HIPAA and Advocate for competent patient

Nurses HIPAA

Published

  1. Was I right to not give information?

    • 15
      Yes, I had to protect patient privacy
    • 0
      No,The family should be informed

15 members have participated

I have been an RN for about a year and a half now and I have recently started on days on a cardiovascular step down unit. I had a 29y.o patient who was completely alert oriented and competent. A patient's family member (aunt) called at the end of the shift to have a "detailed report of what happened" with the patient that day. I said to the "aunt", "I apologize, but unfortunately I am only able to tell you that the patient is here and that he is stable" This is what I had been told since day one of nursing because you can never truly verify who is on the phone even if a password has been created. She was very curt with me and stated that she was a nurse and was his proxy for healthcare and that she had been receiving information all along and why would I say this now? I explained that with her being a nurse she should understand that because of HIPAA it is difficult to verify who she is and the patient is alert oriented and competent and so she is unable to receive information about the patient unless the patient tells her then I offered to transfer her to the patient's room phone which she refused and asked to be transferred to the charge nurse. I thought the issue was resolved after the charge nurse reinforced what I had said and was then transferred to the MD. The next day the stepmother and girlfriend were upset (which I knew nothing about) and called Patient relations, and our manager, and supervisor because of this issue. I had my superiors stand by me, but I am still unsure what to really think and what is right. The aunt wanted to receive information such as lab values, radiology studies, tests, what the plan was, and then silly things such as how many times was he OOB and how many times did he urinate and what color was it (she literally said that). I understand she is concerned, but with my license on the line and HIPAA what am I supposed to do??????

Sorry for the long story.

Specializes in LTC,Hospice/palliative care,acute care.

But anyone could have called and claimed they were you. That's why so many hospitals have a policy in place -code words or numbers,etc. How many of us have ever gotten a call of spoken to a visitor who turned out to be an ex- wife or some long estranged family member just looking for dirt? It happens all the time.

And I just don't understand the willingness of competent adults to give this kind of control to a family member unless they are elderly or infirm or circling the drain.To me it reveals a lot about the patient-I tend to assume they don't want to take an active role in their careplan.

If anyone whether nurse or administrator had refused to talk to me or give me information I was entitled to receive about my family member, I would have called a lawyer as soon as I could.[/quote']

I think this is one reason people are so careful about giving out information to someone,especially over the phone, because there is always someone great ending to go to an attorney.

I think this is one reason people are so careful about giving out information to someone,especially over the phone, because there is always someone great ending to go to an attorney.

My post above referred to information I am legally entitled to. The law is on my side. I'm sorry you don't like that.

Specializes in LTC,Hospice/palliative care,acute care.

But unless the loved one is confused or critically ill and unable to speak why should anyone -POA or otherwise-be wasting anyone's time calling docs and the floor for a report when the patient is perfectly capable of giving them any info they wish? Just because they can,IMHO. It's a control thing,too. You will get a call if your loved one crumps ,no need to call three times a day to find out what color his urine is and how many times he voided,especially if you've been there all day.Get some rest,you will need to be available after discharge to help them in their home.

Specializes in Critical Care.
If the POA cannot be there in person, no, we cannot discuss the patient over the phone ~if THEY call US~ because we have no way of knowing who is actually on the phone. WE can call THEM, however, if the doctor requests it and/or we need a phone consent for something. Usually if a patient is incapacitated, they have a POA who is nearby. We are simply following HIPPA, and not just making up our own rules.

You're facility is actually making up it's own rules, which is pretty common, although not to this degree. In the case of a POA when the POA becomes the active decision maker, you're actually required to facilitate communication, not stifle it.

As for what HIPAA requires:

" If a patient's family member, friend, or other person involved in the patient's care or payment for care calls a health care provider to ask about the patient's condition, does HIPAA require the health

care provider to obtain proof of who the person is before speaking with them?

No. If the caller states that he or she is a family member or friend of the patient, or is involved in the

patient's care or payment for care, then HIPAA doesn't require proof of identity in this case. However, a

health care provider may establish his or her own rules for verifying who is on the phone. In addition, when

someone other than a friend or family member is involved, the health care provider must be reasonably sure

that the patient asked the person to be involved in his or her care or payment for care. "

Specializes in Critical Care.
It's a control thing,too.

