How Has HIPAA Impacted Your work environment???

WhiteCaps · Aug 7, 2003

We've been threatened with $20,000 fines out of the nurse's pocket for violations... like for leaving even a single paper out with a pt's name on it.

Is that a "standard" threat in other places too?

If the gov. is really worried about a nursing shortage, they need to stop complicating the nursing workload!

pappyRN · Aug 7, 2003

Good morning,

I am disabled RN so am not privy to any caregiver/provider inservices given on HIPAA. But, I would like to ask if anyone knows what could happen to an LTC facility for using old lists of the Medicaid patients in my Mom's division and in the hall where she resides as scratch paper? They cut up old papers and lists and use them for scratch pads to take notes for phone calls. I needed a piece of paper one day and asked at the nurses station. That is what I was given. Imagine my surprise when I looked at the reverse side and there was a list of all the Medicaid patients down my Mom's hall. I had already had a feeling that the people on the list were Medicaid pts. before I ever read the list but now I guess I know for sure.

Does anyone know what the penalty is for this kind of violation?

As far as receiving info over the phone, my Mom had to fill out a form stating who could receive info on the phone. A copy is in her chart. There have been many more infractions not only against HIPAA but also violations of her rights and I believe a violation that is actually against state law. Retaliation for a call that was made to the state elder abuse hot line by my sister. In this entire mess there have been numerous violations of HIPAA, Mom's rights and state law along with violations that I think could effect the administrator's nursing home administrator's license from the state regulatory agency responsible for overseeing LTC admins.

My sister and I have not decided what we are going to do about these infractions and careless disregard for the wishes and rights of my Mom.

Our family has been shattered over this and other incidents because the administrator called my brother whom she knows through community organization meetings as he works for a town which borders the LTC's location. She basically ranted and raved to him about the call to the hotline and asked him to handle this matter with my sister and I and to get us "under control"! During his explosive rage to us on the phone he made statements that they could throw my Mom out of this facility and that it could be subtle and orders could be given for up higher that she should be asked to move and also that they could just refuse to do things for Mom etc. I don't know if the admin. said this to my brother or if he was out of his mind and this was a product of his wild imagination. The admin. arranged a meeting with my brother although my Mom objected when told by me that the meeting was planned and stated she wanted to be present at the meeting and wanted no meetings held behind her back. Her request was written on a piece of paper by the eve shift nurse since Mom has a rough time writing due to residual CVA weakness in her hand. The nurse personally delivered that note stating Mom's objections and her demand to be present at that mtg and placed it smack dab in the middle of the admin's desk blotter.(this same nurse said she would swear to it in a court of law that she wrote the note for Mom and delivered it to the admin's desk.. She is looking for a new job because she said that the admin has gone off the deep end lately screaming at everyone) The meeting went ahead WITHOUT my Mom. She wheeled herself down to the main office just off the lobby to ask when the meeting was scheduled and she was told by the receptionist AND the admissions director that my brother had been there but that they had only discussed fireworks for the upcoming 4th of July event for the community and then they "shooshed him out of here"! That was an outright lie because Mom later told my brother how upset she was that he spoke about her business behind her back. My brother also told Mom at that time that they could make her leave the facility if we called the hotline again or didn't back off complaining when things weren't done . He told her that they could stop doing things for her or make her wait extra long when she rings her call bell etc. What a piece of work he is. Trying to scare his 85 yr old Mother! She related her fear to us the next day. She was terrified that she would be thrown out and would have no where to go.We assured her that they could NOT do that to her nor did we beleive that they WOULD do that to her and to stop worrying because IF it happened we would just call the hotline again and file an appeal.

