Basic to all public health is the reporting of communicable diseases, hazardous conditions, and
injuries that are of public health significance. This information is used for tracking the course of
epidemics and for intervening to protect the public health. Reporting duties transcend the patient's
right to privacy and the health care provider's obligation to protect the patient's confidential
information.
The constitutionality of reporting laws has been upheld in several recent U.S. Supreme Court
decisions. In a case involving the reporting of controlled substance prescriptions, the Court
addressed many of the concerns about public health reporting. The Court first noted that common
law did not recognize the right to withhold medical information from the state. Such a right of
physician-patient confidentiality arises from state or federal law and is subject to limitations such
as public health reporting. The Court then held:
Unquestionably, some individuals' concern for their own privacy may lead them to avoid or to
postpone needed medical attention. Nevertheless, disclosures of private medical information to
doctors, hospital personnel, insurance companies, and public health agencies are often an
essential part of modern medical practice, even when the disclosure may reflect unfavorably on the
character of the patient. Requiring such disclosures to representatives of the State having
responsibility for the health of the community, does not automatically amount to an impermissible
invasion of privacy.[Whalen v Roe, 429 US 589, 602 (1977).]
Every state has laws that require physicians to report certain diseases and injuries to a local or
state health officer.[Chorba TL, Berkelman RL, Safford SK, Gibbs NP, Hull HE Mandatory reporting
of infectious diseases by clinicians. JAMA. 1989;262:3018-3026.] Many extend this requirement to
nurses, dentists, veterinarians, laboratories, school officials, administrators of institutions, and
police officials. For some diseases, health care providers are required to report only the number of
cases they see. Other diseases and conditions require health care providers to give identifying
information, such as name, address, occupation, and birth date, as well as information on the
disease and how it might have been acquired.
While states vary somewhat in which diseases must be reported, there are about 60 diseases that
are commonly reportable in all jurisdictions. The state health department can provide information on
which diseases to report and to whom the reports should be directed. Most health departments will
accept reports for diseases that are not on the state list of reportable diseases, although they may
choose not to act on them. Health care providers have no legal liability for making a report that is
not required.
HIV is the only disease where there is a significant difference in state reporting procedures. AIDS is
reportable by name in all states and has been since the beginning of the epidemic. When the test
for HIV was developed, many states required the reporting of HIV because it is the causal agent for
AIDS and standard public health practice is to revise reporting practices when the causal agent for
a disease is discovered. In several states, however, there was political opposition to HIV reporting
because of the fear that public health officials would not protect the confidentiality of the reports
and would use the information for improper purposes. While there is no evidence that this has ever
happened, there are still states that do not require HIV reporting at the time this chapter was
written.
Legally required disease control reporting is not subject to informed consent. Health care providers
do not need medical records releases for disease reporting because neither they nor their patients
have the right to refuse the release of the information. Although patients have no right to be
informed that they are being reported to the health department, it is good practice to do so for
diseases such as syphilis or measles for which the health department will contact them for
additional information.
Health care providers must never knowingly report false information to public health authorities, and
they are liable for any injuries, such as transmission of HIV or tuberculosis, occasioned by false
reports. Although health care providers are not required to personally investigate the information
that patients provide, they must truthfully report what is known to them. In reality, very few health
care providers do not know their patients' correct names and addresses, because few patients pay
cash for medical care or never need a prescription or other order that requires a correct identity.
Health care providers who provide information in good faith are not liable if the information is
incorrect.
Disease registries are a special class of reporting laws. Most disease registries are statewide and
involve either cancer or occupational illness. Some, such as the CDC registry of cases of toxic
shock syndrome, are national. Reporting cases to the registry may be mandatory or voluntary.
Because the objective is not to control a communicable disease, there is often no penalty for failing
to report to a disease registry. However, it is always desirable to have a complete registry because
registries are used to determine the extent of certain problems in the community and to try to
determine causes. If they are inaccurate they may give false correlations and become useless for
research and prevention.
Every jurisdiction requires health care providers to report certain types of injuries to law
enforcement officials or protection agencies, generally including assaults, family violence, and
criminal activity. Although the victim may have a plausible explanation of the injury and be anxious
to avoid reporting for fear of reprisals or because he is under investigation already, proper reports
should be made despite the victim's wishes. It is not up to the health care provider to investigate
the incident before reporting it; that is the job of the law enforcement agency that receives the
report.
Whenever a health care provider suspects that a child has been abused or neglected, that
suspicion should be reported immediately to the child protective agency.[Gaus SM. Reporting child
abuse. "Whistle blower protection" and physician responsibility. Mich Med. 1988;87(4):191-193]
Child abuse is not a diagnosis, however, but a legal finding, and medical personnel who try to
investigate this crime may confuse the evidence to the point that the law enforcement agency
cannot protect the child.[Johnson CF, Showers J. Injury variables in child abuse. Child Abuse Negl.
1985;9(2):207-215] Health care providers should defer to experts in child abuse and neglect rather
than attempting to make an independent determination of abuse.[Morris JL, Johnson CF, Clasen
M. To report or not to report. Physicians' attitudes toward discipline and child abuse. Am J Dis
Child. February 1985;139(2):194-197] The experts will also act as consultants to the courts and
protective services.
Generally, health care providers have a responsibility to report violent or suspicious injuries to the
local law enforcement agency. These include all gunshot wounds, knifings, poisonings, serious
motor vehicle injuries, and any other wounds that seem suspicious. The legal assumption is that
anyone who has knowledge that a crime may have been committed has a duty to report it to the
police. If the patient is brought to the hospital in the custody of the police or from the scene of a
police investigation, then the health care provider may safely assume that the police have been
notified. In all other cases, however, the health care provider should call the police and make the
report.
