# Two sides of the same coin...



## ffemt8978 (Aug 4, 2004)

Responded to a single vehicle, rollover MVA a while back (same one where the other EMT checked pupil response while PT was looking directly at sun).  Law enforcement was already on scene and conducting a DUI investigation.

On scene, PT stated that they were the driver of the vehicle and had consumed "2 beers".  We get the PT loaded and begin transport, during which time I inform the PT that their honesty was critical to their medical treatment because of possible drug interactions and complications.  I must have gotten through, because I was amazed at the response I got.

PT admitted that they were not the driver, but were covering for their significant other so they wouldn't go to jail.  PT then admitted to drinking 10 beers 30 minutes before the accident, smoking a joint 2 hours prior to the accident, and smoking crank 3 hours prior to the accident.  The PT repeatedly asked if the information they provided us was confidential, and I replied that it was but then explained the HIPAA law and its exceptions to privacy/confidentiality.

I didn't volunteer this information to law enforcement (and won't, at least not without a subpeona in my hand) but I did tell the ER staff that was treating the PT.

The other side of this was that I responded to a single vehicle, rollover MVA (noticing a pattern in my neck of the woods?  :blink: ) with a patient that smelled of ETOH.  We load the PT into the ambulance and begin an uneventful transport.  The only thing that was strange was that the patient was not very responsive towards us (most likely due to the alcohol), and his pupils were constricted but reactive.

At the hospital, we're approached by a state trooper asking if we could smell alcohol on the breath of the patient, to which we replied yes.  The trooper then asks for statements from all of us about the odor of alcohol on the PT's breath, thus providing him the necessary probable cause for a DUI investigation.

I'm comfortable with the decision I made on the first call, but was a little hesitant with the second call.  I don't feel the information I gave in my statement violated HIPAA because: 1) I never gave the PT's name in my statement, but referred to the PT as the "sole occupant/driver of the vehicle"; and 2) I did not give any medical information, only a statement about what I observed.

What would you do in situations like these?


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## MMiz (Aug 4, 2004)

Interesting story.  PD responds to many calls with us, and all where PD could be needed.

I've been approached several times regarding incidents like this.  Because we are a private company with an EMS contract, it's often tough to say no in a professional way.  My private company is anal about HIPAA though, and so are all my partners.

I saw this exact story in JEMS, so I'm going to see if I can find the article.  Personally I would have said "I'm not sure," or "I couldn't tell."  I was always told that while I'm on a call, anything I observe, smell, or feel is part of my assessment.

HIPAA is a confusing thing.  I did several searches on the internet but found nothing.  Hopefully some other members on this forum can offer some more advice.

EDIT:

From FireHouse.com



> *
> What information can EMS providers give to law enforcement?
> 
> There are about eight "discreet exceptions" for when a patient's medical information can be shared with law enforcement. The bottom line: These are very specific instances and unless the disclosure fits into one of these specific exceptions, the disclosure should not be made. Examples of these instances include disclosures that are required by law (and you have to look at state law as well), disclosures related to a decedent where the cause of death may be suspicious or may be related to a crime, disclosures about crime victims in limited circumstances, disclosures about a crime that occurs on a health-care provider's premises, disclosures to identify or locate a missing person or suspect, disclosures to alert the public about an imminent danger. You can find more information about these exceptions in the regulation (see 164.512F
> *


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## Firechic (Aug 8, 2004)

HIPPA is generally confusing to everyone!
With the first MVA scenerio, I think what the patient stated about his/her ETOH & drug use would be protected by HIPPA. However, the statement regarding how this person was covering for the significant other - I don't think this would be a violation against HIPPA - because it is a confession to a crime. That person should be arrested for interfering with an investigation.   :angry:


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