mr. rothstein one of the concerns that mr. early raises is that if we have a child in a divorce proceeding or custody proceeding the number one role of the court system is to decide what is in the best interest of the child. that is their principle locus and yet when we have adult patients who are getting mental-health treatment who may or may not able to make decisions about their own treatment needs oftentimes the legal criteria are not what's it in the best interest of the patient of protecting the patient's wishes from a legal standpoint and often the advocates focus on that rather than getting the best treatment option that would benefit them and in society. what are the obstacles to deal with that? >> is a very difficult question. the immediate test would be whether the individual is competent and if the individual is competent health care providers tend to overlook all the other tests. if the individual is competent and a threat to self or others then that overrules the competency issue. if the individual is incompetent

mr. rothstein are far more pervasive than the questions of mental illness.here are americans taking care of their chronically ill older parents or other relatives and i can't tell you how many times i hear from family caregivers that have a parent in the hospital and the family member is expected to do multiple nominations to the conditions, monitor machines and do all of the care coordination in the community and when you ask about what do i need to know to do this and they say i can't tell you because of hipaa. is that wrong and why does it happen? the features that were already mentioned, there is a training that emphasizes the scary aspect of hipaa. it's often done in a way that if you say anything you are going to be in big trouble. and if the training doesn't say that, then the in formal communication among the health care providers particularly the middle level stuff which isn't necessarily physicians, but nurses, social workers, others were terrified kerrigan to get sued or lose their job. meanwhile laptop's lay all over the place and they aren't pay

mr. chairman and members of the subcommittee, my name is mark rothstein. on the faculty of university of louisville and i testify today my capacity and again that they apologize for laryngitis. in my testimony this morning i want to make the following three points. first, the privacy rule is essential to patient care and public health and safety. second, exceptions to the rule permit disclosure of health information for important public purposes and to come additional measures could enhance the effectiveness of the privacy law. first, ever since the hippa, they've established positions to maintain confidentiality of patient health information without assurances of confidentiality, patients are reluctant to divulge sensitive information about physical and mental health, behavior and lifestyle that could be vital to the individual tree. the privacy rule codified this requirement necessary for ethical and affect of individual health care. health privacy laws also are essential to protection of public health and safety are to illustrate this afternoon i'll be