HIPPA Violation? Chemo Infusion Room

Advanced Practice Columnist / Guide · Dec 29, 2014

Hi and welcome to AN.

From my perspective as a nurse and provider (NP), it is a HIPAA violation to discuss sensitive diagnoses and plan of care with a patient within earshot of others who are not involved in the care or decision-making. So, yes, I feel that this does violate HIPAA. Healthcare facilities must be compliant to HIPAA and fines are imposed if violations occur. Unfortunately, some patients do not complain about these scenarios for various reasons one of which is not being aware of their rights to privacy. Would it make you feel better to write an anonymous complaint to the clinic?

brownbook · Dec 29, 2014

I don't know. I work in a busy out patient procedure clinic. Curtains are all that separate clients pre and post procedure. One can easily over hear conversations between Dr.s, nurses, and patients. Maybe the curtain is considered enough to avoid HIPAA problems? It would be unaffordable for your or my clinic to have private rooms for every patient.

psu_213, BSN, RN · Dec 29, 2014

I don't know all the nitty gritty details of HIPAA, but, even it was not a violation of the law, it was definitely bad form on the part of the doc to discuss such details where strangers could hear.

KelRN215, BSN, RN · Jan 1, 2015

I don't think it's officially a HIPAA violation. It's not the best practice but maybe the patient was going to be in the infusion room until the clinic closed or the MD didn't have any time other than the present when he wasn't booked and the information needed to be shared. It's the same as having these discussions with someone in a double room on an inpatient floor. There might not be a conference room available or the patient might be too sick to leave his bed and go sit in a conference room.

HIPAA is not designed to impede conversations between providers and patients based on the potential for incidental disclosure:

Incidental Uses and Disclosures

klone, MSN, RN · Jan 1, 2015

My mother always tells me that HIPAA is a joke and no one follows it.

An attitude like that would get you fired right quick. No, it's not a joke, and yes, people DO follow it. I'm guessing this falls under "incidental disclosure." In semi-private hospital rooms, it's impossible to have a conversation and not have the patient in the next bed hear you. Privacy laws allow for such incidental disclosure, knowing that it's not always possible to be alone in a private room with the door shut.

Esme12, ASN, BSN, RN · Jan 1, 2015

I don't think it's officially a HIPAA violation. It's not the best practice but maybe the patient was going to be in the infusion room until the clinic closed or the MD didn't have any time other than the present when he wasn't booked and the information needed to be shared. It's the same as having these discussions with someone in a double room on an inpatient floor. There might not be a conference room available or the patient might be too sick to leave his bed and go sit in a conference room.
HIPAA is not designed to impede conversations between providers and patients based on the potential for incidental disclosure:
Incidental Uses and Disclosures

This is what it is considered....Incidental usage/disclosure. Now....is the MD inconsiderate? Yes. But but not a violation.

NurseGirl525, ASN, RN · Jan 2, 2015

When there is only a curtain between you and the next patient, things are going to get heard. I've noticed more and more hospitals even making the ER rooms private. That is honestly the only way you would never hear anything. But those kind of things happen all of the time. But is HIPAA a joke? No. We adhere to that strictly. I am a nursing student and I have never seen anyone at my clinicals violate it. It is taken very seriously. But sometimes things cannot be helped.

dudette10, MSN, RN · Jan 2, 2015

To have those in-depth conversations in the infusion room is wrong. However, I would not want the infusion rooms to be designed differently. While I didn't want to have small talk with other patients while receiving chemo, I did like having other people around me. The set up also allows continuous monitoring by the infusion nurses, so it's the safest way to infuse multiple people at a time.

That doesn't change the fact that those conversations should take place in the exam room prior to infusion.

Trauma Columnist · Jan 2, 2015

I work in outpt dialysis units. There is no privacy as (like in the chemo infusion room), the chairs are very close together. We (APNs and MDs) all MUST see our pts while they are on dialysis. This is per Medicare guidelines - the blood must hit the dialyzer PRIOR to us visiting the pt.

I had a very hard time with this as I too feel that this is a privacy violation - we code our pts right next to each other too. So, am not sure how the chemo infusion room is any different. I do offer pts a chance to see me privately but in almost 9 years of doing this no one ever takes me up on it because they don't want to be there any longer than necessary.

yotakagirl · Jan 2, 2015

To clarify a few points... My mother was not saying HIPAA is a joke as far as the need for its existence... she was saying its a joke insofar as its effectiveness and the attention most nurses give to it. She was a DON for many years and then a scrub nurse for general and plastics at UCLA before she retired. She encountered what she felt were egregious breaches of HIPAA and was even a whistleblower for many different wrongs in the hospital and was retaliated against by her upper management. So.... in her eyes HIPAA is a joke so in fact she was almost fired FOR respecting HIPAA but of course wasn't because of lawsuits etc....

Also, I bring up this infusion room scenario because at my mother's previous infusion room she was seen by her oncologist separately and the doctors were rarely if ever seen in the actual infusion room. Most things that needed to be decided on the spot were done over the phone with the nurses and order changes and given through a computer system. I rarely heard most private information unless it involved conversations like "How are you feeling?" "The doctor would like to order new labs such as _____" "You're doctor said we are now changing the dose to _____" and so on. The conversations were not nearly as in-depth regarding treatment plans but were of a more acute nature. Even if I knew a patient was being given a particular chemo drug, which is as many others have said an unavoidable conversation to have in such a setting.... I don't see why it's unavoidable to hear a patient also going to have to undergo more radiation in such in such areas because new growth has been detected and that this is his best option but he should be prepared for the worst... This is a type of conversation I had not been exposed to before being at this new infusion room.

I have been in ERs too where I have even been put in the hall in front of a trauma room at a level 1 trauma center because there is no more rooms and my mother was critical. There, among many other emergent cases, I saw a woman who had hung herself be worked on to no avail and her husband and little daughter come in and were told be the staff it doesn't look good (more specific actually but I can't remember now) and they're taking her up to the ICU. This is of course a situation that is unavoidable for me to hear all this personal information but I don't feel like an effort is being made in a controlled setting at this new center to protect private information at all. My mother used to be really private about her personal information but as she has gotten sicker she has cared less and less and LOVES her care she gets there so we wouldn't ever lodge a complaint... I only initially asked this question because eventually I will be become a nurse too and want to be a great one and would like to understand where HIPAA is supposed to draw the line more fully...

P.S. Sorry I spelled HIPAA wrong in the title of this thread. I cringed when I realized... :arghh:

klone, MSN, RN · Jan 2, 2015

To clarify a few points... My mother was not saying HIPAA is a joke as far as the need for its existence... she was saying its a joke insofar as its effectiveness and the attention most nurses give to it.

I understand what you meant, and I still disagree and my point remains that if you think that people in healthcare don't or shouldn't take it seriously, you may find yourself getting fired. Maybe I've always just worked at those exceptional places that do take it seriously.