Texas Mental Health Law J. Ray Hays, Ph.D. Directions: To receive 4 hours continuing education credit for psychologists, licensed psychological associates, licensed professional counselors and licensed social workers, for this TPA sponsored home study assignment, you must: 1) Read the book, Texas Mental Health Law, in its entirety; 2) Take the test that follows; Mail or fax the test answers along with $75 (TPA Members) or $135 (Non-TPA Members) to the Texas Psychological Association, PO Box 1930, Cedar Park, TX 78630 or fax to (512) 255-1642. Examinations will not be scored without appropriate fee. You must answer correctly 70% or better to pass the examination. If you do not pass, you may retake the test, with payment again of the test fee. First Name: Last Name: Degree Mailing Address: City/State/Zip: Email: Phone: Visa/MC (circle one): Security Code (3-digit code on signature panel): Exp. Date: Check #: Signature: Date: J. Ray Hays Houston, Texas
Name: Privacy of Information Privacy of mental health information is controlled primarily by Chapter 611, Texas Health and Safety Code. In matters of privacy, confidentiality is a broad based term meaning that the professional will not reveal information received from clients to third parties. Privilege is a narrow term that relates to keeping information from being admitted in court. It is a rule of evidence. In Chapter 611 there are 11 exceptions to confidentiality (611.004) and 11 exceptions to privilege (611.006). Confidentiality 1. Confidentiality of mental health information means that you cannot reveal even the name or identity of a patient (611.002(a). When a patient threatens another person and the professional believes the threat, the professional may do which of the following? Chapter 611.004 A. May tell law enforcement personnel (Duty to protect) B. May tell the intended third party victim (Duty to warn) C. May tell the patient s family D. May restrain the patient until the professional can get help 2. A professional may discuss the treatment and progress of a patient with others involved in the treatment of that patient without getting the written permission only under the following condition: See Chapter 611.004 A. Under no conditions, as patient consent is always required. B. When the others are under the supervision of one professional (the treatment team exception) C. When there is a common professional interest in the care of the patient D. When the closest relative of the patient agrees to the consultation 3. In order to collect an outstanding fee from a patient the professional may: See 611.004 A. Not use a collection agency B. Use a collection agency C. Use a collection agency, but must identify the debtor as a patient D. Use a collection agency only under an assumed name 4. When a patient dies the mental health professional may reveal information about the patient in the following circumstances: See 611.004 A. The right to privacy ends when the patient dies B. To the family of the deceased patient C. To the personal representative of the patient D. To law enforcement personnel when the death might be other than due to natural causes 5. When you have a patient in jail a professional may give information about a patient s treatment to the following persons: See 611.004 A. To no one, as there is no exception for jailed mental patients. B. To a designated person, in order to provide care for the patient C. Only with a court order unless there is an emergency D. At the discretion of the lawyer representing the patient 6. Generally, a patient has a right to see the mental health records that are made about them (611.0045). When can the professional keep a record from a patient? A. The patient always has the right to see everything written about them B. The professional does not the patient that parts of the record are not revealed C. Records may be kept from a patient only if the record is revealed to the closest relative of the patient D. The record may be concealed when the professional believes it would be harmful to the patient
7. When a portion of the record is not being revealed to the patient the professional must do which of the following: See 611.0045 A. Tell the closest relative that a portion of the records is not being revealed. B. Tell the patient in writing the reason for denial to portions of the record C. Tell the patient s attorney the reasons for the denial D. Not tell anyone that portions of the record are being kept from the patient 8. When a summary or narrative of the patient s record is requested by a patient or other person properly requesting release of the record what must the professional do? See 611.0045 A. The professional must never give records to patients B. The professional prepares a summary or narrative and provides these C. The professional should give the whole chart rather than a summary D. The summary should only be given to another mental health professional 9. There are legal remedies for a breach of a confidential relationship between a mental health professional and a patient. What are the consequences of an un-permitted breach of confidence? See 611.005 A. A criminal charge of health care fraud can be filed against the professional B. The aggrieved person has a civil cause of action, may sue the professional C. There is no penalty for a breach of confidence D. The person receiving information improperly is held liable for damages 10. There are legal remedies for a failure to comply with a request for disclosure of confidential information. What are the penalties for a failure to disclose information? See 611.005 A. A criminal charge of health care fraud can be filed against the professional B. There is no penalty for a breach of confidence C. The aggrieved person has a civil cause of action, may sue the professional D. The person receiving information improperly is held liable for damages 11. When may a professional disclose confidential information? See 611.006 A. When the professional is sued in malpractice proceedings B. In a license revocation hearing C. When the patient requests the professional to testify in writing D. When the professional is suing to collect on a debt of the patient 12. Under what circumstances may a patient revoke a consent authorizing release of information? See 611.007 A. The patient may not revoke consent after giving it B. Revocation occurs only after 30 days notice has been given to the professional C. Revocation of consent must in writing, signed, and dated to be effective D. The patient must file a lawsuit to revoke a consent authorizing release of information. 13. When a patient requests a copy of all or part of the patient s records, the professional: See 611.008 A. Within 15 days provides the copy of the records B. May charge a reasonable fee for making a copy of the records C. Informs the patient of the information does not exist or cannot be found D. All of the above Required reporting of abuse, neglect, and exploitation. There are certain exceptions to confidentiality that are not contained in Chapter 611 of the Texas Health and Safety Code, including child abuse and neglect (Chapter 261, Texas Family Code), elder and disabled person abuse Chapter 48, Human Resources Code), sexual exploitation by a mental health provider (Chapter 81, Civil Practice and Remedies Code). The following questions relate to these matters in which a professional may be required to breach a confidential relationship because of public interest in safety issues.
