What Is Veterinary Confidentiality
Veterinary confidentiality is a vital part of the veterinarian-client-patient relationship, serving much the same purpose that attorney-client privilege does in the legal realm. When people bring their animals to the vet, they trust that their information will be kept confidential in the same way that they trust that their health information stay confidential when it is shared with their physician .
Maintaining client confidentiality isn’t just a good idea in veterinary practice, it’s the law. Veterinary confidentiality laws vary from state to state, but nearly every state has similar laws regarding the confidentiality of records for patients, with pets standing in as patients in the eyes of the law. For veterinarians in every state, sensitivity to the privacy and confidentiality interests of their clients is important, if not essential, to their professional obligations.
Laws Affecting Confidentiality
Before delving into the specific implications of confidentiality on day-to-day practice, it is helpful for practitioners and owners alike to brush up on what the law actually requires. As is often the case, overall it is a bit of a patchwork. Nonetheless, it outlines protections in some form or another at every level, federal, state, and even at the local level in certain areas.
At the federal level, most of the rule-making governing medical records falls under the purview of The Health Insurance Portability and Accountability Act (HIPAA). A broad overview of the meaning of this acronym has been covered elsewhere, but its salient points include protections against disclosure to anyone other than the legal owner of the record. HIPAA’s Privacy Rule is a particularly useful guide to determining whether something like veterinary medical records can be shared. This rule articulates the limited circumstances under which medical information can be disclosed without the consent of the patient, such as during cases of child abuse. In addition, small practices (such as that of a sole proprietorship) are exempt from complying with the entirety of HIPAA’s requirements. However, the measure’s Security Rule stills sets forth stipulations that regarding the storage of electronic media and data—for example, any information that you store within a computer or email must be protected by a "unique user ID," which in practice essentially means a password.
Most states also have their own laws governing medical records, which by and large track those of HIPAA. A beefier legal overview of this can be found here. However, there are some specific and unique points that pet owners should have in the back of their minds: Oral communications: A verbal conversation between a veterinary practitioner and an owner or caretaker does not require the owner’s written consent to be divulged in court Records: Medical records, including all lab results, must be made available to the pet owner or custodian no later than 14 days after a written request Confidentiality of records: Client information may not be shared with anyone other than the owner or custodian except with a written statement by the client and for purposes having to do with treatment, payment, or other animal-related health care purposes Public inspections: Client information can be inspected by the public unless it is protected under a law or privilege, and as long as the identity of the client is protected (note that full treatment records do not count as identifying information under the law).
Client Privilege and Client Responsibilities
One of the fundamental rights of a client of a veterinarian is the right to have their pet’s medical records kept confidential. In many states, specific laws set out client rights in relation to the services provided to their pets. Where actions go beyond the standard of care delivered through client communication and consenting, veterinarians are liable for breach of contract, negligence, and/or violation of privacy laws. Clients may have other clients vet services or staff release records as they direct, in some cases requiring them to inform others of any restrictions on the use and release of information. Clients can require veterinarians not to share the records with others. Any later consent to share the information does not require effort on the veterinarian’s part to search through all the records to limit how the information is used or shared. Once permission is given, everyone is treated the same as to the validly shared information. Nothing in the law requires consent to share information with other vets or technicians at a vet practice. The situation is different if the pet/animal has been put to sleep or is very ill and dies. Under certain circumstances, pets that die in the home may require the facilitation of storage and/or transport to locations where mass disposal is then done. Clients are responsible for information about their pet which is provided to the vet and intended to serve as a basis for the care provided. Clients must take active measures to limit or eliminate unnecessary exposure of private information when they are required to provide it to the vet. This includes the pet that passes away in the home, or even the dog that sneaks a snack of the cat food or takes a bite of the owner’s dinner. These health conditions may seem unimportant, but as they build an accumulative picture of the health history of the pet, they are very important. Maintaining awareness of what information is given to others for purposes of treatment and why it is necessary can put a stop to practices that abuse client trust in the treatment provider. In other words, clients can be proactive in gaining control of all the record information given in the course of a veterinary visit. A common example of voluntary sharing of information directs follow up appointments to the original treating veterinarian’s service. A dog may have bite wounds that begin pulling apart at the edges and require further care. The pet owner may be told to return to the original veterinarian for repair and ongoing of the same situation. This may be a simple solution to the case. However, a request for record information may also be made just to set up a future appointment and to get the client and animal back in to the original treatment provider. Second opinion vet services should not have to act as appointment reminders for other practices. Only if the client directs that the information is to be shared may this be done. If this is to be done and the information shared, then the limits in the scope of the information shared should also be part of the notice of shared information. The pet owner has the responsibility for any and all follow up care completed with another service. This is particularly true where there needs to be a referral to a specialist or to travel with the pet to a distant city. The second opinion veterinarian would have no contact with the original or referring veterinarian to base their care. Therefore, the second opinion results may vary from the first care provider’s expectations. There is nothing to prevent a veterinarian from forwarding information to the next step in the process or mailing it at the close of the appointment. A second opinion care provider or specialist in the area obtains the information usually as a courtesy to the pet owner and/or other veterinarian. It is the right of the client to have the information timely forwarded to the referral source within the time frames desired by the client. The primary consideration in practice management is that the information in the record, regardless of its availability to multiple people, belongs to the client. They have the right to limit or eliminate it from exposure according to their rights and responsibilities.