I think you hit the nail on the head, but maybe not in the way you meant. There is power in being the gatekeeper of information, that power is demonstrated far more through denying access than it is by providing access, which is maybe why family is sometimes told they can't be given information due to HIPAA, even though according to HIPAA they clearly can be given information.

Patients, unfortunately, are often largely ignorant of their own condition, either by intention, lack of supporting knowledge base, or poor comprehension due to illness, stress, etc, which is why often the best way for the Nurse to help encourage a strong support system for the patient is to clearly and openly communicate.

HIPAA provides for communicating with friends and family in the case of a competent patient, just ask, although you don't even have to do that:

"If the patient is present and has the capacity to make health care decisions, when does HIPAA allow a health care provider to discuss the patient’s health information with the patient’s family, friends, or

others involved in the patient’s care or payment for care?

If the patient is present and has the capacity to make health care decisions, a health care provider may

discuss the patient’s health information with a family member, friend, or other person if the patient agrees

or, when given the opportunity, does not object. A health care provider also may share information with

these persons if, using professional judgment, he or she decides that the patient does not object. In either

case, the health care provider may share or discuss only the information that the person involved needs to

know about the patient’s care or payment for care. "

I don't think you are entitled to anything over the phone, if they can not determine who you are.

My post above referred to information I am legally entitled to. The law is on my side. I'm sorry you don't like that.
Specializes in Pediatrics, Emergency, Trauma.
***** "If the patient is present and has the capacity to make health care decisions when does HIPAA allow a health care provider to discuss the patient’s health information with the patient’s family, friends, or others involved in the patient’s care or payment for care? If the patient is present and has the capacity to make health care decisions, a health care provider may discuss the patient’s health information with a family member, friend, or other person if the patient agrees or, when given the opportunity, does not object. *****A health care provider also may share information with these persons if, using professional judgment, he or she decides that the patient does not object. In either case, the health care provider may share or discuss only the information that the person involved needs to know about the patient’s care or payment for care. "[/quote']

****Pt in OP's post didn't want to discuss information; so OP still had a right to follow through as they did. Sounds like the pt makes his own health decisions. The fact remains per the OP, the pt didn't want to discuss it; in addition, there are instances where PP's gave excellent examples of why they do not give out information on the phone.

If facilities had the unfortunate issue where they've had issues discussing PHI, and they want to ensure that PHI is protected; then the facility has that right to do so in order to comply.

I've had pt's in situations that they had a list, and codes, etc.,and wasn't in the system for anyone to find; for pt safety, the understanding was for all information was to be shared with people present.

Where I currently work; we always involve the pt in deciding whether to share the information; if the pt declines if they are AAO x3 and say NO, they are the ones to tell the person seeking information.

We don't discuss the patient on the phone, period. They have to be there in person, unless they have a code to identify themselves with. Yes, if they want to see labs, physician progress notes, etc., they have to go thru medical records. Anyone can call and claim to be a relative or POA; how do you know who is really on the phone?

I know I'm just a student, but this seems ridiculously restrictive. I also see nurses speaking to family members on the phone in the hospitals often (calls in and calls out). I think I'll just verify this when I get my job as to policy at the specific hospital since it appears there is a wide range of responses

I don't think you are entitled to anything over the phone, if they can not determine who you are.

Read the link MunoRN provided on common questions about HIPAA, point #4 for information on sharing health information over the phone. Then read my first post where I said in my particular case I had the POA and another document authorizing me to advocate for my family member and receive any/all protected health information. I had been by my family member's bedside and had spoken with the nurse, and it would be reasonable to expect that when I telephoned the unit that same nurse would make a good faith effort to identify me, as the nurse did - he/she was able to remember my voice and details of the care he/she had just provided for my family member in my presence. Plus, it would be easy for me to confirm my identity - I could e-mail the documents (they had the POA on file already) plus my identification. The POA and the other document drawn up by a lawyer give me the authority to receive information regarding my family member over the phone, according to HIPAA, so yes, I am entitled to receive information over the phone as I can identify myself in multiple ways.

+ Add a Comment