My Nemesis: HIPAA: What would you do?

[MMiz]

It came up in another topic, so let me rant.

It is required that each patient is provided a HIPAA booklet, and they sign the HIPAA sheet. No big deal. As a private ambulance company, it's a pain when a hospital or nursing home wont give us a "Face Sheet".

The "Face Sheet" provides all the patient information for our run and billing forms. It includes name, address, age, DOB, SSN, drug allergies, and all that other good stuff we require in EMS. Without it, especially in private EMS, it can be a pain. Many of our patients, working in as BLS for a private company, aren't AOX3. When I ask who is the president, I'm no longer shocked when I hear Nixon or Washington.

HIPAA says it's okay for the hospital or nursing home to provide us with the face sheet, but because there are so many myths and misunderstandings about the law, we often get denied.

And that's my problem with HIPAA, it seems people make it up as they go along. As EMS we get stuck right in the middle, having to deal with family, police, and others.

You decide, is it against HIPAA, what would you do?

1. FF goes to the hospital at noon for injury. At 19:00 you respond to a fire and one of the FFs ask how his buddy is doing. You tell him.

2. You ATF a 45 Y/O pt acting "weird" outside a burning house. His entire family is loaded into the ambulance. The two children says "My dad started it," while the mom tells them to hush. PD then question you, what do you say?

3. You're driving back from a call and see 16 y/o with car in ditch in busy interstate on prom night. You call dispatch and stop. Witnesses state patient was weaving in and out of lanes before skidding off road and into ditch, almost flipping car. Because of non-injuries and busy night, PD arrive aprox. 1 hr later, and all witnesses are gone. PD asks what happened, what do you say?

I'd like to see what others might say in these situations.

 

[croaker260]

1.FF goes to the hospital at noon for injury. At 19:00 you respond to a fire and one of the FFs ask how his buddy is doing. You tell him.
Hmm, depends, did you (or your agency take care of him? then there is a pt relationship, and could be interpreted that way if you gave anything beyond "I think hes doing OK."

2. You ATF a 45 Y/O pt acting "weird" outside a burning house. His entire family is loaded into the ambulance. The two children says "My dad started it," while the mom tells them to hush. PD then question you, what do you say?
HIPAA specificaly does NOT prohibit you from passing on information that might help in the enforcement of local, state, or federal laws. The most common example is child abuse reporting. It does not go into great detail as to how to do this though. Some agencies say they must supeona a chart,. but sometimes that is not practical when the chart hasnt been written yet and immediate enforcement is in the best interest of the pt. (Like mental health pt's, child abuse, etc)

3. You're driving back from a call and see 16 y/o with car in ditch in busy interstate on prom night. You call dispatch and stop. Witnesses state patient was weaving in and out of lanes before skidding off road and into ditch, almost flipping car. Because of non-injuries and busy night, PD arrive aprox. 1 hr later, and all witnesses are gone. PD asks what happened, what do you say?
See above.

I'd like to see what others might say in these situations.

 

[ffemt8978]

1. FF goes to the hospital at noon for injury. At 19:00 you respond to a fire and one of the FFs ask how his buddy is doing. You tell him.

Knowing that these questions would be coming, I would probably ask the patient if it was okay to release information to his fellow firefighters, if they ask.

2. You ATF a 45 Y/O pt acting "weird" outside a burning house. His entire family is loaded into the ambulance. The two children says "My dad started it," while the mom tells them to hush. PD then question you, what do you say?

Remember, what you observe (including statements made in public) at the scene is not information that is protected by HIPAA, especially if you did not ask a question that prompted the statement. I would inform PD of what I observed and heard, as long as it did not pertain to patient care.

3. You're driving back from a call and see 16 y/o with car in ditch in busy interstate on prom night. You call dispatch and stop. Witnesses state patient was weaving in and out of lanes before skidding off road and into ditch, almost flipping car. Because of non-injuries and busy night, PD arrive aprox. 1 hr later, and all witnesses are gone. PD asks what happened, what do you say?

Since this pertains to non-medical information, I would tell the PD what the witnesses stated. I would have tried to get at least the witness information (name, address, phone and license plate) before they departed the area, since PD will not be able to use your hearsay statements as evidence.

HIPAA - The poster child for "clear as mud".

 

[MMiz]

ffemt8978,

Your answers were the exact opposite of what I expected. The sad part is, I cant justify my thoughts in any way.

I was always taught that I can't say certain things over the radio. For example:

"Bravo 123 is requesting PD assistance priority 1 to assist in restraining psych. patient."

I've had that happen, and my partner had my call it in via cell phone. What's the problem you ask? Radio Procedure: Direct line to dispatch. Cell Procedure: Call dispatch, wait several rings, get sent to call-taker. Then wait until they can put you through to the dispatcher. It takes time, and on a priority 1 (highest priority, I don't want to wait).