Exceptions to Confidentiality
Exceptions to the Confidentiality Rules
As mentioned previously, there are certain instances where a veterinarian may disclose confidential information. Some examples include:
Public Health Concerns and Animal Diseases
Under most state laws, veterinarians shall report suspected cases of animal disease to proper authorities, such as a state or federal animal health authority. For example, an outbreak of rabies or avian influenza may require reporting to the appropriate government agency. There also may be circumstances surrounding ethical concerns addressed in the AVMA’s Principles of Veterinary Medical Ethics
Abuse of Animals or Young Children
As with physicians, there are mandatory reporting rules for any signs of abuse of children or animals found during the course of providing veterinary care.
Legal Matters
A lawyer may properly receive communication regarding the client/patient if the pet owner issues a written waiver of the confidentiality rights. Subpoenas issued by a court may also compel the release of information. It is strongly recommended that a lawyer consult with a professional in the specific state involving the disclosure of confidential veterinary information to ensure compliance with state law.
What Confidentiality Means For Your Veterinarian
The implementation of confidentiality laws has a significant influence on the operations of veterinary practices. We have seen how these laws impact on a veterinarian’s ability to manage and secure client information including veterinary records. These confidentiality laws are also starting to influence the marketing of veterinary services.
Veterinary practice owners take steps to preserve the confidentiality of their client’s information including the use of dedicated data processing service providers such as veterinary practice management software, veterinary billing service providers and veterinary practice web hosting service providers. There is a growing trend for veterinary practices to use offsite data processing services. This is largely accomplished by using a cloud server where client information, including personal information, is processed, stored, maintained or distributed electronically over the Internet. A veterinary practice must ensure that client consent is obtained if the client’s personal information is stored or disclosed from an offsite data processing service. It is also critical for veterinary practice owners and managers to be familiar with the specific contractual arrangements with their cloud server vendor as the support and security for client information is heavily influenced by this service agreement.
More and more veterinarians are using email to communicate with pet owners. Many veterinary practices have client information on the "cloud." If a client or pet owner wants an electronic copy of the veterinary records, the veterinary practice is required under the law to provide them with a copy without any charge. There are costs involved with the creation of computer records to comply with a client’s request for a copy of the record in an electronic form. I think many veterinarians are not aware that a pet owner is entitled to receive such a copy without charge and if there is a charge for the electronic copy, the client can complain to their provincial authorities to try to enforce their right to an electronic copy. As a side note and from recent experiences with different veterinarians , I have compiled a checklist for veterinarians to consider when preparing electronic copies of their veterinary records.
More veterinarians are marketing their services on their own websites or on pet healthcare portals owned by third party companies. Some veterinarians have taken steps to protect their client’s information by for example, including a disclaimer on the website that information posted on the veterinarians webpage or a third-party pet healthcare portal is not intended to be veterinary advice, is provided for educational reasons only, does not constitute a veterinarian-client-patient relationship, nor is it a substitute for direct veterinary care or consultation. Such a disclaimer will not be sufficient to ensure that the veterinarian cannot be held liable for an error in their information if the information is posted on the website of a third party rather than the veterinarian’s website. In some jurisdictions a veterinarian is considered to be providing veterinary services if they are providing advice and recommendations via the internet.
Veterinarians should be mindful that the Internet is not always private and personal information posted on social media can be viewed by anyone. For example, a recently published article noted that many veterinarians had not appreciated the fact that by joining Facebook groups their activities could be seen by everyone. It was suggested that veterinarians be careful what they say on social media as a veterinarian’s credibility could be questioned if the there is an error in their advice or if s/he is providing medical advice in social media groups when there is no formal relationship with the owner or the pet. Veterinarians need to support the position that social media and the Internet are not always private where client information is shared even within a closed group. Veterinarians should carefully consider the impact on their practice and their liability to their clients or former clients of engaging in social media.
