Way to Go!
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benzocaine
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- Joined: Wed Jul 09, 2003 12:20 pm
- Location: St. Thomas
Way to Go!
People are sometimes way to liberal with others personal business. Woman Sues Hospital for revealing HIV status
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Gene DeMambro
- Posts: 1684
- Joined: Sat Dec 12, 1998 6:01 am
- Location: Weymouth, MA US of A
Sounds like a lot of dough, doesn't it. Too much. But neither should they play fast and loose with her medical info. Leaving the chart on the bed where her supposed "FRIEND" read it (why not sue her? everyone always wants to sue doctors, just not lawyers or anyone else!) isn't that much of a sin. She could have read it when it was just as well displayed in his lap, and that would NOT have been a lapse. So she needs to chill out there--but that other doctor shouldn't have blabbed.
That said, HIPAA is very annoying at times. One patient's insurance (stay away from Aetna, they were awful) wouldn't give me their ADDRESS for 10 minutes or tell me how to submit a form to get her an MRI, (no parting with her info required, though I had her insurance number and al that good stuff) because I didn't have a tax ID #, which residents don't usually have. Oh well.
That said, HIPAA is very annoying at times. One patient's insurance (stay away from Aetna, they were awful) wouldn't give me their ADDRESS for 10 minutes or tell me how to submit a form to get her an MRI, (no parting with her info required, though I had her insurance number and al that good stuff) because I didn't have a tax ID #, which residents don't usually have. Oh well.
--Ian
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Gene DeMambro
- Posts: 1684
- Joined: Sat Dec 12, 1998 6:01 am
- Location: Weymouth, MA US of A
What would you propose they make more stringent? And how would you manage the following situations?
1) You are a hospital doctor discharging someone home. You are required to report major events to the primary outpatient doc and to relay what needs to be done at the next visit by the terms of your job. Should you ask each patient permission to speak with their outpatient docs before doing so? What should you say in this conversation? I discharged 6 patients today, so this came up 6 times today for me. What would make this different, if anything would, from speaking to another doctor in the same hospital who is doing, say, a consult on the patient. Should you ask the patient permission to speak to other doctors involved in their care while hospitalized?
2) You are a primary care doctor when someone calls from another hospital across town. They say a patient of yours came in very sick and is now unconscious and they urgently need to know what his allergies and medical problems are as well as the results of major tests recently. Family hasn't returned calls yet, they're in california too. The patient is out of it. How should you identify the caller? What should you tell them? That cvame up thursday for me.
Potential patients might well ask themselves instead of the above:
1) Do I want my doctors to be in good communication about how best to take care of me?
2) Do I want my doctor to be able to transmit potentially lifesaving information to other doctors in a serious situation?
Then ask yourself... if a patient comes to a million ERs and clinics looking for narcotics or seeking treatments they don't need, and one physician knows their complaints are falsified, does that doctor need the patient's permission to tell another doctor who otherwise has to take everything the patient says at face value? Is this good for the system? How is this different from a nurse in the ER letting the visiting doctor know a patient is a drug addict well known to them? Should that be illegal?
1) You are a hospital doctor discharging someone home. You are required to report major events to the primary outpatient doc and to relay what needs to be done at the next visit by the terms of your job. Should you ask each patient permission to speak with their outpatient docs before doing so? What should you say in this conversation? I discharged 6 patients today, so this came up 6 times today for me. What would make this different, if anything would, from speaking to another doctor in the same hospital who is doing, say, a consult on the patient. Should you ask the patient permission to speak to other doctors involved in their care while hospitalized?
2) You are a primary care doctor when someone calls from another hospital across town. They say a patient of yours came in very sick and is now unconscious and they urgently need to know what his allergies and medical problems are as well as the results of major tests recently. Family hasn't returned calls yet, they're in california too. The patient is out of it. How should you identify the caller? What should you tell them? That cvame up thursday for me.
Potential patients might well ask themselves instead of the above:
1) Do I want my doctors to be in good communication about how best to take care of me?
2) Do I want my doctor to be able to transmit potentially lifesaving information to other doctors in a serious situation?
Then ask yourself... if a patient comes to a million ERs and clinics looking for narcotics or seeking treatments they don't need, and one physician knows their complaints are falsified, does that doctor need the patient's permission to tell another doctor who otherwise has to take everything the patient says at face value? Is this good for the system? How is this different from a nurse in the ER letting the visiting doctor know a patient is a drug addict well known to them? Should that be illegal?
--Ian
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Gene DeMambro
- Posts: 1684
- Joined: Sat Dec 12, 1998 6:01 am
- Location: Weymouth, MA US of A
I'd imagine those disclosures are permitted disclosures under HIPAA, especially if, as stated, that "You are required to report major events to the primary outpatient doc and to relay what needs to be done at the next visit by the terms of your job." If there truly is indeed some statutory or legal requirement, then case closed.
