The father of 6-year-old Patrick Patterson took him to Baptist Hospital to treat a fractured arm and abrasions. The triage nurse asked Patrick's father what caused the injury, saying the park's jungle gym had fallen on him. During their time in the emergency department, Patrick's father was hesitant to let him be left alone with hospital staff. Based on Mr. Patterson's explanation, the emergency department staff suspected that the injuries were not acquired. If Patrick had fallen from playground equipment and presented for treatment immediately, the abrasions would not have been clean. During Patrick's x-ray, the staff did not allow his father to accompany him. They questioned Patrick about his injuries, and he verified his father's explanation. After Patrick had been questioned, the staff asked him if he was ever afraid of being hurt by anyone at home. He consistently denied abuse or fear of abuse, which was noted in his record.

Before leaving the Emergency Department, Mr. Patterson requested that a notice be placed in the record that he was to be notified before releasing Patrick's records to anybody else. He included in the notice that Patrick's parents are divorced, and his mother, the noncustodial parent, may not access Patrick's records without his consent.

The following weekend, Patrick's mother presented to the Health Information department requesting copies of records of the Emergency Department visit. She stated that she suspected his father had been physically abusing him and wanted to review the documentation.

Discussion Questions

1. Would the hospital be justified in investigating Patrick's mother's concern about abuse?
2. Regarding Patrick's mother's abuse concern, should she be referred to another hospital department or another organization?
3. What internal and external forces impact this case?
4. What are the legal issues addressed in this case? How do state laws address access to health records by noncustodial parents?
5. What are the ethical issues addressed in this case?
6. How would you respond to Patrick's mother if you were the Release of Information Clerk?
7. Using the case method, evaluate possible actions that should be taken and determine the best option.