Is this HIPPA breach or just rudeness?

[Apple-Core]

Hi

Hoping somebody can advise me. This is not homework, these two incidents happened to me personally and as a student nurse, I am not 100% sure on what constitutes HIPPA violation and/or what is just (what I perceived to be) rudeness.

Incident 1: I had been referred to a specialist. I lost the contact details, so I went in to my doctors office to request the information. I was stood at the reception desk. The waiting room was full. The receptionist/medical assistant (I think they double up on duty) started looking for the information I requested. She kept sighing a "huffing" and then, very loudly, said, "I can't see any specialist you're talking about, although you have *LOADS* (said in sarcastic tone) of specialists listed here.... optical specialist, osteopathy, behavioral health specialist, cardiologist....."

At that point I stopped her because I was mortified/embarrassed (the entire waiting room overheard) and, furthermore, did not recognize the specialists she was talking about. Then she said, "oh, silly me, I'm in the wrong chart", and went back to looking. (She did give me contact details, but after I got home they were the wrong ones....ugh!).

Was she violating HIPPA by yelling all that info out in public, or was she just being ridiculously insensitive and unprofessional? As it turned out, it wasn't actually my info, but at the time she didn't know that.

Incident 2: I took my daughter to the OBGYN for a personal reason. To begin with the receptionist stank of cigarettes, which I realize is a personal choice but for an OBGYNs office I was quite disgusted. Not a HIPPA violation, obviously, but it was bad start!

Anyway - when I told the receptionist why we were there she literally looked shocked/disgusted and raised her eyebrows. I explained we'd be sent from her PCP office to make an appointment with them and she started asking questions about the situation (questions that I don't feel she should be asking because they were to do with treating the problem, but perhaps that is perfectly ok to do, I don't know??). Then she said, "wait here", and asked for my daughters "medical care plan" which I had with me. The medical care plan is the print out that they give you after an appointment with the PCP. It had nothing to do with the reason we were there, and didn't even mention it on there. I told her that, but she still grabbed it out of my hands and walked off.

After she returned she said she'd need a longer appointment time then went into details about why. Again, I felt TMI for the reception desk. We made the appointment. No, I did not say anything at the time because of my daughter.

As we were leaving, a second receptionist sat down next to her. We left, but the way their office is designed it is somewhat open plan. I had a feeling she was going to talk about us after we left, so I hesitated by the door where she couldn't see us, and sure enough as soon as she thought we were gone, she started gossiping about my daughter with the second receptionist.

Needless to say, an already difficult situation has now really upset my daughter and I was livid. However, I am not sure where I stand regarding complaining because a lot of the behavior was "body language", which is purely subjective on my part (although I am fully aware of what she was thinking based on that alone), such as rolling eyes, raised eye-brows, pursed lips, etc.

Thoughts? Let it go? Contact there manager? Make a generic complaint about customer service?

Thank you in advance -

[JKL33]

From my perspective, I was thinking that since I was identifiable as the patient, and the receptionist was shouting out the list of specialists I'd be referred to, the people in the waiting room overheard it and were now aware of all the specialists I'd been to see, so could then infer from that the type of medical problems I have or had.

As it turned out, she was shouting out the list of specialties from somebody else's chart. However, that is somewhat beside the point.

I'm guessing because nothing specific was mentioned, it isn't considered a violation. Perhaps if she'd shouted out "oh yes, I see you went to see the endocrinologist about your hypothyroidism", then that may have been an issue??

I don't think it technically is beside the point that the info was from the wrong chart. I think that little detail means that technically there was no disclosure of identifiable PHI. The information disclosed did not actually have a (correct) patient identifier attached to it whatsoever. Furthermore, the receptionist stated (probably as loudly as everything else she'd said so far) that it specifically wasn't the OP's information, so for those who couldn't help overhearing and assuming the information was the OP's - that got straightened out, too...as wacko as the whole scenario sounds.

