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Duty to report and provide patient information to child protection agencies
An article for physicians by physicians
Originally published December 2007
IL0740-2-E

Of interest to all physicians

Physicians have an obligation to maintain the confidentiality of patient information. However, the Canadian Medical Association’s Code of Ethics recognizes there are circumstances where a patient’s personal health information may be disclosed to other parties when it is required by law. The duty to report potential child abuse is an example of one such situation.

Duty to report

Physicians in every province and territory have a legislated duty to report to the child protection agency any potential child abuse. This duty generally arises where there are reasonable grounds to believe or suspect that a child is being abused, or is at risk of abuse. In light of the serious consequences of reporting, careful consideration should be given to the circumstances that may give rise to an obligation to report and to the specific obligations established by the applicable legislation. Physicians are generally protected from being found in breach of confidentiality where the report is made in accordance with the legislation, in good faith, and without malice.

Relevant information only

Physicians will want to provide only the relevant information necessary to make a proper report. For example, this would generally include only divulging the facts and circumstances that gave rise to the belief or suspicion of abuse. Where practical, physicians may consider submitting a written report to the child protection agency. In most jurisdictions, the child protection agency is not entitled to a complete copy of the clinical record without the consent of the patient (or legal guardian) or a Court order.

In some instances, the child protection agency may request information from a treating physician because they have received information from another source that a child is being abused. Requests for this information may be framed with a reference to the physician’s obligations under privacy legislation. However, while privacy legislation may permit physicians to disclose patient information in certain circumstances, it does not relieve physicians from the obligation of considering patient confidentiality. In response to these requests, a physician should review the medical record of the child to determine whether, in this new light, there is information contained in the record that gives the physician reasonable grounds to support the assertion the child may be abused. If so, the physician should respond to the child protection agency’s request for that information. However, the physician must ensure only the necessary relevant information is provided. Where the physician’s review of the medical record does not give the physician reasonable grounds to support the assertion, the physician should advise the child protection agency that, while prepared to cooperate, he or she is not able to provide the requested information without the consent of the patient (or legal guardian) or a Court order.

If in doubt about how to respond, physicians are encouraged to contact the CMPA for advice.