hipa question

[emtcutie]

So i had a patient in the e.r the other day who was a family friend. The patient had a stomach virus and was dehyrdrated. The patient also told me and the nurses he/she was depressed. He/she had stopped taking their medications including some very important heart meds. Since i knew them i told them i would stop by later to see how they were doing after they were relased. I did that today. When i arrived at the retirment community were he/she lived at with a plate of cookies, they told me "i don't feel like doing anything, i don't want to eat or drink, i'm not going to make it much longer, i just want to go back to sleep., I am not ok" Of course this concerned me. The patiant apparently had not eaten anything in a few days, I want to help him/her but i don't know how. I know you can share informtation if you believe the patient is a danger to him/herself or others, but this is a very gray area... what do i do?

[tcripp]

So i had a patient in the e.r the other day who was a family friend. The patient had a stomach virus and was dehydrated. The patient also told me and the nurses he/she was depressed. He/she had stopped taking their medications including some very important heart meds. Since i knew them i told them i would stop by later to see how they were doing after they were released. I did that today. When i arrived at the retirement community were he/she lived at with a plate of cookies, they told me "i don't feel like doing anything, i don't want to eat or drink, I'm not going to make it much longer, i just want to go back to sleep., I am not ok" Of course this concerned me. The patient apparently had not eaten anything in a few days, I want to help him/her but i don't know how. I know you can share information if you believe the patient is a danger to him/herself or others, but this is a very gray area... what do i do?

HIPAA is designed so that you aren't telling the world about your patient as it relates to their care as provided by you or their personal information obtained by you.

If you have a legitimate concern that your patient/friend isn't doing well and is depressed...that is continuity of care. If your plan is to notify his/her doctor/nurse or to contact a family member, then you are doing it for the betterment of your patient. Of course, what I'd be curious to understand is the health condition of your patient. Is he terminal? Is he so old that he's just tired and really ready to let go of this world? Maybe it's just time and he knows that it is coming?

You aren't violating any laws by letting someone know that he is depressed and potentially suicidal. Not to mention...you are visiting this person now as a friend...not his medic.

But I go back to my questions...

[Richard B the EMT]

Notify the facility floor nurse in charge of your observation, especially if the friend is behaving significantly different than what you consider their normal.

My Brother In Law works at the nearest hospital to me, as an XRay Technician. My grandmother collapsed from what later would be diagnosed as Phlebitis, making her delirious, and acting possibly senile. When my Brother In Law went to see her in the ER, and saw the ER crew treating her as if her family had just tried to foist off a senile old woman on them, he advised them, in no uncertain terms, that this was Altered Mental Status from her regular, and as such, to do something for her. They did, discovered the Phlebitis, and treated her for it.

(FYI, this happened the day after I had just become an EMT, May of 1974!)

[emtcutie]

HIPAA is designed so that you aren't telling the world about your patient as it relates to their care as provided by you or their personal information obtained by you.

If you have a legitimate concern that your patient/friend isn't doing well and is depressed...that is continuity of care. If your plan is to notify his/her doctor/nurse or to contact a family member, then you are doing it for the betterment of your patient. Of course, what I'd be curious to understand is the health condition of your patient. Is he terminal? Is he so old that he's just tired and really ready to let go of this world? Maybe it's just time and he knows that it is coming?

You aren't violating any laws by letting someone know that he is depressed and potentially suicidal. Not to mention...you are visiting this person now as a friend...not his medic.

But I go back to my questions...

he isn't that old, and no he isn't terminal. He lost his wife a few years back. He has been treated for depression before, but hasn't been taking any of his meds for that or any of his other medical conditions. I don't want to blow this out of proportion but i don't want to take it lightly either. There is a wellness center located in the retirment community that i could possibly get in touch with. Another person told me to conact adult protective services. Unfortunatley i don't know much about his family and wheter they are involved with him or not so i don't know if anyone else is aware of the current circumstances.

[EMS49393]

How do you know all this information about him? Has he told you that he has stopped taking his medication? Has he made other statements that indicate he is depressed and lost his will to live?