HIPAA violations are associated with PHI - Protected Health Information, which is associated with an identifiable patient. Now if she had instead yelled out, "Oh, I'm in John P. Doe's chart, not yours!!!" - well that is an improper disclosure of J.P. Doe's info.

I know it seems weird, but if an information disclosure like this is not associated with correct identifiers, then there wasn't a disclosure of identifiable information. I haven't come across anything in the law that says its a violation if the information is incorrectly assumed to be about a certain person, but isn't.

[CBlover, BSN, RN]

The second scenario would have made me livid as well. Just from beginning to end everything was so inappropriate and unprofessional. And everyone is downing the "eaves-dropping." I think what she did was smart and plenty of HIPAA stories I know include similar situations where nurses were at the nurses station gossiping and family members/pts heard it (were trying to listen aka "eaves-dropping") and those staff members got in trouble. The fact you stayed to listen is clever in my opinion and whether it's "ok" or not is left up to personal judgment. Just because it's not ok doesn't mean it may not be worth it. I think the mother instinct here led to it and the outright nastiness of the desk staff. Just my blunt honesty.

[Horseshoe, BSN, RN]

From my perspective, I was thinking that since I was identifiable as the patient, and the receptionist was shouting out the list of specialists I'd be referred to, the people in the waiting room overheard it and were now aware of all the specialists I'd been to see, so could then infer from that the type of medical problems I have or had.

As it turned out, she was shouting out the list of specialties from somebody else's chart. However, that is somewhat beside the point.

I'm guessing because nothing specific was mentioned, it isn't considered a violation. Perhaps if she'd shouted out "oh yes, I see you went to see the endocrinologist about your hypothyroidism", then that may have been an issue??

Okay, was she really "shouting"? Or is that your subjective memory of it because you felt she was speaking loudly enough for others to hear. It just seems highly unlikely that she would have actually, truly been "shouting."

Needless to say, an already difficult situation has now really upset my daughter and I was livid. However, I am not sure where I stand regarding complaining because a lot of the behavior was "body language", which is purely subjective on my part (although I am fully aware of what she was thinking based on that alone), such as rolling eyes, raised eye-brows, pursed lips, etc.

As to the body language, you can never be certain of what people are thinking. We all interpret those kinds through the lens of our own feelings, values, experiences, biases, insecurities, etc. Yes, we can suspect a person may have negative feelings about an interaction based on non verbal cues, but you can never really claim to "know" what is going on in their mind.

Sounds like poor customer service; the office manager should be notified, but I'd stick with the actual facts and none of the subjective inferences.

ETA: sounds like that's either what you did or plan to do.

[Kooky Korky, BSN, RN]

If the gal is going to smoke at work, she should not be wearing smoke-smelling clothing around patients

and probably her coworkers would like that she wear something else, too.

I guess it's not a HIPAA violation since she had the wrong chart. But Ms. Loudmouth Miserably Unhappy needs to rein herself in. No one needs her stinking reeking and her negativity and her taking out her frustration on people at work.

As for the "eavesdropping" - I don't see a problem with you wanting to know what they were going to say about you and your daughter. furthermore, they need to be more careful about when they gossip about patients.

I think that IS a HIPAA violation and I would have confronted them right then and there myself. I'd also make sure their employer is aware of their unnecessary

tongue-wagging.

[Apple-Core, ASN, BSN, RN]

I don't think it technically is beside the point that the info was from the wrong chart. I think that little detail means that technically there was no disclosure of identifiable PHI. The information disclosed did not actually have a (correct) patient identifier attached to it whatsoever. Furthermore, the receptionist stated (probably as loudly as everything else she'd said so far) that it specifically wasn't the OP's information, so for those who couldn't help overhearing and assuming the information was the OP's - that got straightened out, too...as wacko as the whole scenario sounds.

HIPAA violations are associated with PHI - Protected Health Information, which is associated with an identifiable patient. Now if she had instead yelled out, "Oh, I'm in John P. Doe's chart, not yours!!!" - well that is an improper disclosure of J.P. Doe's info.

