The legality of an EMT telling over non-medical info divulged during treatment

[Just Plain Ruff]

Yes, I have trouble with the editor and formatting also.

I usually just do it in word and then paste it.

[AnthonyM83]

I always understood protected information to be things that would lead to identification of a patient...that's usually how I see it. I see 3 different situatiosn here.

Ex1: Patient tells you an interesting NYTimes article he was reading about. Or a funny interaction he had with a co-worker 10 years ago. That information by itself would be fair to repeat, right?

So, it wouldn't then be confidential MERELY by the fact that it was said during treatment.

Ex2: Patient tells you some really interesting story that involves him. If you tell someone else that information with the fact taht it's HIS story, you'd in effect be violating HIPAA only by identifying your patient. But if you leave out the identifying info...I have never been told that info by itself is confidential.

Ex3:

BUT if patient decides to tell you how he's robbing a banks through some computer glitch at his IT job, making millions each year...is can you tell THAT? (it's not mandated reporting) I THINK I was told crimes are reportable...but it makes sense not to report most of them...

Thoughts?

[DwayneEMTP]

Yes, I have trouble with the editor and formatting also.

I usually just do it in word and then paste it.

Yeah, I've tried that, but I must use the wrong version of Word as the editor hates the formating.

I'm not sure what the deal is. I used to think it was happening because I use Safari as my browser, but today I had to cut it out of IE and put it into Safari to get it to post.

Maybe it's just bad karma?

Dwayne

[JPINFV]

Something else to keep in mind is that treatment and health care operations are both permitted uses of health care information and are not limited by HIPAA. Treatment is defined as the following. "Treatment is the provision, coordination, or management of health care and related services for an individual by one or more health care providers..." As such, I would argue that disclosing that a frequent flier has a communicable disease and, in the past, has spat on crew members is an important piece of information for providing and coordinating health care and related services.

http://www.hhs.gov/ocr/privacy/hipaa/understanding/summary/index.html

[paraloco]

Ok, this if on a different angle. An individual commits a heinous crime in your community. An intense manhunt ensues. One of your co-workers posts a picture of the person on the dashboard of the ambulance, above the glove compartment. I'd say the chances of seeing this person are slim, but what if you pick up a patient, and their family riding up front sees that and knows him/her/it. "they got a picture of that baby-boy in the ammalance!" I'm for law and order like most folks, but this strikes me as asking for trouble. I took it down and put it out of sight.

[fiznat]

What Information is Protected

Protected Health Information. The Privacy Rule protects all "individually identifiable health information" held or transmitted by a covered entity or its business associate, in any form or media, whether electronic, paper, or oral. The Privacy Rule calls this information "protected health information (PHI)."12

“Individually identifiable health information” is information, including demographic data, that relates to:

the individual’s past, present or future physical or mental health or condition,

the provision of health care to the individual, or

the past, present, or future payment for the provision of health care to the individual,

and that identifies the individual or for which there is a reasonable basis to believe it can be used to identify the individual.13 Individually identifiable health information includes many common identifiers (e.g., name, address, birth date, Social Security Number).

....

De-Identified Health Information. There are no restrictions on the use or disclosure of de-identified health information.14 De-identified health information neither identifies nor provides a reasonable basis to identify an individual. There are two ways to de-identify information; either: (1) a formal determination by a qualified statistician; or (2) the removal of specified identifiers of the individual and of the individual’s relatives, household members, and employers is required, and is adequate only if the covered entity has no actual knowledge that the remaining information could be used to identify the individual.15

That is the extent of the federal law. There may be additional restrictions based on state law. In my opinion, our ethical responsibilities to patient privacy go somewhat farther than the law does.

[Lone Star]

Playing devils advocate...

What happens if your HEP positive pt is an angel until loaded into theambulance and then spits in your face while you take their blood pressure? Yourestrain them and put on a spit mask..yadda yadda. Next time they swear theywere in a bad place last time,(all sweet and doe eyed) that it will neverhappen again, but it does.

Do you tell the crews that you think likely to run on this pt to be aware thatthis pt is a terribly sneaky spitter? Or protect that information and let themlearn, and be exposed, on their own?

Dwayne

Edited (God only knows how many times it will take) to fix formating.

It's my understanding that you can inform the other crews of the tendency to spit on/at practitioners, but you cannot pass on the 'condition'(hep pos)unless it's directly related to the transfer of care.

As far as conversations unrelated to the 'condition' or care; I wouldn't be discussing that with anyone other than the patient. As I stated earlier, practitioner/patient privelige applies. Not only that, but "John Q. Public said...." equates to nothing more than 'gossip' in my book, and I try to steer clear of that as much as I possibly can. What I discuss with my patient (uless it's something I'm REQUIRED to pass on, stays between the patient and I.

While conversations not related to patient care may not be governed by HIPAA, I'm pretty sure that you'd still have to be careful not to cross that line of slander/libel.

[crotchitymedic1986]

I don't think this is the scenario that will get you in trouble. Instead, I think you are more likely to get in trouble when in a crowded restaurant, usually by two ways: 1. You are talking with your partner or family about the calls you ran last shift, and someone overhears your conversation. OR 2. Your dispatch gives out too much information during the dispatch of the call while you are inline at Burger King, and everyone hears it: M-2, respond to 1234 Main Street, the Smith Residence; on a 39 year old male with anal itching. Or "use precautions, patient is HIV positive".

Don't forget all the nosey folks who have scanners at home too.

Edited October 26, 2010 by crotchitymedic1986

[Happiness]

I did read a few of these replys, here is my take on it.

#1 if I encounter a violent pt (but as you know everyone is afraid of me)(and just had one the other day) I will make it a point to make sure that everyone in my station knows they were violent with me and to be careful if you have this person in the back.

#2 I had a pt who is 73 years old and is a bit bustier than most. She was having lung (chest pain). When I asked her what she thought may be the issue her reply "I have Titlash". I started to laugh and asked her to explain this to me. With her family in the room she said "My daughter was driving so fast around a corner the other day my tits did a zig when i did a zag and it has hurt ever since" The whole room burst out laughing, As you can tell I do tell this story but no names are mentioned.

To the original poster, Remember when you are repeating anything that has been said in confidence to you from a pt use your common sense. If it is a confession of a crimminal offence or you suspect abuse then there should be something in your policy manuel. If you hear something from someone else that is questionable again use your common sense and dont repeat it.

Treat others as you want to be treated. So if you dont want people talking about you then dont talk about others.

Happy