Amendment to the Goldner-Perry Act

By Mike Lee, MD

This year, RI State law has changed regarding how we contact someone on behalf of opioid overdose patients. This memo details the new law and the important change to our practice.

Emergency medicine physicians are on the front lines of the opioid epidemic, caring for an increasing number of patients after an opioid overdose. According to the Rhode Island Department of Health, in 2018 there were 1399 opioid-related overdoses treated in Rhode Island emergency departments and 314 opioid overdose fatalities. According to the CDC, Rhode Island has the 11th highest mortality rate in the United States from drug overdose.

An opioid overdose is an important opportunity to provide behavioral counseling, take-home naloxone, and referral and/or initiation of addiction treatment. To this end, in June 2016, the State of Rhode Island passed the Alexander C. Perry and Brandon Goldner Act which established standards for discharge planning from hospitals for patients who present with substance use disorders. One of the items in the legislation included notifying a patient’s emergency contact, but required patient consent to do so.

In July 2019, an amendment to the Perry-Goldner Act effectively removed the requirement for this consent in certain circumstances. Those specific circumstances follow a recent clarification of federal HIPAA law regarding opiate overdose specifically. In it, the Department of Health and Human Services allows for disclosure of PHI if there is a “serious and imminent” threat to a patient’s health, and when disclosure would “prevent or lessen” this threat, even if the patient does not consent to this contact.

This offers us an important tool when treating this deadly disease. It allows us to do what physicians have done for ages – involve a loved one in the care of a patient when you are acting your patient’s best interests.

We recognize this new amendment can create a difficult situation for physicians who are trying to balance respect for a patient’s privacy and autonomy with prevention of future harm. In the year following an ED visit for opioid overdose, rates of fatal overdose range from 1% to 5% and about one in five people will have another nonfatal overdose. Given the high morbidity and mortality associated with opioid overdose, it is reasonable for physicians to conclude that opioid overdose patients are at serious risk for subsequent harm following an ED visit. However, there is no guidance in the Perry-Goldner Act, federal HIPAA law, or the literature as to what constitutes an imminent threat.

We encourage emergency physicians to make their own determination as to what constitutes a “serious and imminent” threat on a case-by-case basis. We recognize that emergency physicians will often have to make this determination with incomplete information (patient’s reports, EMS report, review of medical records etc.…).

One approach would be to first offer to contact someone on behalf of the patient and do so if the patient consents. This contact can be identified by the patient and does not have to be the emergency contact on the chart. If the patient does not consent, then the doctor can make a determination whether or not there is a “serious and imminent” threat to the patient’s health and whether contacting someone without the patient’s consent would lessen that threat. In this situation, only the minimum amount of information needs to be conveyed. We also encourage physicians to document their decision making in the medical record.

More specific guidance on how to interpret and implement this portion of the amendment to the Perry-Goldner Act may be forthcoming in the future from the Department of Health. Until that time, we encourage providers to think carefully about the issues raised by the amendment and discuss them with hospital and emergency department leadership at your institution.