N.W.T. man says doctor shared 'too much information' about his illness to employer
Doctor told employer that man may have 'episodes of mania' and possible diagnosis
An employee with the government of the Northwest Territories says his doctor shared "too much information" about his mental illness with his employer.
The man had experienced a "psychotic break" and was admitted to a hospital; he then had to take time away from work, according to a recent review published by the territory's Office of the Information and Privacy Commissioner.
In turn, the government — his employer — asked his doctor for a medical prognosis to see if, and when, he was fit to come back to work.
"The complainant feels that the [doctor] provided far more detailed medical information about him in the prognosis forms than was appropriate or necessary," wrote Elaine Keenan-Bengts, the territory's privacy commissioner, in her review. Her office reviews complaints made about the handling of personal health information under the N.W.T. Health Information Act.
The incident took place over 2017 and 2018.
The man, who is not named in the review, had signed the government's Request for Prognosis consent form, which authorized his doctor to release information to the government.
In one particular letter, a doctor with the Northwest Territories Health and Social Services Authority made specific references to the man's mental state and listed specific symptoms.
Very likely, this individual feels a sense of fear, vulnerability, and maybe even a little bit of shame.- Jordan Friesen, Canadian Mental Health Association
The doctor said that the man required "supervision at home intermittently to ensure [he's] stable and taking meds," and that he experienced "episodes of mania."
In another letter to the employer, the doctor revealed the man's possible diagnosis.
"The employer had no need or right to know about the complainant's moods, or that [he] was having episodes of 'mania,'" writes Keenan-Bengts.
She added that the government had "no right or reason to know" whether he needed supervision at home, which is outside of the workplace. She said the employer just needed to know whether the man was fit to work or not, and a possible date of return.
Employee did not consent: privacy officer
"All information provided to the employer was improperly disclosed," said Keenan-Bengts in the report.
Although the employee had signed a consent form, Keenan-Bengts said the consent was "invalid."
All information provided to the employer was improperly disclosed.- Elaine Keenan-Bengts, privacy commissioner
She said the employee considered the consent to be limited to the disclosing of non-specific information.
According to Keenan-Bengts's report, the health authority argued that there are opportunities for the patient to request information to be redacted. But Keenan-Bengts noted that there was nothing in the consent forms telling the employee that they may withhold or withdraw consent once it was given.
The privacy commissioner recommends the health authority:
- Create formal guidelines on what kinds of information should or should not be shared with employers.
- Train all medical staff on the nature and amount of personal health information to be shared with employers, and on valid consent.
- Help amend the N.W.T. government's medical prognosis consent forms, or for the authority to create its own consent forms that have clear language about disclosure and consent.
These recommendations are not legally binding.
CBC asked the health authority whether these recommendations were put in place.
"In this case, the recommendations require multi-organization collaboration and we are working at implementing the recommendations. This work is ongoing," David Maguire, a spokesperson for the authority, said in an email.
Maguire noted that training covers access to information, consent and how to "appropriately share information with external parties."
"This training is mandatory for all staff who interact with patients and their health information."
Employees have 'a lot of control' over information
Writing prognosis letters for employers is a "grey area" for health-care professionals across the country, because they don't receive formal training on it, said Jordan Friesen, the national director of workplace mental health with the Canadian Mental Health Association.
"This is an area that a lot of practitioners struggle to navigate, by no fault of their own," he said.
He suggested that education on disclosure of employee health information should start at medical and nursing schools.
Friesen said employees should remember that they have "a lot of control" over the amount of personal information they want to share.
"Very likely, this individual feels a sense of fear, vulnerability, and maybe even a little bit of shame," Friesen said. "Disclosure of any health condition, any health-related disability in the workplace — it is a personal choice."
There should be a clear, documented consent in these situations, he said.
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