My HIPAA mistake. - page 3

I have done a HIPAA violation, and looking back on it, i can't believe i did this. As an older nurse, it has not been the easiest of things for me to reform my previously sloppy (by today's... Read More

  1. by   somenurse
    Quote from Armygirl7
    Thank you for this story and reminder of how hard HIPAA can bite you!

    I work in the ER and I had the grandfather of one of my son's best friends as a patient one night. He knows me, knows my son, knows his grandson is at my house frequently etc. It was soooo weird to go home and NOT say anything to my son! It took a lot of effort! And my son never said anything in the next few months like "Oh Malik told me you were his grandpa's nurse," or something like that so I was glad I never said anything because maybe the kid didn't know his grandpa was in the hospital. But it was definitely unnatural. HIPAA can really catch you unaware.

    I hope this doesn't hinder your career. I agree with other posters - why wouldn't you just take your colleague aside and say something? I am amazed at the "gotcha" attitude of certain nurses.

    yes, i so understood the difficulty you have faced, in staying silent, about the grandfather, i have been in those shoes, too. It is harder than it sounds.

    RE: Why didn't i take colleague aside,
    well, i had no idea she was upset, she said nothing to me, at all. She went and FILLED OUT THE PAPERWORK and when i was summoned to the director's office,
    i spoke with our director about it, not her.

    it can't just be shredded up, even IF the nurse was actually innocent. INstead of shredding it up, an innocent nurse just adds HER side of the story.

    I was not innocent, but, even when a nurse IS innocent, my impression is,
    that THAT charge stays in your employee file,
    along with your side of the story, too.

    so that each time it is come across, in your employee file,
    the next reader has to slog through it all,
    to decide,
    and RE-decide,
    if that nurse did, or did not,
    commit a HIPAA violation.

    ONCE THAT COMPLAINT IS FILED, my impression is,
    it is now a permanent part of your employee file, forever.
    Last edit by somenurse on Dec 2, '12
  2. by   somenurse
    Quote from blondy2061h
    Couldn't T just call your manager and tell her that he had previously told your boyfriend about the surgery and asked you to call him and update him?
    THAT would have worked,
    but, i was too slow on my feet, when presented, in the facility director's office,
    with a formally written up HIPAA violation complaint against me.
    If someone had just pulled me aside casually, informally, to talk to me about my error, i might not have been so blown away, and i might have come up with better responses,
    when faced, in a very formal manner,
    with a very formal HIPAA complaint, all written out already on the proper forms and all,
    i just kinda went into minor level of shock, and did not come up with good responses to exonerate myself. Even 1 small white lie would have saved me,
    IF i had thought up one quickly,
    but, i just admitted it straight up. LATER, oh my, LATER, i thought of 100 better replies than "OH, i'm so sorry!"

    but, at the time, i was kind of frightened, blown away, wasn't quick on my feet. *sigh*.

    Also, i am not sure, but, i think, it may have been obvious, that i was lying, if i tried to plead that "T" had asked me to call my BF to tell him he was going to be home in an hour. I think it was clear, by overhearing "T" and me conversation, that "T" was not expecting any help from my bf that day when he went home.

    I can't recall "T"'s reply now, but, "T" did not expect my BF to go over and check on him, and probably said something to that effect. ("T" did not mind my bf checking on him, but, i think, it would have been clear to a bystander, that my telling my bf that "T" was about to go home, was MY idea, not "T"s idea).
  3. by   somenurse
    Quote from blondy2061h
    Couldn't T just call your manager and tell her that he had previously told your boyfriend about the surgery and asked you to call him and update him?

