Pt. Privacy Issues

[Catrina]

I can justify this in my own head, but that doesn't necessarily mean I'm right! Here's the deal; just curious to hear other opinions. I had a call the other day for a vaginal bleed, and we arrived on scene to find an 18 y/o girl who complained of severe abdominal pain and had bled about 1/2 a cup of blood. Said she tested positive for a pregnancy test 3-4 days ago, last period was about the 1st of January (morning sickness prompted the test). Prob. miscarrying, as I hear those over-the-counter pregnancy tests are highly accurate, but we didn't know for sure. The girl was understandably upset and all. She lived at home with her parents, who apparently didn't know about the pregnancy. Anyway, when we got to the ED, the parents arrive having not a clue about what was going on with their daughter, and they were visibly upset. I discreetly told mom that her daughter was bleeding, and she asked me if she was pregnant, and I said the test was positive. She asked me if her daughter was miscarrying, and I specifically said that in my unprofessional opinion, I believed she was, but the ED staff would provide the official diagnosis.

I'm sure I violated some confidentiality rule; however, I felt that in this case it was appropriate, as the parents were extremely concerned and the daughter was in too much pain to effectively communicate with them. They were accompanying her into the pediatric ED. Any thoughts? I'm still rather new at this, and I'm curious as to what your thoughts are regarding whether or not I should have told the mother what was going on.

[engine4cLT]

I wouldn't have told the parents anything other than that she was being evaluated by the ED and that they should hear something soon. I would have told them that she was stable, if that was the case, and that she was receiving the best of care.

[DaSharkie]

I am with the Lietenant on this one. Never - EVER - discuss patient information with anyone. Even a spouse, at the EMS level of care, can be tricky. This is even more important considering 2 things with this particualr patient - she is 18, therefore she is emancipated and the parents have absolutely NO need or right to know. I do not sy this to be mean spirited to you, and I hope that you understand this, but as you are new to the profession and this is a legal quagmire, it is a good opportunity to teach and guide.

I discreetly told mom that her daughter was bleeding

This is the only part I would have safely been able to relay to them as they probably already knew this. Further inquiry would have been directed to guiding them to speak with the physicians/PAs/NPs at the ED.

she asked me if she was pregnant, and I said the test was positive.

This is not the mother's business to know or be learned from an EMS provider. Especially considering that the patient was 18 and it is fairly resonable to assume (and I hate assuming) that the patient would inform the parents of her status at her own time of choosing, no matter the course the pregnancy were to take. This is especially true as the patient has given you her findings of an OTC pregnancy test.

she asked me if she was pregnant, and I said the test was positive. She asked me if her daughter was miscarrying, and I specifically said that in my unprofessional opinion, I believed she was

By stating so, the angst and turmoil between the family could easily be escalated, and IF the patient is not pregnant and IF the patient is not having a miscarriage, then they have a diagnosis from you (even though it was your "opinion" as that is how we in EMS must base our treatments) that may conflict with what the ED staff will diagnose. Should that occur, we now have a medical difficulty present with conflicting diagnosis.

I'm sure I violated some confidentiality rule

This is what HIPPA is all about. Take this as a learning tool, chalk it up to experience, and hope that no problems come out of this and no cpmplaints are filed.

however, I felt that in this case it was appropriate

The law has no gray area on this matter, as it strictly dictates who information can be shared between. It was not appropriate to do so.

as the parents were extremely concerned

As they should be, and as most people would be. However, this does not allow for the sharing of information regarding the patient to them.

As for the patient being able to communicate with them effectively, that is what the providers at the hospital are there to do. They will communicate the information that they are able to, and the information that the patient authorizes them to. Only in the case of a necessary surgical procedure would additional information be given to the patient's next of kin.

I'm still rather new at this, and I'm curious as to what your thoughts are regarding whether or not I should have told the mother what was going on.

As I said, I did not critique this in a mean spirited way or in a manner to offend you. I thought that the best manner to address this would be piece by piece as I did.

[Catrina]

I wouldn't have asked for your opinions if I was certain about the appropriateness of my actions. I appreciate your honest counsel, as I see this as a learning experience. Your reply didn't sound mean-spirited to me at all.

You're right--the pt was 18, and a legal adult. When I spoke to her mother, I think I was more confirming what she already knew, but I definitely should have done a better job of protecting my pt's confidentiality. I think that I assumed that because the parents and daughter appeared to have a close relationship, that everything was OK, without giving thought to my legal obligations.

I understand my pt. confidentiality reponsibilities, I assure you, but any tips on how to actually answer the mom's questions would be appreciated. Being evasise about their daughter's condition could have potentially intensified a negative reaction.

[medic563]

Just curious, did you go through the HIPPA training at where you are working/volunteering? Your action is illegal with punishment up to $50,000 fine and up to 1 year and jail. And even more than that, it is pretty unprofessional. We need patients to trust us when we are interviewing them, and part of that trust is that we will not be telling anyone not directly realted to their medical care. Although we have that trust, dont promise or tell a patient that we have similar to the Doctor/patient privaledge because in many states you can be compelled by a judge to testify of patients interactions with you.

[Weruj1]

I wouldn't have told the parents anything other than that she was being evaluated by the ED and that they should hear something soon. I would have told them that she was stable, if that was the case, and that she was receiving the best of care. ..since she was 18 thats all you can legally say ........

