts you directly and asks for the records or she produces a court document ordering you to do so, then you’re done. Imo even if a lawyer sends you a note, tell them to get a court order. Risk of potentially inappropriately releasing records seems worse than her making random threats.

 

[Angler]

MY opinion-I don't have to give her the records. I'll be contacting my lawyer. I called the guy again 3x after I got the communication and NO ANSWER (I'm terminating him as a patient saying that this is a serious situation and his lack of communication is significantly contributing to this problem and a violation of our treatment relationship that he already violated in other regards).

100%. You have reason to believe that he isn’t giving consent and that the release is not valid. You could be liable if you release the records because there is reasonable doubt about the authenticity of the signed document. He’s told you that wife could be his adversary. Your attorney should advise.

 

[whopper]

Just wanted to add, the most frustrating situations I've had as a clinician were often times from family members and not the patient.

E.g. I see some 18 year old and that person won't sign a release. Their parent calls me incessantly despite that I tell the person to stop contacting us. Or I see a patient with a drinking problem telling me "I'm only here cause my wife told me if I don't see a doctor she'll leave me but I'm not going to stop drinking." Then the wife calls, there's no HIPAA release and demands to know why her husband isn't getting better. And they won't shut up even though I already know what's going on. This guy doesn't want to stop drinking and is only using me as an obstacle to keep his marriage going a little bit longer. "What kind of uncaring doctor are you?

Or someone calls up, there is a release but the family member wants to make it about them and none of it is relevant to the patient other than to know WTF this person is frustrated by the same family member.

 

[annoyedpsychiatrist]

I got a patient who I saw for a few years, his diagnosis and most of the medical stuff is not relevant. He would do better with treatment but stayed in the mild to moderate range.

Getting to the point, the patient's wife several month's ago requested all of the patient's financial transactions with my office. So, the obvious out of the way, I told my assistant to tell her no. There's no HIPAA release. So okay fine. That settled the issue for several days.

I later see the patient and he gives me reason to believe his relationship with his wife is now possibly adversarial because divorce was discussed. So, and I have seen this before, I've seen patients sign releases, but when circumstances change want the release rescinded, but forgot they signed a release. IMHO it is unethical and wrong when doctors don't remind patients of signed HIPAA releases when circumstances change, and then the other person who's name is on the release exploits this issue.

So later on she provides us with a signed release (and I'm not handwriting expert but it does look like his signature within reason) for records. Cause I have reason to believe that the signature isn't his (signatures could be faked), cause he never contacted me once and told me he wanted the financial records, cause his relationship with is wife may be adversarial with evidence to back it up, I do the common sense thing. I call him to verify if he signed it and to ask if he himself actually wants the records.

I called over 10x and leave a message stating his wife wants information and I don't know what his opinion is. No answer. He never calls back.

So she again demands the financial records. So I ask, why isn't he asking for them? She won't answer. I did the nicey-nicey thing and called her up, but no answer. She refuses to talk to me except via e-mail, (Which IMHO only made the situation worse, kind of like a flame war on an social media forum where written words heighten tension where as actual discussion could be soothing). Then the last communication she gave out a very direct threat saying she will not communicate with me any further unless it's me giving her the records (tone of the communication was extremely upset and accusatory), and failure to provide her with the records within days will prompt her to seek legal action. Again the patient himself never once requested records nor have I noticed any signs of disability where the wife would have to step-in in a good faith manner if he needed her to do this for him.

So this is my reasoning.
1-I HAVE A FIDICIARY RESPONSIBIBILITY TO MY PATIENT, NOT HIS WIFE.
2-There's a release signed, but this does not entitle that person to the patient's records. HIPAA says a release allows me to share information but doesn't make it that I must share it. Only the patient is entitled to them. I have reasons to doubt the authenticity of the release and evidence to believe the wife has an adversarial relationship with the patient. I call the patient, and despite several calls he doesn't call back, so therefore while I do not believe I'm legally wrong if I give her records (signed release that looks like it's okay), I have good reason the dynamics in the marriage have changed and to believe it is against the patient's interests to give the records. The tension, anger, and lack of answers to questions beg the question that the spouse may have bad intent, and further I believe I don't have to give them to her. I only have to give them to THE PATIENT or his guardian or his estate.

So I get a letter from the wife stating if I don't send her the records "because my husband is entitled to them." (Remember she's not the patient, he is) if I don't send out the financial records she's taking legal action against me.

MY opinion-I don't have to give her the records. I'll be contacting my lawyer. I called the guy again 3x after I got the communication and NO ANSWER (I'm terminating him as a patient saying that this is a serious situation and his lack of communication is significantly contributing to this problem and a violation of our treatment relationship that he already violated in other regards), and see where it goes from there. I'm currently of the opinion I'm doing nothing wrong in a legal or ethical sense, but will possibly have to waste some time and money on lawyer's fees.