I know it seems weird, but if an information disclosure like this is not associated with correct identifiers, then there wasn't a disclosure of identifiable information. I haven't come across anything in the law that says its a violation if the information is incorrectly assumed to be about a certain person, but isn't.

Yes, I can see what you're saying. Very close call then, because had she been in my chart then that would have been my info! I don't even know what she *wasn't* in my chart - the whole thing was weird.

[Apple-Core, ASN, BSN, RN]

Okay, was she really "shouting"? Or is that your subjective memory of it because you felt she was speaking loudly enough for others to hear. It just seems highly unlikely that she would have actually, truly been "shouting."

As to the body language, you can never be certain of what people are thinking. We all interpret those kinds through the lens of our own feelings, values, experiences, biases, insecurities, etc. Yes, we can suspect a person may have negative feelings about an interaction based on non verbal cues, but you can never really claim to "know" what is going on in their mind.

Sounds like poor customer service; the office manager should be notified, but I'd stick with the actual facts and none of the subjective inferences.

ETA: sounds like that's either what you did or plan to do.

Yes, she was actually shouting. She wasn't the person sitting at the very front of the reception desk, she was off to the side. Screaming/shouting, no. Shouting to be heard, yes. And unfortunately people in the waiting room definitely heard because I turned round to see if people were reacting to her behavior, and they were .

I can see what you are saying, but I actually think that body language is, in many ways, more "honest" that the words coming out of our mouth. You can tell an enormous amount from facial expression and/or body mannerisms. In this case, I got an eye roll, raised eyebrows, and the "wide eye" look (wish I could demo it to show you - lol!). Let me put it this way - I was left, in no uncertain terms, exactly what her "real message" was - and my suspicions were validated by what I overheard.

Imagine the look a teenager gives you when your telling them off...!

[JKL33]

Yes, I can see what you're saying. Very close call then, because had she been in my chart then that would have been my info! I don't even know what she *wasn't* in my chart - the whole thing was weird.

After I my last reply I sat there thinking that, although unlikely, I'm sure there are certain situations (small communities, for example) where this woman's behavior could have caused real damages...whether they would be legally recoverable or not I don't know, but surely having a waiting room full of general acquaintances (who might include friends, family, bosses/supervisors, others you interact with in the community) who hear the wrong information and then have a hard time mentally disassociating you from it could have some ramifications.

Her lack of professionalism (and common sense) was crappy to be sure. She deserves suspension and re-education and monitoring for improvement.

[Medic/Nurse, BSN, RN]

You were treated very poorly.

In the case of Incident 1 -- if that was my primary that I have a good relationship with and was satisfied with, I'd prolly just let it go or perhaps with a polite conversation with someone - either the staffer, the office manager or my doc (depending on the relationship). I'd tend toward a private word with this staffer. But the circumstances would have to exactly right. Otherwise, I'd speak to my doc or clinic management.

Incident 2 - yeah, just move on. It's that simple. Find another provider. Why go through that misery. I will never beg to see someone and once gatekeepers treat you poorly - yeah, what kind of access do you think you will ever get if you have a problem?

Anyway, don't overthink it. Just move on. No more real energy on it. Do not invest in clinical relationship.

I would write a succinct letter to the clinical compliance officer, your health insurer explaining why - they play loose with PHI, careless, sanitary issues. Rather than "eavesdrop" you paused to write a note in your journal and "overhead" disrespectful whatever - I know, I know, but given the way you were treated you don't have to take moral high ground here.

Good luck.

I try to just address things where I find them. It's tough.

:angel:

[/username, BSN, RN]

Definitely neither a HIPPA breach, or a HIPAA breach, which is the one you should actually be worried about. I have no idea what a HIPPA is...

[Apple-Core, ASN, BSN, RN]

Definitely neither a HIPPA breach, or a HIPAA breach, which is the one you should actually be worried about. I have no idea what a HIPPA is...

Yeah - my typo, or ignorance...whichever way you wish to see it

[/username, BSN, RN]

I would probably say ignorance, which isn't a huge deal. It's about as common as people conflating their hospitals policy with federal law.