Case Examples and Real-Life Scenarios
The legal complexities around veterinary confidentiality laws may be best illustrated with a few real-world examples. The American Veterinary Medical Law Association has stressed the importance of these laws for veterinarians, but what happens when these laws are put to the test?
Case #1 – Diagnosing Infecting Disease
One of the most high-profile cases to test veterinary confidentiality laws was brought to public attention in 2009 after two puppies were diagnosed with a contagious and potentially deadly infection from Africa known as Brucella canis. The owners of the puppies enlisted the help of the Animal Legal Defense Fund in a lawsuit to force the veterinarian to disclose the names and addresses of the other pet owners who had been treated in his office at the same time as the infected dogs. The veterinarian had cited veterinary confidentiality laws as a reason for withholding this information. After a long and bitter fight, the case eventually made its way to the New Jersey Supreme Court, which ruled that the veterinarian could not be forced to identify the other pet owners due to the potential for public panic over the rare and not well understood disease. This case proved two important points: that agricultural confidentiality laws cannot protect a veterinarian from disclosing information when ordered to by a court, and that science-based arguments for the potential harm caused by the public disclosure of confidential information are often more persuasive than a blanket appeal to privacy rights.
Case #2 – Treating Endangered Species
But agricultural confidentiality laws are far from the only legal statutes designed to protect veterinary professionals when treating animals, and according to one expert, this could be a problem. In order to preserve potentially endangered species, veterinarians and zoo managers have had to create and enforce strict medical privacy policies when dealing with these animals. In some cases, state wildlife agencies cite these policies as reasons to deny access to records, and at the same time, the Endangered Species Act gives governments the right to audit these agencies. What happens if these two rights come into conflict with each other? This is precisely what occurred when an animal rights activist group decided to sue the Oregon Zoo when it refused to hand over records for a healthy black rhino named Mambo. Although many of the records requested were strictly medical in nature, others contained information such as the zoo’s breeding plan and diet for the 14-year-old rhino. Because this public information could potentially violate federal protections for endangered species, the zoo denied access, claiming that the necessary confidentiality agreements with veterinarians would be broken. The case is still pending.
These case studies reveal the sometimes controversial side of veterinary confidentiality laws, and the potential for animals to suffer when these laws are pushed too far. This discretion means veterinary professionals and their clients should be informed of how these laws are likely to be applied in a court of law so they can avoid both legal liability and health complications in the care of their beloved pets.
Tips for Your Veterinarian
It is vital that veterinarians and their practice staff familiarize themselves with their own state veterinary confidentiality laws. Most states have enacted these laws because of complex mental and medical health issues, but many state laws extend this authority to the veterinarian-patient relationship.
Veterinarian-patient communications are confidential. If you intend to provide any such information, you must first obtain the owner’s written consent. Moreover, many state licensing laws require that veterinarians conspicuously post a notice to their clients stating the owner’s right to access their pet’s records.
The veterinarian should also consider taking the following additional steps:
• Ensure preprinted prescription pads are protected.
• Limit access to computerized files.
• Carefully consider what information is sent by e-mail and how it is sent.
• Ensure any records unsecured before leaving work.
• Promote the veterinarian-client-patient relationship.
Conclusion & Summary
This article has outlined the various laws and regulations governing veterinary confidentiality, the responsibilities of veterinarians and pet owners, and the consequences of violating these laws. Given the sensitivity of the information exchanged, and the trust that’s essential in the veterinarian-pet owner relationship, these rules exist not only to protect the interests of the veterinarians, but also those of pet owners and their beloved companions.
To briefly recap:
Veterinarians are bound to respect the privacy of both their clients and patients. A breach of this confidentiality—even if it’s not an intentional or malicious violation—could land the veterinarian in legal hot water. Pet owners have the right to expect that their veterinarian will keep their medical information private and secure. Your veterinarian will take steps to seek your permission before releasing any medical records about your pet. While there may be a few exceptions to these rules—such as with payment disputes , potentially contagious diseases, and the investigation of animal abuse—the overwhelming majority of your pet’s medical information will remain private. The laws governing veterinary confidentiality can appear complex, especially in the midst of an emotionally charged time. But understanding your own rights—or those of your animals—can reduce stress, avoid costly disputes, and ultimately foster stronger bonds between veterinarians, pet owners and their pets.
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