We require HIPAA signatures on our "HIPAA Forms". For psych patients, I often don't allow them to sign. Whether it be the combative pt, or the one that just finished doing his business is public, I'm not ready to hand them a pen. So we have to write on the form why they couldn't sign. I was told writing "PUTS (pt unable to sign" due to psych. condition" is unacceptable, and a violation of HIPAA.

I can't put a run form on the dash for a second while I get something out because of HIPAA. I can't leave me clipboard on the cot with the run form on top while we load the pt because of HIPAA.

Damn HIPAA.

 

[ffemt8978]

Originally posted by MMiz@Aug 4 2004, 10:08 AM
ffemt8978,

Your answers were the exact opposite of what I expected. The sad part is, I cant justify my thoughts in any way.

I was always taught that I can't say certain things over the radio. For example:

"Bravo 123 is requesting PD assistance priority 1 to assist in restraining psych. patient."

I've had that happen, and my partner had my call it in via cell phone. What's the problem you ask? Radio Procedure: Direct line to dispatch. Cell Procedure: Call dispatch, wait several rings, get sent to call-taker. Then wait until they can put you through to the dispatcher. It takes time, and on a priority 1 (highest priority, I don't want to wait).

We require HIPAA signatures on our "HIPAA Forms". For psych patients, I often don't allow them to sign. Whether it be the combative pt, or the one that just finished doing his business is public, I'm not ready to hand them a pen. So we have to write on the form why they couldn't sign. I was told writing "PUTS (pt unable to sign" due to psych. condition" is unacceptable, and a violation of HIPAA.

I can't put a run form on the dash for a second while I get something out because of HIPAA. I can't leave me clipboard on the cot with the run form on top while we load the pt because of HIPAA.

Damn HIPAA.

I agree that HIPAA is confusing, but I have read the law and have several discussions with several hospital privacy officers about this subject.

As far as your radio transmission goes, it is perfectly acceptable. You are not providing any information over the radio that is protected by HIPAA (Pt. name, medical problems, or treatments). Also, you have to remember that radio frequencies are public domain. When you are paged out to a call, you are given the address and a brief description of the problem. Anybody with a scanner can get the same information at the same time, and it is LEGAL.

Leaving the clipboard on the dash is a big no-no. In that case, you are providing the general public with specific information about a person and their medical condition.

The thing with HIPAA is that everybody is extremely gun shy of it, because of the civil and criminal sanctions built into it. The core of the law is the same as we have always been doing in maintaining patient confidentiality. HIPAA has specific exceptions to the release of information without informing the patient, and law enforcement use is one of them.

 

[ffemt8978]

Originally posted by MMiz@Aug 4 2004, 10:08 AM
ffemt8978,

Your answers were the exact opposite of what I expected. The sad part is, I cant justify my thoughts in any way.

I was always taught that I can't say certain things over the radio. For example:

"Bravo 123 is requesting PD assistance priority 1 to assist in restraining psych. patient."

I've had that happen, and my partner had my call it in via cell phone. What's the problem you ask? Radio Procedure: Direct line to dispatch. Cell Procedure: Call dispatch, wait several rings, get sent to call-taker. Then wait until they can put you through to the dispatcher. It takes time, and on a priority 1 (highest priority, I don't want to wait).

We require HIPAA signatures on our "HIPAA Forms". For psych patients, I often don't allow them to sign. Whether it be the combative pt, or the one that just finished doing his business is public, I'm not ready to hand them a pen. So we have to write on the form why they couldn't sign. I was told writing "PUTS (pt unable to sign" due to psych. condition" is unacceptable, and a violation of HIPAA.

I can't put a run form on the dash for a second while I get something out because of HIPAA. I can't leave me clipboard on the cot with the run form on top while we load the pt because of HIPAA.

Damn HIPAA.

Okay, I'm curious now. What part of my answer is the "exact opposite of what I expected"?

 

[rescuecpt]

My county is just starting to transfer over to the 800mhz radios. We have one zone operational, which contains "channels" for Hospital North, Hospital South, MedCom East, MedCom West, Car-to-car, and Regroup.

There are two more zones not yet in service, and within the next year or two, there will be zone 2 dedicated to ALS for Medical Control use. There are 5 different medical control settings, and due to the way the 800mHz operates, it is nearly impossible to pick up an entire conversation. The worst anyone could hear is one transmission, but it would eliminate the problems we have with cell phones in our area. Of course you would not give the patient's name or address in any transmisison, you would have to have a post-call call in to Medical Control to give that info.

 

[ffemt8978]

Originally posted by rescuelt@Aug 9 2004, 01:06 PM
My county is just starting to transfer over to the 800mhz radios. We have one zone operational, which contains "channels" for Hospital North, Hospital South, MedCom East, MedCom West, Car-to-car, and Regroup.

There are two more zones not yet in service, and within the next year or two, there will be zone 2 dedicated to ALS for Medical Control use. There are 5 different medical control settings, and due to the way the 800mHz operates, it is nearly impossible to pick up an entire conversation. The worst anyone could hear is one transmission, but it would eliminate the problems we have with cell phones in our area. Of course you would not give the patient's name or address in any transmisison, you would have to have a post-call call in to Medical Control to give that info.

