HIPPA question

[yadda_yadda_yadda, LPN, LVN]

Hello everyone...

Here's a situation I need some input on:

A friend of mine works @ a small assisted living facility, capacity of 6 residents. Type B facility. It is a FOR-profit facility,

Currently, housing only 2 residents, both male. One is 29 and suffered a catastrophic brain injury in 2005 & is 100% dependent (so not a 'true' assisted living case, more like total care)---the other is 74, also a TBI..but able to feed himself & propel W/C, ambulates unpredictably (when least expected, he's found to be out of bed--and has even wandered out of the facility twice)

The admissions paperwork states that no violent/combative resident will be accepted. If any condition requiring isolation occurs, the resident will be sent off premises for treatment.

OK-- The 74 year old was KNOWN to be violent upon admission. Apparently, the staff learned that the man was accepted due to the facility's funding...to keep the facility afloat, because after 6 months of operations, the only permanent resident was the 29 year old...and there were budgetary concerns...obviously.

Well--the 74 year old was discovered to also have scabies. ---AFTER, of course, he had sat all over furnishings that the other client's family & children sit upon, etc..etc.. The family also used the toilet in the living pod shared by both residents (since their family member is 100% dependent, the toilet was never used.....until the 74 year old came along)

The nurse manager repeatedly ignored pleas from the LVN's & rehab tech's to get a dermatology eval for this man...so this condition went undiagnosed/untreated for nearly 2 months.

The 74 year old also dislocated a staff member's knee, during a violent episode of what SHOULD have been simple ADL's...making the staff miss 2 weeks of work.

During that time, the family of the 29 year old noticed OBVIOUS changes in the environment...the absence of a primary caregiver...and damages appearing about the unit. (holes in the wall, tiles kicked loose in the shower)---all without a doubt, from non-accidental events.

There also had been "education leaflets" about "Preventing Scabies" left in the kitchen area ---in full view of the family.

OK--if the family of this man asked an LVN or tech "What the heck is going on here?"--Is there something we need to be aware of---and confronted the staff with a direct question about the scabies (and voiced an awareness of having seen the resident covered in rash, scratching, AND the "Preventing Scabies" literature):---I'd imagine that a simple FACIAL EXPRESSION told the tale...but...if the truth were told:

Could a nurse lose their license?

Could a CNA/CMA lose their certification?

The family is up in arms over being lied to time & time again...feels that their money ($15K a month...yes...$15K)...is not being applied towards the type facilty the admissions criteria contract states...and feels that their son is basically vulnerable to both contagions...and possibly violent attacks. (the 74 year old DOES ambulate..and wander...and we all know, that "try as we may"..we cannot be everywhere @ all times.)

My main questions are regarding licensure issues. The rest is gravy & the staff @ this facility fully intend on leaving their employment --as they are actively looking for other jobs.

I was asked to search for an answer & honestly didn't know myself.

Thanks in advance to all who respond!

What I'm needing to know is this: if any of the nurses or techs that work @ this facility DID say something--even though it were TRUE, could it cost them their LICENSE...(no one is worried about losing their jobs @ this place!)

[firstaiddave907]

well I am a cna and i was taught at least to always wash your hands and if you have something contiguous to call in to work and to tell them you can not come in . i would think if that person got anyone else sick and if she has a history of giving people staff infections than i think you could loose your certification. but i am not totally sure but thats a great question.

[DDRN4me]

you dont have to tell them WHO has scabies. you can say that the house has been exposed and that they may want to have themselves checked by thier primary md. has the other individual been treated? that should happen along wit h a thorough cleaning of all furniture and carpets in the facility. scabies does happen but the patient should have been treated ..did he not see his primary in all that time?? i would look for another less risky position soon,,you are putting your license on the line from what you are saying!!

[RobCPhT]

Maybe you should get yourself a lawyer and fight the battle or just walk away. I hate to see the state board crack down on people who get caught up in situations. It seems like this whole situation has gone on for too long. If you believe in good faith that patient care has been compromised you need to take action on it.

[vampiregirl, BSN, RN]

What a tough situation! Unfortunately it doesn't sound like there is alot of support from management. Good luck to everyone involved.