I ask for this reason, if he told you, chances are he is looking for help and this is his way of asking. People that are committed to ending their life typically will not tell anyone before they take the final step. It's the ones that make the subtle remarks that you can truly help. I would definitely figure out who is the most appropriate person to tell and let them know the situation.

Sometimes medication stops working. A person can be on, say, Effexor for 15 years or 3 years and wake up one day completely depressed and suicidal. It means their maintenance anti-depressant has likely stopped working and needs changed. This guys medication could have stopped being effective which is snowballing him into a depression where he is exhibiting potentially dangerous behavior.

Bottom line, he wouldn't share with you if he didn't need you to figure out how to help him.

[Lone Star]

As TCripp stated, HIPAA prevents you from yapping about your patient to every Joe Schmoe and John Q. Public, but relating this information to the floor nurse, physician, or even protective services would fall under 'continuum of care', since he/she was your patient, and he/she DID personally turn to you and let you know of his/her depressed state.

I would feel that there was a duty to act, and by passing on the information to those that are directly involved in his/her day to day care is only being an advocate for this patient.

Also as '93 said, those that are serious about 'giving up' are the ones that won't say anything until it's too late to do anything to prevent/stop them.

[HERBIE1]

The information you learned was in the context of being a health care provider, and was revealed to you by the patient. You did not learn it from their medical records or from 3rd hand information. As such, it would violate no confidence or HIPAA law to inform the staff what you have learned. You mentioned the person is noncompliant with their medications, so at the very least you should bring up that fact to someone in authority who can do something about it. It may simply be a case of someone who is tired of dealing with their various illnesses, advancing age, etc, and they realize their condition may not significantly improve. Maybe it's a simple medication adjustment. Maybe a social service/therapist issue. Either way, I would certainly make the notifications.

Sadly, depression in those who have lost a long time spouse is common. Some can move on, while others never fully recover. Tough situation.

[scubanurse]

Have you tried to talk to the patient/friend about your concerns? Sometimes when we are close to the patient we are caring for we tip-toe around questions that would not be a problem to ask if they were a complete stranger.

I would ask them if they are thinking of killing themselves. Just be blunt and honest as that tends to be better than the tip-toeing. Tell them you are concerned that they are not taking their medications and discuss with them getting some additional help. Your friend/patient may be using you as a resource to reach out to get more help. In my experience, people do not enjoy being depressed and aside from severe mental illnesses, most want to get better.

Just my $0.02 worth.

Good luck to you and your friend/patient.

[emtcutie]

I stopped by the other day with some food for him because i knew he want making any food himself; He had reluctanlty excepted buy wouldnt eat it. He was sleeping (even though it was 3pm) so i didnt stay long because i could tell he didnt want me to. I was able to talk to him a little and maybe that is what he needs. I try to reassure him and convince him that his wife wouldn't want him to give up. That seemed to get a little bit father I guess. I am just worried about him. I have informed the wellness center at the retirment community; they are in charge of overseeing all health related issues and concerns with the residents. Unfortunatly they told me there is little they can do because he is in the right state of mind and if he chooses not to eat or takes his medicine he is allowed. They are only allowed to intervene if the patient CAN'T eat or take his meds, due to a medical condition. So at this point I will just try or make frequent visits, and try and just listen, because you guys may be right in that that is what he needs.

[HERBIE1]

I stopped by the other day with some food for him because i knew he want making any food himself; He had reluctanlty excepted buy wouldnt eat it. He was sleeping (even though it was 3pm) so i didnt stay long because i could tell he didnt want me to. I was able to talk to him a little and maybe that is what he needs. I try to reassure him and convince him that his wife wouldn't want him to give up. That seemed to get a little bit father I guess. I am just worried about him. I have informed the wellness center at the retirment community; they are in charge of overseeing all health related issues and concerns with the residents. Unfortunatly they told me there is little they can do because he is in the right state of mind and if he chooses not to eat or takes his medicine he is allowed. They are only allowed to intervene if the patient CAN'T eat or take his meds, due to a medical condition. So at this point I will just try or make frequent visits, and try and just listen, because you guys may be right in that that is what he needs.

Good for you. Sounds like you are doing everything you can do, given the circumstances.

Good luck.