Child abuse or neglect 14. The definition of abuse as it relates to children includes which of the following: See Chapter 261, Family Code A. Mental or emotional injury to a child B. Permitting a child to be in situations where development is materially impaired C. Physical injury resulting in substantial harm to the child D. Sexual conduct harmful to the child s welfare 15. A professional must report child abuse or neglect within what time frame? See Chapter 261.101 Family Code A. Immediately B. Within 48 hours C. Within five days D. Within 30 days 16. Abuse or neglect of children must be reported to whom? See Chapter 261.103 Family Code A. Any local or state law enforcement agency B. The agency designated by the court for the protection of children. C. The sate agency that licenses the facility where the abuse or neglect occurred D. The Department of Protective and Regulatory Services 17. The contents of a report about abuse and neglect must contain which of the following information, if known: See 261.104 A. The name and address of the child B. The name of address of the person responsible for the child C. Any other information pertinent concerning the abuse or neglect D. All of the above 18. When a report of child abuse is made a professional takes what actions? See 261.104 and 261.106 Family Code A. Must give his or her name to the agency, may not report anonymously B. May give his name to the agency, as the name of the reporter is confidential C. Must tell the abuser, if possible, that a report is being made D. Must not tell the abuser that a report is being made 19. A person who fails to report suspected child abuse is subject to what sanctions under the Family Code? See 261.109 A. There is no sanction for failure to report B. Failure to report is a misdemeanor C. Failure to report in a felony offense D. Failure to report results in license revocation Sexual exploitation by a mental health service provider 20. A mental health professional who is told about the sexual exploitation of a patient by a mental health service provider is required to report that conduct (Chapter 81, Civil Practice and Remedies Code). To whom must such behavior be reported? See Chapter 81.006 A. The prosecuting attorney in the county where the behavior occurred B. To the state-licensing agency of the mental health service provider, if any C. The State Attorney General D. Only A and B
21. The report of sexual exploitation of a patient must be made within what time frame? See 81.006 A. Immediately B. Within 48 hours C. Within five days D. Within 30 days 22. A mental health professional that knows of such exploitation but does not report it is subject to what type of sanctions? See 81.006 A. There is no sanction for failure to report such behavior B. Disciplinary action by the professional s licensing board C. Failure to report is a misdemeanor D. Both B and C Abuse of elderly persons and disabled persons is covered in the Human Resources Code in Texas. Such abuse generally refers only to acts of the abused person s caretaker, family member, or other individuals who have ongoing contact with the person. Acts by others would be treated as criminal acts, if the acts reached that extent rather than as abuse. Elder and Disabled Person Abuse 23. Abuse or neglect of an elder or disabled person is defined as what types of behavior? See Human Resources Code A. Negligent or willful infliction of injury B. Cruel punishment resulting in harm C. Unreasonable confinement D. Intimidation 24. Elder abuse must be reported within what time frame? See 48.051 A. Immediately B. Within 48 hours C. Within five days D. Within 30 days 25. The report of abuse or neglect of an elderly person must contain which of the following information? See 48.05 A. The name of the elderly person B. The name of the person responsible for the care of the elderly person C. The nature of the elderly person s condition D. The basis of the reporter s knowledge 26. Failure to report suspected elder abuse results in what type of sanction under the Human Resources Code? See 48.052 A. There is no sanction for failure to report suspected elder abuse B. Failure to report is a felony C. Failure to report is a misdemeanor D. Failure to report results in license revocation Caselaw related to duty to warn/duty to protect. In Texas the duty to warn/duty to protect issues has been the subject of one case which has reached our State s Supreme Court. That case is Thapar v. Zezulka (see page 117) and clarifies what a professional can and cannot do when the professional believes a patient may be dangerous. Since this is a Texas Supreme Court case we can be fairly certain that the court will not make a radical change in the view of the duties and responsibilities of a professional unless there are radically different circumstances presented by a case. The following question relate to the case of Thapar v. Zezulka.
27. The plaintiff, Lyndall Zezulka, claimed that Dr. Thapar did not warn her of Ms, Zezulka s son s threats against her husband that he later carried out by killing Henry Zezulka. What was the Court s holding in this case? A. The psychiatrist should have notified the family of the patient s threats B. There was a duty to warn of the threatening statements by the patient C. Warning the victim is not permitted by 611004(a)(2) of the Health and Safety Code D. There is a duty to the family to protect them 28. The Supreme Court ruled in Thapar that A. There is no duty to warn third party non-patients B. There is no duty to protect third party/non-patients C. There is a duty to keep confidential information from third parties D. All of the above The question of the relationship between a therapist, a minor child, and the parents is the subject of the case of Abrams v. Jones (see page 123). In this case the parents were divorced, the mom seeks treatment for the child who says she will not talk to the therapist unless he promises not to tell her parents what is said. He agrees, with some limitations. The father asks for the records and what results is a contest to see whether or not an agreement between a child and a therapist can take precedence over a parent s right to know what is going on in therapy. 29. The court held in Abrams v. Jones that a parent A. has the right to a child s records of therapy B. has no right to a child s records of therapy C. is not always acting in the best interests of the child D. can have access only by suing the therapist 30. When a professional withholds access to a child s record what may a parent do to get access to the record? A. Petition the District Court for appropriate relief, i.e., sue the therapist B. Have the records released to another professional and get them from the second therapist (611.0045(e)). C. Both of the above D. The parent may not have access to the records