[Antikigirl, ASN, RN]

First I think it is good to break this down into State Board rules and Facility rules. Take the facility rules and keep them far off because when it comes to State Board Rules facility rules mean very little! It is the State Board Rules that dictate what the RN's, LPN's, and CNA's should have been doing and reportin, and you are held to those rules!!!

If the facility was warned by the staff...was this DOCUMENTED? If not it 'wasn't done'...so make sure that these items are always documented (I use to put down items like "facility managment/administration Mr/Mrs ___________ notified of ________ at 1203 by phone on date". And perhaps quotes of what I said and their reaction...simple to do, and good CYA!).

Scabies is an infectous disease! It is also reportable to most state infectious control departments so that they can do follow up and prevent the spread into the general population in such facilites as yours and others. If this was true in your area, the MD should have been notified, and the RN should make sure that the MD's office notified the proper authorities. If not, that ball was dropped by the RN and the MD...not good at all!!!

The violence...now that should have been reported by the person injured! Charges against the patient should have been filed, and the legal system allowed to proceed with charging the patient and sentencing that is appropriate for the action. People always shy from that because "well they didn't mean it" or "they didn't know" or "they were on medications".....that is NO excuse, and let the legal system find the proper justice for them (and perhaps proper placement and assistance ).

Now the hipaa...you can in no way say a word about a resident or their health issues at all to anyone that isn't their healthcare provider or MPOA. However, you can differ them to your ADMINISTRATION if they have questions concerning the facility and safety issues of their loved one...it is the administrations job to handle these issues in regards to safety of facility! I would divert that to them, and DOCUMENT that I did so in the patient's chart (the family's patient's chart...I would document the converstation and whom I refered them to!).

Also, if a nurse or CNA sees potential for danger for a patient or sees actual harm...it is a mandatory report issue, and if it was not reported...you darn betcha you can get in deep trouble, loose a license/certification, and be brought up on neglect charges if the family of the victim so chooses! The family and patient depend on the staff to provide a safe environment or report if it is no longer safe...so does the STATE!

Basically...I would get the heck out of dodge fast! I certainly would!

[yadda_yadda_yadda, LPN, LVN]

Thank you SOOOOOOO much!

The primary concern all along had been for the 100% dependent patient...based on the fact the for +6 weeks, his direct care giver's clothing had DIRECT contact with the pt. infested with scabies.So DARNED RIGHT there was legitimate reason/just cause to see possibility of 'transmission' from one to the other.

Handwashing aside---if you've just wrestled someone all over the place doing ADL's & they have scabies, "chances are"....you've likely got a few on you!--and since the manager neglected to get the dermatology eval for all that time, no isolation precautions (gowns, mainly) were used AT ALL. They weren't even AVAILABLE to staff!---Not to mention, his clothing & linens were strewn all over the carpeting each shift, wrestling to change him, and do necessary care!

Thing is, with there only being 2 residents...it was immediately KNOWN by the 100% dependent man's family "who & where" the scabies came from......without the staff ever mentioning a name---simply by sharing their concerns---LEGITIMATE ones...the process of elimination revealed the source.---so the so-called "HIPPA violation" actually amounts to a process of common sense on part of the family. DUH...2 patients...our son DOESN'T have scabies....the old patient is covered in a rash & scratching all the time...VOILA! The old man has scabies! ------- Amazing deduction on the part of the family, wasn't it, now?! :)

Notices of resignation are being turned in today. :)

[yadda_yadda_yadda, LPN, LVN]

The RN/Nurse manager & a RN,FNP 'evaluated the rash' ---and neither one saw fit to do a scraping. Both of them determined it "allergic dermatitis"---Yea, RIGHT!

There aren't any regular MD visits @ this facility. Meds are refilled as needed & the MD is only contacted if there is a change. (THAT in itself is scary!)

Thanks for all the support & input! :)

[Antikigirl, ASN, RN]

The fact that they did not have proper PPE (Personal Protective Equipment) is AGAINST the labor laws! You have a very ligitimate and large suit there!!!!! So do the patients!!! Hello OSHA!!!!!

You poor guys, I am very sorry...but good thing you are getting out of there, and I hope you inform the right authorities quickly to protect the patients and others from ever going to that facility till things change drastically!!!

Keep us up to date please! I am very interested in your case here!