This is not quite accurate. There are "Trunk Tracking" scanners which are able to follow any conversation in the 800 MHz band with ease. The ONLY way to ensure that your transmitted information remains private is to use some type of encryption system.

As a side note, most scanners sold in the US have the cell phone and military frequencies blocked, making cell phones actually a little more secure than a standard 800 MHz radio. Occassionally, a cell phone will use a frequency outside of the blocked frequencies in scanners, allowing the call to be heard.

 

[rescuecpt]

I'm working with what I've been told... and that was it from a supposedly reputable source. Maybe this is part of why it's taken 4 years to get basic communications up and running on the 800mHz and why medical control wont be up and running for another year or two.

 

[MMiz]

Sorry for the late reply on why I had opposite responses, things around here are crazy to say the least.

I was taught that all three of those examples were clear HIPAA violations. Again, I wish I had some amazing reason for why I believed so, but I dont.

I actually have my HIPAA training booklet behind me. As soon as I have the time I'll go through it.

Again, sorry for the delay, I'm working EMS, have two big web design projects, just found out the I need an additional class for the fall to graduate (20 credits that term), and I have a meeting tomorrow with a supervisor. :blink:

As far as 800 MHz goes, I'm not sure how secure that actually is. I know I can hear other med control radio reports using my radio, and I know many new scanners can also. When in doubt, I try to use my cell.

 

[ffemt8978]

I used to be the Communications Officer for my previous department, so I can give everyone a crash course in 800 MHz radios if they so desire.

But, for right now, you are correct, MMiz, in that cell phones are more secure than radios (for the most part).

As far as HIPAA goes, it all comes back to whether or not the information is PHI (Private Health Information), who is asking for the information and why, and under what part of HIPAA that you are going to release the information.

 

[ffemt8978]

Okay, here we go again...

Responded to a single vehicle rollover MVA (again) with two occupants. Both subjects were without injury and refused transport after an examination in the back of the ambulance. My PT was the driver, and denied any LOC, ETOH, or drug use, and had no visible injuries. Just as we were finishing the exam, a state trooper steps into the ambulance and asks if anybody needed treatment. When we informed him that they had both refused treatment, he then asked what the vital signs were for the driver. I looked at my IC, who gave me the go ahead to release the vitals (all within normal limits).

This one bothers me, because it is obviously dealing with PHI, but my IC for the call was a VERY senior officer in my department (hint, hint). I'll admit that I'm not as gun shy about HIPAA as some people are, but I don't think that this information should have been released. The only defense I have on this one is that when I looked at my IC for permission, I stalled long enough for both patients to voice their objections (which they didn't).

Has anyone else ever had a law enforcement officer ask for a patient's vital signs?

 

[MMiz]

ffemt8978,

:unsure: This one seems pretty clear to me, but its clear my idea of HIPAA isn't the best. I've never had a cop ask for vitals, and never seen a cop ask for vitals.

Again, I think being on a FF you have a different relationship with PD than I do as a private EMT-B.

Maybe others have input.

 

[ffemt8978]

It seemed pretty clear to me also, but I wasn't about to argue with the IC in front of the trooper or the patients.

 

[ffemt8978]

This gets even better and better...

At our meeting recently, we were informed that we were no longer allowed to give written statements to law enforcement officers about what we observed on scene (car was on its roof, beer bottles every, etc...) because it is protected under HIPAA. We are allowed to tell the LEO if we detected the odor of alcohol on the patient's breath, or if the patient admitted to us that they had been drinking or using illegal drugs.

Does this seem right to everyone else? I mean, I can't tell a LEO what any passerby can tell him but I am allowed to divulge information obtained during my exam and treatment of the patient.

 

[rescuecpt]

Originally posted by ffemt8978@Aug 30 2004, 10:19 PM
This gets even better and better...

At our meeting recently, we were informed that we were no longer allowed to give written statements to law enforcement officers about what we observed on scene (car was on its roof, beer bottles every, etc...) because it is protected under HIPAA. We are allowed to tell the LEO if we detected the odor of alcohol on the patient's breath, or if the patient admitted to us that they had been drinking or using illegal drugs.

Does this seem right to everyone else? I mean, I can't tell a LEO what any passerby can tell him but I am allowed to divulge information obtained during my exam and treatment of the patient.

That's a little out of whack from everything I've heard. If there's a single vehicle drunken-driving accident, and PD didnt show up until after the fact, there will be no eye witness report because the driver didn't see what happened, and EMS can't say anything because of HIPAA? I know that's an extreme, but c'mon....

 

[ffemt8978]

It seems like some lawyer is just waiting for a chance to make money off this.

I'm guessing what actually happened was that when the situation was explained to our lawyer, it got messed up along the way and he was given a different scenario than what actually happened. (At least I hope this is the case.)