Thoughts?

Agreed that if the patient wanted his wife to have the records, why couldnt he just give them to her himself? Thats who should give them. I would ignore her until she sends a subpoena for them, but also like you said, try to contact the guy and have him discuss it with his wife; unless for some reason he is fine with her having them and makes that abundantly clear.

But we both know when a spouse is requesting financial records its not typically for altruistic reasons

 

[nexus73]

Why would anyone demand financial transaction records with such intensity unless it was for nefarious purposes? The wife has no reasonable explanation for why she wants them, just that the patient wants them. But to me that's suspicious even if the patient was to request financial history themselves. Do patients actually ask for financial records rather than medical records? If patient actually wanted that you could provide it but seems very irregular.

 

[whopper]

I can see various reasons why someone would want financial records for nefarious purposes. E.g. in a divorce the person could claim their spouse is a psychological train-wreck, lied about treatment, cost the spouse money for the treatment. Anyone with bad intent, intelligence, and creativity could morph the records' data into weaponization.

The intensity suggests something is off, the patient's wife only asking and the patient never requesting himself is also off, add to it he told me he and his wife are having problems. This isn't smoking gun there's something wrong, but definitely enough for me to say I'm not giving them out, nor do I have to give them out. There's a (questionable) release signed, but even with that release signed I only have to answer to the husband, not the wife. HIPAA releases allow me to release information but doesn't make it mandatory. End of story unless he verifies he wants the records.

 

[calvnandhobbs68]

So I get a letter from the wife stating if I don't send her the records "because my husband is entitled to them." (Remember she's not the patient, he is) if I don't send out the financial records she's taking legal action against me.

Document everything you're doing with attempted phone contact records, your discussions with the patient about this, lack of patient indicating that he wants these records released, warn your malpractice insurance about the situation and then let her bring it if she wants. Chances are it's all empty threats or you'll get some BS threat from divorce lawyer that has no legal standing.

The always right answer is also what splik stated above, the patient is always welcome to their own records and can share them with whoever they choose. If he's not interested in getting his own records, that also indicates something weird is up.

 

[comp1]

Stop all communication with the wife immediately including by letters, phone, email, text, social media...however she was trying to communicate. Block however possible. You not only have no patient-doctor relationship with her, you have no relationship with her whatsoever and any further communication with her blurs that line. Definitely agree with terminating the relationship with the husband ASAP. Make that as formal as you possibly can. Only have your lawyer respond to certified or otherwise properly served court orders from her attorneys. If the husband wants records, he can request them himself unless there is some sort of conservatorship in place.

 

[annoyedpsychiatrist]

I can see various reasons why someone would want financial records for nefarious purposes. E.g. in a divorce the person could claim their spouse is a psychological train-wreck, lied about treatment, cost the spouse money for the treatment. Anyone with bad intent, intelligence, and creativity could morph the records' data into weaponization.

The intensity suggests something is off, the patient's wife only asking and the patient never requesting himself is also off, add to it he told me he and his wife are having problems. This isn't smoking gun there's something wrong, but definitely enough for me to say I'm not giving them out, nor do I have to give them out. There's a (questionable) release signed, but even with that release signed I only have to answer to the husband, not the wife. HIPAA releases allow me to release information but doesn't make it mandatory. End of story unless he verifies he wants the records.

yea this screams divorce related. Realistically she needs to cool down, because in the discovery phase of divorce all financial records are typically forced to be provided, from credit card statements to retirement accounts to bank accounts, etc.

There is probably a hidden angle like you said, where she may try to argue he cost her a lot of marital assets for all of his "extensive mental health treatment" and therefore she should be entitled to more in a divorce settlement. Or she may play it further saying that he had to spend so much money because he was unwell during the marriage and caused her psychological abuse. Im sure its something like that. I would not be surprised if she has already started talking to a divorce lawyer and plans on blindsiding this guy.

 

[Candidate2017]

Stop all communication with the wife immediately including by letters, phone, email, text, social media...however she was trying to communicate. Block however possible. You not only have no patient-doctor relationship with her, you have no relationship with her whatsoever and any further communication with her blurs that line.

They say vampires can come into your home only if you invite them in. OP turned into a child psychiatrist and engaged with this non-patient far too much, far too long.

We all make mistakes. Sometimes I inadvertently make eye contact with a homeless person. But won't engage in a discourse on whether I have a dollar to spare. No means no. If someone continues to ramp up an unwanted interaction, the assumption is they are up to no good.

So I get a letter from the wife stating if I don't send her the records "because my husband is entitled to them." (Remember she's not the patient, he is) if I don't send out the financial records she's taking legal action against me.

A patient is entitled to their medical records, but a spouse is not a patient, and financial records are not medical records. End of story. She is not entitled to anything or even sue on his behalf, unless he's dead and she's his rep. I doubt any bloodsuckers with a law degree are interested in doing her bloodsucking.