Back to the story-we left off where my brother had a mtg with the admin and Mom went to the office to find out what time it was starting.The admin. staff lied and told my Mom that they never got her note and that the mtg was short, they talked about fireworks and then he left! THEN, sometime after their mtg, the admin. taped a paper over the contact's name section on Mom's face sheet where the directive from the ADMINISTRATOR NOT MY MOM, was that they were now to call my brother for anything that came up instead of me or my sister whom Mom had appointed to handle these matters. The admin signed the note. We knew nothing of it's existence. Well Mom got sick and one brave nurse called me and said you know I could lose my job but I don't think what is going on is right. I did not call your brother because he doesn't even know what is going on with your Mom since he is barely ever here. She's the one who told me about the note. I then had the next day's eve shift nurse show my Mom what the admin had done. Well,of course Mom knew nothing about this note in her chart saying to only call my brother and signed by the admin, my Mom was outraged at her nerve and so were we. I asked the evening shift nurse to remove the note and place my sister and I back in the section of who is to be notified. Mom was right there with me and also asked for her to remove it. She was the same nurse who had written the note about the meeting for Mom. She told me that they are not allowed to remove notes from the chart that were directives from the office. Luckily, I saw the admin and asked her if she had seen my sister wheeling my Mom down the hall. She said no so I told her not to leave because my Mom and sister and I had something to discuss with her. I went to get my sister and the admin saw us coming down the hall and tried to sneak out. But, my sister's big mouth yelled down the hall and told her to stop because Mom wanted to say something to her. Mom told her that she absolutely did NOT want my brother to be listed as a contact... that she wanted me. She said to my Mom "So, you don't want your son's name on there?" Mom answered "No, I want it just the way it was before YOU changed it without my permission!" The admin. said "So, you want your daughter on here because she's a nurse?" Mom said "No, I want her on there because she's my daughter and that's who I want. I have never told you I changed my mind!" The admin looked like a deer caught in the headlights. BUSTED!!!

So, because of the call she made which ticked off my brother... my sister and I no longer have ANYTHING to do with my brother and never will again after the horrible things he said to us and accusations of problems that she embellished in relating her side to him and because he didn't even give us the opportunity to tell him why the hotline was called- he just slammed the phone on me. BTW, the state div of aging hotline was called because being on Medicaid makes it almost impossible to get dental work done. Mom had a painful tooth and needed some dental work. For anyone who has followed any of my other posts, you'll recalll that the staff neglected to brush Mom's teeth over the period of about 5 MONTHS despite numerous requests to admin to take care of the situation. I told the admin that when her teeth rotted and she had to get extractions that since she couldn't manage to get her staff under control that I was going to come to her and SHE was going to pay for the dental work. She managed to have a dentist examine Mom. He said she needed SEVEN extractions, dentures and a bunch of other stuff. Well, unknown to us, when the admin saw that list she had decided that SHE was NOT going to pay for any of it. BUT, she didn't tell us. So, we were under the impression that she was working on the arrangements with the dentist. She was supposed to be finding a dentisit to do the work. She let the ball drop and Mom developed an abscessed tooth with swelling, redness and a temp elevation and needed antibiotics. She took them for seven days. Well, we thought after that she would have her work done. We kept asking when and no one could answer. So, we asked the eve shift nurse to leave a note for the day shift and have them find out. There is a male nurse who HATES me and won't even talk to me. He wrote on the note asking about when Mom's dental work is being done "If the daughters want to know when her dental work will be done, tell the daughters to make a call to the dentist themselves with about ten exclamation points. Well, it pissed my sister off royally because of it's tone and sarcastic innuendo rather than keeping in mind that the patient was having problems with infection and pain and that this same patient has a hip prosthesis and coronary stents making her susceptible to subacute bacterial endocarditis! She took her cell phone and went outside and hotlined them for failing to provide Mom's dental work. In the meantime, I was able to speak to a friend who is a dentist and as a matter of fact had been Mom's dentist and he agreed to do her work free. He said it was bs that she needed SEVEN extractions. She needed ONE and that tooth was now infected.(different from the previous infected tooth) That's the story in it's condensed form except I called the LTC Ombudsman and talked to the director for our region. I asked him his opinion if these things were HIPAA violations and he said yes, and there are also rights violations, state law violations and violations that should be reported to the nrsg home admin. licensing board. He also encouraged me to report this to CMS-centers for Medicare and Medicaid services. When I asked him if she could transfer my Mom because of any of this mess or in response to a hot line call having been made, he no, absolutely not because you have 30 days to appeal and she would have to write the order for Mom to be transferred. He did say that the admin could try to make my sister's life and my life miserable.

I believe we did the right thing under the circumstances. There are so many things that we probqbly should have reported to the state in past incidents such as...her hip fx, bactermia with high temp and no one knew she was critically ill and close to septic shock, an MI which the nurse did not take the symptoms seriously and blew them off as stomach problems and Mom went on to have an MI requiring 3 balloons and 4 stents, repeated episodes of dehydration, frequent bladder infections, wearing THREE nitro patches because the CMT FORGOT to take the other two off resulting in dangerous drops in her bp and nasty HA etc.

I would greatly appreciate any thoughts on these matters. Moving her out of this facility will NOT be an option we would exercise. In spite of these problems and others, it is the best nursing home around within at lest a 30 mile radius. Due to my frail health and also time constraints it is imperative that we keep her in a facility that is close to where we live. Thank you, in advance, for your comments. I appreciate the opportunity to receive opinions from my colleagues.

Warm personal regards,

PappyRN