Dental Protection has received a number of enquiries with regard to the status on confidentiality of records and applications made by Revenue and Customs for access to records as part of routine tax investigations. Dentists have a duty to protect the confidentiality of patients’ records. This obligation is subject to a number of caveats.
In what circumstances is a practitioner required, by law, to allow access to a patient’s records?
The Dental Council’s Ethical Guidance states that disclosure of information relating to a patient’s attendance or treatment may only be given with the patient’s consent, except when required by law. The Data Protection Act also states that the restrictions on disclosure of personal data do not apply if the disclosure is required for the purpose of preventing, detecting or investigating offences, apprehending or prosecuting offenders or assessing or collecting any tax.
There are a number of provisions under Irish law which may require practitioners to grant access to the Revenue to documentation, including medical records. Not all the provisions are precisely clear on the extent of the obligation.
Under sections 900 and 905 of the Tax Consolidation Act, 1997 (as amended), a person shall allow a Revenue official entry into any premises and provide books of accounts and other requested documentation for inspection. The Act does, however, state that it shall not be construed as requiring a person (a practitioner in this instance) to disclose information of a confidential medical nature.
Under Section 18 of the Value Added Tax Act, 1972 an authorised officer of the Revenue may enter a business premises and seek the production of, search for and inspect any books, invoices or other documentation relating to services provided. Similarly, Chapter 4 of the Tax Consolidation Act, 1997 gives the Revenue Commissioners broad powers to access books or papers relating to the payment of tax. In this specific provision there is no specified exemption as to the disclosure of medical records.
Dental Protection’s advice therefore on the issue of potential breach of confidentiality is:
- Advice should be taken on each and every instance where such records are sought.
- Notwithstanding the above, Dental Protection advises members that all financial records should be kept separately from clinical details. If financial records are held within the same clinical notes, then they should be on a separate sheet that contains no clinical details whatsoever.
- If records are to be disclosed then the minimum records necessary for the purpose of satisfying the inquiries of Revenue and Customs should be disclosed. Where possible this should be in the presence of the practitioner and clinical details should be concealed in an appropriate manner.