Still, this may be a good time to up your garlic supplements, wear a crucifix, and carry some stakes.

 

[WisNeuro]

They say vampires can come into your home only if you invite them in. OP turned into a child psychiatrist and engaged with this non-patient far too much, far too long.

We all make mistakes. Sometimes I inadvertently make eye contact with a homeless person. But won't engage in a discourse on whether I have a dollar to spare. No means no. If someone continues to ramp up an unwanted interaction, the assumption is they are up to no good.



A patient is entitled to their medical records, but a spouse is not a patient, and financial records are not medical records. End of story. She is not entitled to anything or even sue on his behalf, unless he's dead and she's his rep. I doubt any bloodsuckers with a law degree are interested in doing her bloodsucking.

Still, this may be a good time to up your garlic supplements, wear a crucifix, and carry some stakes.

Legally, financial records that pertain to healthcare billing are part of the designated set.

"Individuals have a right to access PHI in a "designated record set." A "designated record set" is defined at 45 CFR 164.501 as a group of records maintained by or for a covered entity that comprises the:

• Medical records and billing records about individuals maintained by or for a covered health care provider;
• Enrollment, payment, claims adjudication, and case or medical management record systems maintained by or for a health plan; or"

 

[nexus73]

If was a narcissist, I'd certainly be vindictive if my idiot husband's idiot psychiatrist bolstered his self-esteem to the point he asked for a divorce.

 

[whopper]

In a good faith attempt I called the patient again, after 4 phone calls he picked up, and told him 1-"you're wife is real real real upset" 2-while there's a release did you remember signing it and do you want me to share the records, and 3-he needs to arrange a meeting between his wife, him and I by the next day cause she's real mad and making inappropriate requests and I'd like our treatment relationship to have healthy boundaries and without people being upset. I also told him he simply could've called us to clear this all up.

The guy didn't seem to give a damn either way, said he signed the release, dismissively apologized for his wife and didn't seem concerned.

So he agreed to make the meeting, then didn't do so. So I call him again and he won't answer the phone. Then the wife sends an angry e-mail stating "your attempts to call my husband damage your doctor-patient relationship. Stop calling him."

WTF.

OK I made the last attempt to be a nice guy doctor. I'm terminating this case now.

 

[comp1]

Yeah, wouldn't have done that last communication, but at least it'll all end now.

 

[WisNeuro]

Yeah, wouldn't have done that last communication, but at least it'll all end now.

I think it's good from a CYA perspective. He acknowledged the ROI and data requests. So that can now be documented, and requested records sent. The only thing that could possibly be an issue in this case was if the provider felt that the patient did not have capacity to sign the ROI or is under "undue influence." But, you'd have to have pretty good justification for doing so and not releasing health records.

 

[whopper]

We'll see if this zombie vampire bloodsucker stops coming after my receptionist. Wouldn't be surprised if there's some future related headache issue.

 

[SeniorWrangler]

I’m not a lawyer but sometimes it’s best to just wait for the subpoena.

 

[WisNeuro]

I’m not a lawyer but sometimes it’s best to just wait for the subpoena.

Depends on your state's patient records laws. We have a 30-day limit for legitimate requests here. In the above situation, I would just document well and release the records.

 

[smalltownpsych]

Depends on your state's patient records laws. We have a 30-day limit for legitimate requests here. In the above situation, I would just document well and release the records.

Agree. Since the guy said it was ok to release the records and affirmed that he signed it, I would probably just send it at this point and hope that is the end of it. Since it is just financial records being requested, it sounds like she just wants to deduct that from the settlement as opposed to something more nefarious like suing the psychiatrist for ruining a perfectly good marriage.

 

[WisNeuro]

Agree. Since the guy said it was ok to release the records and affirmed that he signed it, I would probably just send it at this point and hope that is the end of it. Since it is just financial records being requested, it sounds like she just wants to deduct that from the settlement as opposed to something more nefarious like suing the psychiatrist for ruining a perfectly good marriage.

Even is she had this intent, I have a hard time seeing a case like that go anywhere. I can't imagine all but the scummiest lawyers even wanting a piece of that mess.

 

[WisNeuro]

Speaking of those records laws, citing those is a great way to get someone to speed up their forwarding of records to me when I have been waiting.

 

[smalltownpsych]

Even is she had this intent, I have a hard time seeing a case like that go anywhere. I can't imagine all but the scummiest lawyers even wanting a piece of that mess.

Yeah, I was being a little facetious. I was just thinking of an incident at the car repair shop the other day when the lady ahead of us was yelling profanities at the people at the counter for calling her ex-husband. She was going on about this stuff for like fifteen minutes to anyone and everyone who happened to come by. I mused to my spouse, I’m surprised that the marriage didn’t work.

 

[psychma]

I would not have engaged with the wife.