    T offered to do that,
    but, i told him i thought that would make it worse,
    but, you are probably right,
    I should have let T write his note or make his call, cuz T was no less than horrified i got into any trouble over our conversation.
    T wanted very very much, to go to bat for me, to help me get back OUT of trouble again. NOw, i am not sure why i didn't let him do it, not sure. At the time, i thought it'd make things worse,
    i wasn't sure if i'd get into trouble a second time, for even telling T i had got a HIPAA violation over his conversation with me....i didn't know if that would be seen as sharing stuff with patients that they shouldn't have to worry about.

    honestly, i still don't know THAT answer....

    also, at same time,
    i might have been seen as a "liar"
    since it was kinda obvious to any bystander who could hear us two talking,
    that my calling my bf was MY idea, not "T"s idea.....

    but yeah, i did NOT respond well, when presented with formal written up HIPAA complaint. Later, i thought of 100 better responses than "OH, i am so sorry!"

    yeah, LATER i thought of best things to say. but, at the time, i didn't.
    Last edit by somenurse on Dec 2, '12
  4. by   somenurse
    and slightly wonder,
    what would happen,
    if i had done like criminals do, when charged with a crime,
    just remain silent.

    I wonder, what would my director have thought,
    IF i had replied, something like, "Well, this is very serious charge. I was not expecting this at all, and wish to think about this more before i reply. I would like to go home, gather my thoughts on this very serious charge, and meet with you tomorrow to discuss it further."

    maybe, IF i had delayed my response a bit, to gather my wits about me first,
    maybe my director would have seen THAT as suspicious, the way cops do. who knows?
    anyone know if delaying reply til next day would only have dug me in further into suspicious behavior? or would that delay have been viewed as reasonable reply, who knows...

    if i had done that, (went home to think about it, instead of blurting out apologies while in shock)

    i would have come up with better response, than, "oh, i'm so sorry!"....
    Last edit by somenurse on Dec 2, '12 : Reason: cuz i never say anyything 'just right' the first time....
  5. by   somenurse
    Quote from Ginger's Mom
    I would ask your chief privacy offer, if it was a true Violation this needs to be reported to the federal government. I think you made a small error in judgement not a violation.

    wow, this may have been reported to the federal govt, i don't know. I do recall, massive amounts of paperwork, and seriousness which was absolutely frightening to me, though....that part, is a very vivid memory to me, indeed. shiver!

    Our fairly small outpatient surgery center, was attached by corridors to the physical hospital, but, was a free-standing, not part of the hospital,

    and we didn't have a chief privacy officer, really, just the director. but, GOOD TO KNOW for anyone who works in a larger facility, to know if this happens to them.
  6. by   T-Bird78
    Quote from psu_213
    Why was the other nurse so interested in what was happening on the "other side" of the curtain from her pt? How did he/she know that you didn't have permission from T to tell your guy about T's impending discharge? I'm still not 100% sure a violation took place here. Anyway, move on from it and try and stay away from this other nurse.
    If there's just a curtain between the beds then it would be easy to overhear the conversation.

    To the OP, maybe next time have "T" sign a release that you can disclose his information to your guy. Sorry this happened. Someone tried to get me in trouble for HIPAA violations that didn't happen. Minor pt came into the office with a cousin, cousin left when pt's mom arrived. Cousin got a note for work to explain her tardiness. Cousin's employer called our office asking if she was really there at all or if the note is fake. I verified she was at the office but could not tell her any more details. Employer asked if she was the patient or her kid or who was the pt. I again explained that without a signed release I can't tell employer anything other than cousin had been in our office and the note was real. Employer said she would contact cousin's general manager and have her fired for being late. Employer also went on and on about cousin's attendance and tardiness and she's faked doctor's notes before. A couple of hours later cousin's mom called and demanded office manager. She told the manager that I had given details to the employer and was furious. I told cousin's mom that I had not, nor could not, give any details to employer. Cousin's mom was going to try to contact a higher person at our company and report me. I had documented everything and we notified the higher-ups what had happened. Never did hear anymore about it.
    Last edit by T-Bird78 on Dec 3, '12
  7. by   BostonTerrierLoverRN
    Quote from Jean Marie46514
    wow, this may have been reported to the federal govt, i don't know. I do recall, massive amounts of paperwork, and seriousness which was absolutely frightening to me, though....that part, is a very vivid memory to me, indeed. shiver!Our fairly small outpatient surgery center, was attached by corridors to the physical hospital, but, was a free-standing, not part of the hospital, and we didn't have a chief privacy officer, really, just the director. but, GOOD TO KNOW for anyone who works in a larger facility, to know if this happens to them.
    What a totally undeserved nightmare!
  8. by   somenurse
    It has been 8 years since this event, but, I still, to this day, have a couple of questions.

