disclaimer: This was a conversation my coworkers and I had the other day and was curious on opinions.

If a nurse were to seek help for alcohol and/or drug addiction and disclosed that he/she diverted narcotics from patients, would that counselor be required to report this to the board or to their employer?

My coworkers say no due to confidentiality. I think stealing drugs from patients would fall under the "harm to others" clause.

What do you guys think??

Also, if a nurse is drug tested and is positive for methadone or suboxone (for which they had a valid prescription) is that reportable??

I would say HIPAA and the protected counselor-client relationship trump all other concerns. I would hope the information would remain confidential. It will be interesting to hear what others have to say.

At first you should warn, after that you should inform to authority.

I think it would be a mandated report situation. Perhaps by saying you used to but stopped you'd avoid that, but I wouldn't want to put money on it.

I recently had a discussion in my BSN program about this. There is a great article on medscape all about mandatory reporting:

http://www.medscape.org/viewarticle/585562

There are different laws in different states that may or may not define in what circumstances a nurse has to report another nurse. Some examples given under the "State Laws" section of this article (2008): In Texas, you can refer the impaired nurse to abuse counseling instead of to the nursing board; Michigan states that if you are a nurse with a professional nursing relationship (you are caring for) another nurse, you do not have to report. In Nebraska, in that instance you still could report them if you deemed that not doing so would be a danger to public health (which I think would apply if you knew that they would continue to divert drugs from patients).

You must know the specific laws of your state. In the "HIPPA and Mandatory Reporting" section, the author interprets HIPAA and breaks down your responsibility in the situation where you are caring for an impaired nurse into a step by step process: 1. Does your state mandate what and how you should report this? (If not, the author states, then don't) 2: Does the state law state that you should not report if the nurse is a patient (then don't report)? 3. Will exposing the nurse to the appropriate authorities "be limited to the relevant requirements of the law" or would they excessively violate her HIPPA rights?" and 4. Do you feel you have to report the nurse to protect the public?

The article states that HIPAA does allow for the disclosure of this private information if that disclosure is required by state law, and when it is "necessary for the oversight of the health-care system;" the author of the article seems to state a nurse should only report if required by state law.

In the "Patients in Alcohol and Drug Abuse Treatment" section, the author states that federal regulations regarding the privacy of nurses who you are treating for drug abuse or psychiatric issues (they are in your care and actively being treated for their addiction) override the state's requirement to report them.

This article also points out that if you see a colleague (who's not your patient) doing these things, you are considered to have met your legal obligations by reporting it to management or a supervisor (someone who is "reasonably able to prevent or lessen the threat") who is supposed to take care of the rest (reporting it to the board, etc).

The bottom line is that you should examine your state's laws and know when federal regulations override them.

http://www.hhs.state.ne.us/crl/SMRRequire.pdf

http://www.medscape.org/viewarticle/585562_5

http://www.hhs.state.ne.us/crl/smrrequire.pdf

http://www.medscape.org/viewarticle/585562_5

xt...you beat me to it.....lol

the summary is as follows...

"under the health care portability and accountability act (hipaa) of 1996, clinicians are responsible for implementing safeguards to ensure that an individual's health information is used only for purposes related to treatment, payment, or operations; that only the minimum amount of necessary information is disclosed; and that disclosure is made only to individuals who need to know the information in order to treat the patient, conduct the practice's operations, or obtain payment for services. however, there are exceptions that authorize clinicians to reveal information that normally would be protected by hipaa. for example, a hipaa exception authorizes clinicians to report child abuse. here is hipaa's language giving clinicians the go-ahead to report information that would normally be protected:

• a covered entity may use or disclose protected health information to the extent that such use or disclosure is required by law and the use or disclosure complies with and is limited to the relevant requirements of such law.
  
• clinicians are permitted to disclose private health information to a health oversight agency for oversight activities authorized by law including audits, civil, administrative or criminal investigations, inspections, licensure or disciplinary actions, or other activities necessary for the oversight of the health-care system, government benefit programs, compliance with governmental regulation or compliance with civil rights laws
  

so, if nurse 1 believes he or she is required by state law to report nurse 2 for an infraction or condition that nurse 1 discovered while nurse 2 was a patient, nurse 1 must closely examine state law and the 2 hipaa exceptions to determine whether the facts of the situation match the provisions of the law. nurse 1 will need to answer the following questions:

1. is the disclosure required by law in your state? if not, do not report. if yes, go to question 2.
   