But look at some of the scenarios where protected health information mnay be disclosed without an authorization:
But look at some of the scenarios where protected health information mnay be disclosed without an authorization:
- Disclosures for law enforcement purposes - Is it too much to ask to get a damn warrant? And if a judge won't sign a warrant, this give you a chance to do an end run around the Constitution.
- Uses and disclosures about decedents - You are the respresentative for a decedant's estate and you want PHI? Then show me a Certificate of Appointment by the Probate Court. The dead aren't entitled to the same protections as the living?
What the hospitalist team at the hospital feels is good policy and expects of me (both rightly I think) are unfortunately quite separate things from what HIPAA allows. There is conflict between good practice and legal, in that situation, sadly.
In the other, it may be an emergency, but to what lengths would I have to go to establish that? Anyone could call me and claim to be the hospital downtown. Now, I may be able to tell over the phone, but shouldn't I force them to fax me something official or hang up and call the hospital for a connection to more prove it? Perhaps, but prohibitively time ineffective.
I'm with you Gene, on not forking data over to the cops on a whim. Both on privacy grounds and because it sets the doctor against the patient, in many cases without good enough cause.
I AM quite upset at some of the restrictions made against us with HIV testing. We canot test ANYONE without their permission... if they're not conscious, or competent, we can't test them period. Not even if it's necessary for their care (though we'd be forced to find out in other ways, or to guess, because we couldn't effectively treat many of their propblems without knowing), or with ten family members' permission. And what is most upsetting about this is that a needle stick in the ICU on an unconscious patient then buys the nurse or doctor 1 MONTH of toxic, unpleasant, and highly expensive ($2000) medication to reduce the risk of HIV. If we could simply run a viral load on them, all of this owuld be avoided. In virginia, legal sanity allows deemed consent; anyone admitted to the hospital agrees to be tested like this by virtue of their presence. They don't have to get the results if they decline, but they are tested. They in turn can expect the same from their health care team if the situation is reversed.
In the other, it may be an emergency, but to what lengths would I have to go to establish that? Anyone could call me and claim to be the hospital downtown. Now, I may be able to tell over the phone, but shouldn't I force them to fax me something official or hang up and call the hospital for a connection to more prove it? Perhaps, but prohibitively time ineffective.
I'm with you Gene, on not forking data over to the cops on a whim. Both on privacy grounds and because it sets the doctor against the patient, in many cases without good enough cause.
I AM quite upset at some of the restrictions made against us with HIV testing. We canot test ANYONE without their permission... if they're not conscious, or competent, we can't test them period. Not even if it's necessary for their care (though we'd be forced to find out in other ways, or to guess, because we couldn't effectively treat many of their propblems without knowing), or with ten family members' permission. And what is most upsetting about this is that a needle stick in the ICU on an unconscious patient then buys the nurse or doctor 1 MONTH of toxic, unpleasant, and highly expensive ($2000) medication to reduce the risk of HIV. If we could simply run a viral load on them, all of this owuld be avoided. In virginia, legal sanity allows deemed consent; anyone admitted to the hospital agrees to be tested like this by virtue of their presence. They don't have to get the results if they decline, but they are tested. They in turn can expect the same from their health care team if the situation is reversed.
--Ian
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benzocaine
- Posts: 2107
- Joined: Wed Jul 09, 2003 12:20 pm
- Location: St. Thomas
Ian,
Excellent point about HIV testing and consent. I was pleasantly surprized to find that yes, I as a health care worker have some rights... in VA that is. When I first started working as an RRT in Mass I had the very unpleasant experience of a needle stick. The woman totally spazzed while I was getting an ABG.. and I got stuck. What a G.D. sick feeling it is! Luckilly she consented herself to be tested for HIV... she didn't have to. The prophylactic drug coctail that they offered then makes you sick as hell. I decided I would take my chances and not take the drugs as she had not had a blood transfusion in many many years and her 75 YO husband (supposedly) didn't fool around.
Gene and Ian. Are you Hip with HIPPA
Excellent point about HIV testing and consent. I was pleasantly surprized to find that yes, I as a health care worker have some rights... in VA that is. When I first started working as an RRT in Mass I had the very unpleasant experience of a needle stick. The woman totally spazzed while I was getting an ABG.. and I got stuck. What a G.D. sick feeling it is! Luckilly she consented herself to be tested for HIV... she didn't have to. The prophylactic drug coctail that they offered then makes you sick as hell. I decided I would take my chances and not take the drugs as she had not had a blood transfusion in many many years and her 75 YO husband (supposedly) didn't fool around.
Gene and Ian. Are you Hip with HIPPA
