Duty to Warn and Mandatory Reporting

• **Duty to warn and protect (Tarasoff): where a patient makes a credible threat against an identifiable person**, the clinician must take reasonable steps to protect — which may include warning the intended victim, notifying police, or hospitalising the patient. A vague threat against no one in particular does not trigger it.
• Suspected child abuse and neglect: reporting is mandatory and based on reasonable suspicion. Physicians do not investigate first, do not need proof, and are protected from liability for good-faith reports. The same applies to elder and dependent-adult abuse in most states.
• Notifiable communicable diseases are reported to public health authorities; the list varies but includes tuberculosis, syphilis, HIV, measles and many others. Partner notification for some infections is performed by public health rather than the physician directly.
• Impaired drivers, certain seizure disorders, and gunshot or stab wounds are reportable in many jurisdictions.
• **Intimate partner violence in a competent adult is generally not mandatorily reportable** in most states — the response is to assess safety, document and offer resources, respecting the patient's autonomy.

Permitted versus required disclosure

• Permitted: the HIPAA Privacy Rule (45 CFR §164.512) allows protected health information to be released without authorization for public health activities, to avert a serious and imminent threat, and for certain law-enforcement purposes. Permission is not obligation.
• Required: state statute or case law compels disclosure. Failure exposes the physician to licensure action, misdemeanor charges, and civil liability. Board questions almost always turn on this distinction.

The Tarasoff doctrine

• Tarasoff v. Regents of the University of California: the first (1974) ruling articulated a duty to warn; the rehearing broadened it to a duty to protect, which may be discharged by warning the victim, notifying police, initiating civil commitment, or intensifying treatment. "Protect" is the operative verb.
• Elements: (1) a special relationship — the therapeutic relationship itself; (2) a serious threat of violence; (3) a reasonably identifiable victim. Diffuse threats ("I hate everyone") fail element 3 and do not trigger the duty, though they still demand risk assessment.

Mandatory reporting standards

• Reasonable suspicion, not proof, is the trigger for child abuse reporting; the federal Child Abuse Prevention and Treatment Act (CAPTA) conditions state funding on physician mandated-reporter statutes. Reporters acting in good faith receive statutory immunity, so the safe answer is always to report.
• Investigation belongs to Child Protective Services, not the clinician. The physician documents objective findings, obtains indicated imaging and labs, and ensures the child's immediate safety.

Disease surveillance

• Notifiable conditions flow from clinician/laboratory → local or state health department → CDC via the National Notifiable Diseases Surveillance System, whose case definitions are set jointly by CDC and the Council of State and Territorial Epidemiologists. Reporting is mandated by state law; the CSTE list is advisory to states.
• Partner services for syphilis, gonorrhea, chlamydia and HIV are typically executed by health-department disease-intervention specialists, preserving the index patient's anonymity where possible.

• Tarasoff = duty to protect, not merely warn: acceptable actions include warning the identifiable victim, notifying law enforcement, and hospitalizing the patient. The buzzwords in the stem are credible/serious threat plus a named or readily identifiable victim.
• No identifiable victim, no Tarasoff duty: a generalized threat obligates clinical risk assessment and possibly commitment, but not third-party notification.
• "Reasonable suspicion" is the reporting threshold for child abuse — never "proof," never "after the skeletal survey." Good-faith reporters have statutory immunity under CAPTA-based state law; failure to report is the punishable act.
• The physician reports; CPS investigates. The classic wrong answer is confronting the caregiver or attempting to verify the history first.
• Notifiable disease reporting needs no patient consent — it is an explicit HIPAA public-health exception; state law mandates it and CDC/CSTE standardize case definitions through the NNDSS. Partner notification for STIs is performed by health-department disease-intervention specialists, not by the treating physician calling contacts.
• Non-accidental trauma buzzwords: fracture in a non-ambulatory infant, posterior rib or metaphyseal corner/bucket-handle fractures, retinal hemorrhages with subdural hematoma, injuries whose mechanism keeps changing, and delayed presentation.
• Intimate partner violence in a competent adult is the great distractor: assess safety, document, offer resources, respect autonomy — do not report over her objection in most states. Contrast with child, elder, or dependent-adult abuse, where suspicion alone compels a report.
• Impaired drivers and seizures: reporting rules are state-specific; the universally safe answer is to counsel the patient not to drive and document that counseling, then follow state law on notifying the licensing authority.
• Minors: most states allow confidential care for STIs, contraception, and substance use, but a suspicion of abuse overrides adolescent confidentiality — that override is the tested point.