2. does state law provide an exception to mandatory reporting when the impaired nurse is a patient? if so, do not report. if not, go to questions 3 and 4.
   
3. will the disclosure be limited to the relevant requirements of the law?
   
4. is the disclosure necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public?"[end quote]
   

http://www.medscape.org/viewarticle/585562_5

so, under most state statutes it is law that phi can be released in the instances of mandatory reporting. madatory reporting laws vary state to state so you must check with your state regulations. by statute, most states protect the confidentiality of the proceedings, reports, findings, and conclusions of peer review entities. the statutes also permit "any person to provide information or data relating to the physical or psychological condition of a person; the necessity, appropriateness, or quality of health care rendered to a person; or the qualifications, competence, or performance of a health care provider. a person acting in good faith, without malice, is not civilly or criminally liable for furnishing information or data to a review entity."

but.....the requirements for mandatory reporting of nurses by nurses differ widely from state to state

"oregon regulations instruct the nurse to base the decision to report on the licensee's past performance, a demonstrated pattern of substandard practice, errors in practice or conduct derogatory to the standards of nursing (despite efforts to assist the licensee to improve practice or conduct through a plan of correction), and the magnitude of any single occurrence for actual or potential harm to the public health, safety, and welfare. michigan directs nurses to report other nurses when they have "reasonable cause to believe" the nurse is impaired.

examining your state's law

when you review your state's law, look for:

• a definition of reportable events or situations;
  
• a description of level of suspicion (ie, must you have first-hand knowledge, or is "reason to believe" or "suspicion" enough?);
  
• direction about whom to report to;
  
• exceptions from duty to report; and
  
• consequences of failing to report" [end quote]
  

really read the medscape article, i hope this helps....

If someone were to disclose information about me while I was a pt who actively sought medical treatment, I would be talking to a lawyer so fast.

If someone were to disclose information about me while I was a pt who actively sought medical treatment, I would be talking to a lawyer so fast.

It's not just medical treatment or alcohol addiction it's deversion and depending in the state is a part of mandatory reporting.....just saying.

I get the whole diversion thing, but isn't a certain amount of proof required. What day, how much, what pt or pts? I work psych and the things people say and the actual event is rarely the same.

If you're caring for a pt who happens to be a coworker and they tell you something that could be potentially fatal to their career, I would seriously make sure they have little standing under the privacy laws or your gonna get yourself into a whole lot of trouble. I think it becomes a different entity once the coworker is a patient.

Very interesting topic.

I get the whole diversion thing, but isn't a certain amount of proof required. What day, how much, what pt or pts? I work psych and the things people say and the actual event is rarely the same.

If you're caring for a pt who happens to be a coworker and they tell you something that could be potentially fatal to their career, I would seriously make sure they have little standing under the privacy laws or your gonna get yourself into a whole lot of trouble. I think it becomes a different entity once the coworker is a patient.

Very interesting topic.

I agree and one of the reason's I have always had a policy of NEVER going to the hospital where I worked....TMI for others to share. HIPAA or not there are things about my health that I don't want shared. Besides I would have trouble looking at someone who has done personal thing for me........This happend once I got admitted while on duty for PNA....I was sick in the ICU. The hospital found out I had an auto immune progressive disorder, I had to tell them because I was on some pretty heavy immuno-supressives and guess what? After I was better..... My performance began to suffer until I was "let go".

I don't like people knowing too much of my personal stuff and access to my chart is not one of them!!!!

[sOUNDCLOUD][/sOUNDCLOUD]Not only is there HIPAA, but substance abuse patients have additional federal laws protecting their privacy. Anyone who is receiving alcohol or drug abuse treatment (a patient) must consent to the release of any medical records/information. Additionally, this federal law overrides state law! So if your patient is a nurse, and is getting substance abuse treatment -at your facility or elsewhere, you are NOT supposed to report them, even if your state law says you can/should.

I also saw a second medscape Q&A where a nurse had a patient who was also a nurse. The patient told them that she was taking drugs from her job and using them. They were told by their board and lawyers NOT to report because the patient is protected by HIPAA. She asked the health care attorney if that was correct. The healthcare attorney also stated that you can not report a nurse if she is/was your patient due to HIPAA.

I'm curious as to why this thread has been resurrected by a new poster more than five years after it ran its course.