[Catrina]

Originally posted by medic563
Just curious, did you go through the HIPPA training at where you are working/volunteering? Your action is illegal with punishment up to $50,000 fine and up to 1 year and jail. And even more than that, it is pretty unprofessional.

Yes I did.

My intentions were to help the mother get a hold of the situation and relieve her bewilderment-although I still did the wrong thing, I wasn't being merely careless with patient info. I recall saying that I understand my failure to protect my patient's confidentiality--I'm aware of that already, but thanks. It is my intention to provide patient care of the best quality, and I failed to do so in this case, although in the big picture, I think my actions helped to alleviate the mother's shock. However, the end doesn't justify the means. I appreciate the input of EMTs more experienced than I, and I know I will be much more considerate of patient confidentiality in the future.

[Weruj1]

As you are learning ...........no good deed goes unpunished.

[spearsm]

I'm with Weruj1 about your comments to mother.
"She is in good hands, and you will know something soon."

If mother continued to ask, I would have told her the truth. "Maam, under the law, I can't say anything."

So many times I have been cornered, and so many times, I have to say the same thing.

[medic563]

Catrina,
I was actually just curious. I know some of the volunteer departments around my area are very, very, lax in providing the appropriate training. As far as the actual incident, I've always believed that a mistake is only a mistake if you dont learn from it, and you repeat it because you havent learned from it. So although you screwed up, its not the end of the world. By asking the question about it I'm sure you are trying to learn from it. I agree with several of the other posters that you can comfort a family without releasing sensitive information.

[Catrina]

That's a good point you bring up, medic563. I take full responsibility for my own actions, and I, like everyone else, received HIPAA training in EMT class, but my corps is woefully inadequate in training its members in respecting pt. confidentiality. Not once have I seen mandatory training or even a voluntary class on the subject. It's interesting because it's not typical of other corps in the area I live. There have been numerous times when PCR's have been left in plain view, documents with patient info haven't been shredded, etc. Patient confidentiality doesn't seem to be a high priority, which is sadly unprofessional and unfortunate, not to mention potentially lawsuit material.

However, as I said, I learned about pt. confidentiality along with everyone else in EMT class--no excuse there! I asked because I wanted to learn, and that I have, and I can assure everyone and myself that I will be much more professional in the future in regards to respecting my the privacy of my patients. Thanks all for your input.

[btroutm]

I agree with everything that has been said. Catrina, what happened was more than just breaking a rule, it was breaking the law. It was a clear-cut failure to maintain patient privacy. Regardless of how upset the mother may be, you have a responsibility to protect your patient's rights. That being said, the fact that you're here asking about it says alot. Everybody makes mistakes...the key is to learn from them, which you apparenly have. In the future, I'd try to avoid discussing specifics with family members. It will only get you into trouble.

[IACOJRev]

Let me speak as an employee of a Level 1 Trauma Center and not a fire chaplain.

Originally posted by Catrina
Anyway, when we got to the ED, the parents arrive having not a clue about what was going on with their daughter, and they were visibly upset.

Since you were already at the hospital, it would have been wise to refer the parents to hospital staff immediatley instead of having the conversation with them. She was their patient now, not yours. According to HIPAA, good intentions do not excuse violations of patient confidentiality.

Now there is a good chance that the daughter may have eventually given permission to the hospital to share information with her parents, however, you would not be covered under that permission. Your department would have to have obtian thier own permission - in writing - before you would permitted to share any information.

Originally posted by Catrina
She asked me if her daughter was miscarrying, and I specifically said that in my unprofessional opinion, I believed she was, but the ED staff would provide the official diagnosis.

There is no such thing as an "unprofessional opinion". If you are an "unprofessional", please find a new job. Pardon my bluntness, but do you really believe that you are unprofessional? If this ever went to court and you stated that you gave an "unprofessional opinion" the lawyers would eat you alive!

When in doubt -- PUNT! It may seem inconvient to the family, but it will do a few of things...
(1) Provide a way out for you so you don't have to feel obligated to share any "opinions".
(2) Identify the family to the hospital staff.
(3) Allow for actual (and accurate) diagnosis, status, treatment information to be related to the family directly from the attending staff (as provided for under the law and hospital policies).

Make it clear to the family that your thinking of their best interests and having direct communication with the hospital staff would be the best source of information for them.

[mittlesmertz]

(shooting the poor dead horse...)
I never, never, nope not ever tell family members about a pt's status. I told a family member of a chest pain pt that I transported something like, "I dont think it's a heart attack, he's just fine".
Of course the pt coded 10 minutes later and died.(turned out to be a PE). I felt pretty bad, as the family member went to the cafeteria to get coffee instead of going back to see the pt. This was way before HIPPA, but now I always tell em to check with the RN/MD, as I can't discuss the pt's condition. If they're really freaked out I give the "they were stable when I dropped them off" line, but even that makes me a little nervous.
For what it's worth...

[RoryEl]

The simple answer is to tell her mom your sorry but federal law prohibits you from discussing this and she should talk to her daughter. I'm sorry but my hands are tied! Besides the potential fine and jail time should be persuasive.

She may get mad but its the truth and you will not have to remember what lie you told her.