Disclosing records to family members

A  practice receives a call from the father of a 21-year old patient with a history of drug addiction who recently died following an overdose. He wants access to her medical records because he is convinced his daughter had sought help with depression from her GP and claims the practice failed her. Records show that the patient had had a termination when she was 16 and she had specifically requested that no one should be told about this. The practice manager rings us for advice.

Our advice

The practice has a duty of confidentiality to the patient which continues after her death. While the Access to Health Records Act 1990 makes provision for access by the patient's personal representative, this is not an absolute right.

In this instance, the father should not be given access to information which the patient would not have expected or consented to be disclosed. This includes details of the termination but may also include information about her mental health if it was considered this might be related to the termination procedure. Nor could he be given access to any information which might allow others to be identified without their consent, e.g. the person who supplied her with drugs.

You therefore need to decide whether the father could be given access to the records with this information 'blacked out' or if it would be better to invite him to meet the patient's GP first to discuss her care, making clear that the patient herself wanted some information in her records to remain confidential. This would also be an ethical response as the GMC states that doctors "must be considerate to those close to the patient and be sensitive and responsive in giving them information and support" (Good medical practice, 2013, paragraph 33) and that they "should not refuse to listen to patients' relatives on the basis of confidentiality" (Confidentiality, 2009, paragraph 66).

You should also bear in mind that the patient's death is likely to be the subject of a coroner's inquiry (or a fatal accident enquiry in Scotland) and that the practice will have a statutory obligation to disclose relevant medical information if ordered to do so. It may be a good idea for the GP to explain this to the patient's father and make clear that the practice will be co-operating with the coroner's investigation which will look into the circumstances of the patient's death.

The outcome

The practice manager arranged for both parents to visit the practice and speak to the patient's GP about their concerns, with the GP's agreement. They knew about their daughter's addiction and he was able to answer their questions about the treatment she received. He explained that the coroner was investigating the patient's death and would be looking into the background, including whether she was suicidal and if anything could have been done to prevent it.

The coroner reviewed the patient's records and obtained statements from the GP and the patient's addiction counsellor. He concluded that she had not taken drugs for several months before relapsing and she had not appreciated that her tolerance had diminished during that time. He recorded a verdict of accidental death which her parents accepted.

Learning points

• Your practice's records access policy should be easy to find on your website and available on request.
• Check the identity of those requesting records. If not the patient, they should have their written consent or the necessary legal authority.
• Respond to access requests within 40 days and ensure patients who want copies are aware of charges.
• Ensure someone is on hand to answer any questions when patients are inspecting their records.
• Unless they relate to healthcare professionals, get consent before disclosing entries which concern third parties or black these out.
• Factual corrections can be made at the patient's request but it should be clear who made them and when.
• The records of deceased patients can be requested in writing by those with a claim arising from their death or the patient's representative or executor. Consider other requests on a case-by-case basis.