Question

An adult female patient presents to the dental office

with fractured teeth, a lacerated lip and a black eye.
She is with her 6 year old son, who is crying and
upset. The dentist's receptionist discretely reports
that the child was asking his mother "Why was
Daddy hurting you?" Upon questioning, the patient
confides that her husband was the source of her
injuries and indicates that she would not be pursuing
any action. She is referred to a specialist due to the
complexity of her dental injuries, but she requests
that the source of her injuries not be disclosed. What
is the dentist's obligation?
A. Respect the patient's request regarding
confidentiality.
B. Report her injuries to an adult protection
agency.
C. Forward all information, including the source of
the injuries, to the specialist.
D. Report the situation to a relevant child
protection agency.

Answer 1

The dentist's obligation may include reporting suspected domestic abuse and potential child endangerment to appropriate authorities, as well as respecting the patient's wishes within the legal framework. HIPAA allows for exceptions to patient confidentiality when mandated by law.

Step-by-step explanation:

In the scenario presented, the dentist has several ethical obligations to consider regarding the patient's confidentiality and potential domestic violence situation. While respecting the patient's request for confidentiality is important, dentists, like all healthcare providers, may have a legal mandate to report suspected cases of domestic violence. Certain jurisdictions require healthcare professionals to report instances where they suspect domestic abuse that has led to serious injury.

The presence of a child in an environment where domestic violence is occurring is an additional factor that complicates the decision. The dentist might be required by law to report to a child protection agency, as children are considered a vulnerable population and are subject to mandatory reporting laws regarding their safety and welfare.

Regarding forwarding information to the specialist, while the patient's specific request for non-disclosure of the cause of injuries should be taken seriously, the dentist must balance this with the requirement to provide the specialist with enough information to treat the patient effectively and safely.

The Health Insurance Portability and Accountability Act (HIPAA) does indeed protect patient confidentiality, but it also allows disclosures without patient consent when required by law. Thus, the dentist must be knowledgeable about and compliant with pertinent laws and regulations regarding domestic abuse and child welfare. The dentist should also provide the patient with resources and support, such as contact information for domestic violence hotlines and counseling services.