5: Ethical and Legal Considerations

Eventually, your community may want to formalize decisions made about the issues discussed by writing protocols, which are documents that contain information about how the MDT is going to operate, i.e., the procedures. (For examples see the Toolkit item: Sample Protocols and Policies). Procedures describe the steps taken to complete a specific function in the day-to-day operations of the organization  and are critical to well-functioning MDTs. Protocols should be somewhat flexible. Too much specificity contained in the protocols can be used against the MDT under certain circumstances.

In addition to an MOU or IAA, you will want to develop linkage agreements with external service providers. The linkage agreement defines how the MDT will transfer relevant information to individuals who provide direct services but are not officially part of the MDT.

Each agency on the MDT will have its own confidentiality requirements. However, the MDT must develop a confidentiality policy that meets the needs of the MDT while not violating any one agency’s confidentiality policy. See Toolkit item: Sample Protocols and Policies, for a sample confidentiality policy and sample confidentiality forms.

Possible Approaches for Handling Confidentiality: MDTs have struggled with confidentiality since their inception. However, innovative MDTs have developed approaches for managing – not ignoring – confidentiality that allows MDTs to share information among team members while maintaining client confidentiality. Below is a list of possible solutions.

• Some issues of confidentiality are addressed in statutes (see Toolkit item: MDT Statutory Review). For example:

  • Colorado stipulates that information shared among the MDT is confidential.

  • Illinois’ Elder Abuse and Neglect Act (Illinois Public Act 85 - 1184) provides immunity to any appropriate provider of services who consults with the elder abuse provider agency in the development of a service case plan for a victim of substantiated abuse.

  • California’s statute expressly allows MDTs to share information with one another.

  • Maine’s Elder Abuse Fatality Review Team relies on a Maine statute which allows team members to obtain information from other team members and also provides immunity to team members who share that information and thereby avoid a HIPAA violation.

• Some entities have offered clarification of policies, for example in the context of Health Insurance Portability and Accountability Act (HIPPA) and financial institutions.

• Include a confidentiality provision in the MOU (see Toolkit item: Sample MOU from Denver).

• Individuals who are not MDT members but are attending a case review meeting for a specific purpose may sign a confidentiality pledge prior to the meeting.

• Ask clients to sign consent forms to share case information with other MDT members.

• Have all MDT members sign a confidentiality agreement at each meeting.

• Use pseudonyms or initials when discussing cases during a case review meeting.

• Include written reminders about confidentiality (with applicable state code sections) and place the confidentiality reminder on the case review meeting agenda.

• Prohibit note taking during case review meetings except for the MDT Coordinator.

• Establish procedures to protect documents shared during a meeting, such as collecting all paper documentation after the meeting and shredding duplicate documents.

• Ensure that any paper or digital files are appropriately kept confidential and safe. For example, keep documents in locked file cabinets and store electronic files on password protected computers behind a firewall.

• Periodically provide verbal reminders not to use names during case review meetings.

• Remind people not to present “discoverable” information during a case review meeting.

• Have each agency’s attorney submit a ruling (interpretation) permitting the agency representative to share information with other MDT members.