HIPAA and one's own spouse/partner

Wuzzie · Nov 23, 2016

Why would a spouse be any different than say, your neighbor?

pmabraham, BSN, RN · Nov 23, 2016

Yes, in terms of spousal privilege (privileged communication) from my point of view.

I would like to find specific information from HHS on the subject matter vs. interpretation; but, I've been unable to do so.

Wuzzie · Nov 23, 2016

And you probably won't because the law is clear that the only people who are to be privy to this information are those involved in the direct or continued care of the patient. Unless you and your spouse care for the same patient there should be no discussion that includes identifiers between the two of you. There is no "spousal privilege" applicable here.

pmabraham, BSN, RN · Nov 23, 2016

I appreciate your sharing, but in terms of the law being clear, do you have a citation / link you can share so that I can read it? Please know I'm not arguing or debating; I'm just trying to find the actual source material to review vs. word of mouth or other forms of interpretation away from the actual source. Thank you.

elkpark · Nov 23, 2016

What are you looking for, something in the HIPAA law that says, "Except that it's okay to discuss PHI with your spouse"? Or, "And, remember, this means you can't disclose PHI to your spouse"? There is no "spousal privilege" in this situation. "Spousal privilege," the legal concept, means that spouses can't be compelled (in court) to disclose information that they were told by their spouse, or testify against their spouses. It doesn't mean there is some special immunity that people are allowed to tell their spouses stuff that they are forbidden to disclose to members of the general public. There's nothing in the HHS rules about spouses, specifically, because, as already noted, for HIPAA purposes, your spouse is no different than any other person. If your spouse is directly involved in the individual's care, discuss away. If not, you need formal authorization from the client to disclose any protected information.

Just don't start down the road of talking about clients at home -- problem solved.

Marital Privilege | Wex Legal Dictionary / Encyclopedia | LII / Legal Information Institute

Can spouses be forced to testify against one another? | Criminal Law

Wuzzie · Nov 23, 2016

I have reviewed it and not found anything specific to your request. I believe the wording they use makes it very clear to whom you can release this type of information and your spouse is not included. You are searching for a unicorn.

JenTheSchoolRN, BSN, RN · Nov 23, 2016

Why would you want to share such information with your spouse? Is your spouse a nurse? I mean, my spouse isn't in the medical profession and I have never discussed identifying patient information with him. Why would I? I have nothing to gain from it and it will not help the patient in anyway (HIPAA aside). I don't think the patient would appreciate me taking their private health info home to share with my spouse, just as I would not appreciate any nurse treating me to do the same.

Of course, sometimes I've talked to general terms about my day (since I am a school nurse, things like "visits were very high today, I'm exhausted"), but most of time, he knows he doesn't "get" it and we both say we had hard days and talk about other things.

chare · Nov 23, 2016

Wuzzie said:
I have reviewed it and not found anything specific to your request. I believe the wording they use makes it very clear to whom you can release this type of information and your spouse is not included. You are searching for a unicorn.

Actually, the University of Toledo Frequently Asked Questions about HIPAA Privacy document that the OP referenced specifically addresses this, stating that it is not allowed.

Quote
Q. May I discuss patients with my spouse if he/she doesn't work here and promises to keep it secret?
A. No.

pmabraham, BSN, RN · Nov 23, 2016

Yes, the University of Toledo referenced it, but I cannot find any legal case (aka legal precedent) or actual verbiage in HIPAA to support the interpretation.

Please keep in mind I'm not for or against the situation; I'm just trying to find an actual source document that either comes from HHS or is a legal precedent. So far I just have people telling me no, and citing anything but HHS or a legal case were it was proven to be a HIPAA violation.

elkpark · Nov 23, 2016

pmabraham said:
Yes, the University of Toledo referenced it, but I cannot find any legal case (aka legal precedent) or actual verbiage in HIPAA to support the interpretation. I talked to a nurse practitioner today who shared they regularly share information with their spouse. I pointed to my quest to find an actual citation (aka legal case or HIPAA outright wording) that would state otherwise.
Please keep in mind I'm not for or against the situation; I'm just trying to find an actual source document that either comes from HHS or is a legal precedent. So far I just have people telling me no, and citing anything but HHS or a legal case were it was proven to be a HIPAA violation.

I guess that, since the HHS rules are clear about under what circumstances, and with whom, providers are allowed to share information, and spouses aren't included as individuals with whom one is authorized to share info, I'm wondering why you feel you need to find some specific language or a legal precedent. I don't understand why there would be any question of whether it's okay to share info. Under HIPAA, people can only share protected info with the categories of individuals/entities listed in the HIPAA rules, and spouses aren't on that list. What's hard about that?

The nurse practitioner you spoke to is acting unethically, if s/he is actually freely disclosing protected health info and discussing cases with a spouse who is not directly involved in the clients' care, and that is the responsibility of that nurse practitioner.

Here's another source that is not actually HHS, but is providing guidance/interpretation to professionals on HIPAA compliance, that specifies that disclosing info to one's spouse is a violation:

"HIPAA policies explicitly state that patient information should never be given to any third party who is uninvolved in the patient's care. Even releasing information to the patient's own family requires stringent release of information guidelines. The patient's own spouse wouldn't have access to the records without explicit consent of the patient â€” so why should your spouse?"

HIPAA Violations to Avoid | HealthWorks Collective

I doubt you're going to be able to find exactly what you say you're looking for; but I don't see why that's a big deal. The law is clear about to whom info can be disclosed; other healthcare professionals who are directly involved in the client's care, third party entities for payment purposes, and other individuals when the client authorizes the disclosure. Very few of us have spouses who fall into one of those categories.

chare · Nov 23, 2016

pmabraham said:
Is it against HIPAA for a healthcare professional (doctor, nurse, etc.) to discuss any identifying details about a patient they cared for with their spouse?
[â€¦]
Where can I find something more specific as to whether or not a healthcare worker can mention (or not) anything to their spouse?
[â€¦]

Does HIPAA allow you to reveal protected health information to your neighbor, who is not involved in the care of the patient? Why would you think it would allow you to do so with your spouse, if he or she is not involved in the care of the patient? How is he or she any different than your neighbor?

pmabraham said:
Is it against HIPAA for a healthcare professional (doctor, nurse, etc.) to discuss any identifying details about a patient they cared for with their spouse?
I did find http://www.utoledo.edu/offices/compliance/Privacy_FAQs.html where it appears the answer is "no," but I cannot find any on Health Information Privacy | HHS.gov that would actually cite the portion of the law the utoledo.edu is basing their answer on.
[â€¦]

You do realize that the document you're citing here specifically states that this is not allowed, don't you?

pmabraham said:
Yes, the University of Toledo referenced it, but I cannot find any legal case (aka legal precedent) or actual verbiage in HIPAA to support the interpretation. I talked to a nurse practitioner today who shared they regularly share information with their spouse. I pointed to my quest to find an actual citation (aka legal case or HIPAA outright wording) that would state otherwise.
[â€¦]

I am not sure what it is you are asking. Are you looking for a source stating that it is okay to disclose a patient's protected health information to your spouse, who is not involved in the care of the patient? Or, are you looking for a source that states that you can do this?