    #1) IF IF If i had agreed to let "T" contact my manager, to state he that he had told me to call my bf (not true really, but, T would have lied to help me), or that he was 100% fine with my calling my bf,
    could i have gotten into further trouble, by discussing my HIPAA violation with T?
    I do not know, if that would have been a second violation. It could easily be viewed as poor taste, or lousy decision on my part-----to worry a patient over an employee matter,
    but, i'm not sure if that would have been legal/illegal?? Would that have been seen as another HIPAA violation?

    Or, that (discussing my HIPAA violation with T himself) might not be a law, but, a facility rule....?
    I was unsure, and frightened, which is why i never allowed T to go to bat for me, cuz it would have been obvious that i had discussed my being in trouble with T himself,
    and i feared that might also be against some rule.

    anyone know?

    Would a nurse who is decided to be innocent of a HIPAA charge, still have the charge filed in her employee file forever? No doubt, her side of the story, exonerating her, would also be attached to the charge,
    my impression is, the paperwork would NOT be shredded if it was determined she was in fact, innocent, but, instead, the paper work would be kept in her employee file forever.

    I wonder if i am right on that. That doesn't' apply to MY hipaa charge, i was NOT found innocent,
    i'm just curious now, if anyone knows what happens to all the formal HIPAA paperwork, if the nurse IS found innocent?

    i THINK it IS part of that nurse's permanent employee record, forever, even if she is found innocent. obviously, if the formal paperwork is NOT YET FILLED OUT, well then, that's a whole other deal,
    but, i think ONCE THE FORMS *ARE* FILLED OUT, they are never ever shredded up, ever. I could be wrong.


    Can future employers tell if i had a HIPAA violation? If there is a federal note on me somewhere (not sure, really), does that show up in some kind of federal info site on nurses anywhere?
    This very well might have been reported to the feds, i don't know. I think it was, cuz wowza, there sure was a lot of paperwork, tons and tons of paperwork was filed and stuff on this matter. some of it might have gone to the feds, i can't recall now, if they told me that. They might have told me that, and at the time, it might not have fully registered with me, might have seemed 'normal' to me to do have a federal paper filled out, never having seen a HIPAA violation before....
    I might not have even fully understood at the time, in my state of shock,
    which papers were fed reports, and which were other reports.

    there was a lot of reports, i remember that.
    I also recall, in snippets, getting the impression that the director was unhappy that the facility itself would now have some kind of 'ding' against THEM, now, since i had done a HIPAA violation, but,
    i can't recall WHO would see this ding against the facility, maybe JCAHO, or some other licensing board, or medicare, or who....but, i recall feeling like the whole facility now had some kind of overall demerit against it now....

    Do any nurse managers here or people in hiring positions know, is there some flag on my name, "She's had a HIPAA charge" or anything show up?
    Or maybe on the state board of nursing site, am i flagged in any manner?
    Did this get reported to the state licensing board?? anyone know? I have renewed my license, no trouble, but, i wonder,
    can future employers see some flag by my license now?
    Last edit by somenurse on Dec 3, '12
  9. by   BostonTerrierLoverRN
    That would be getting way too legalese for me or my colleagues here (but you have 6 RNs here at my facility), who all say they would seek a LNC or Attorney. If nothing more- just to understand the ramifications of the "violation."

    I believe you could beat this, I would have done exactly as you did, apologize, face the music, and pray for it to pass. But after reading 4 pages of threads telling me this is ridiculous- I would lawyer up!

    How can they blame you for wanting to clear your name and reputation. When you wrote this originally, I don't think you were expecting the feedback you got were you? I hope it had given you some energy to face them.

    In my thoughts- you have done nothing wrong- I am sorry if I am, but I still don't think you deserved the aftermath. I think your understanding now that you think the same. Good Luck whatever you decide.
  10. by   somenurse
    Yes, Boston Terrier, you are right, i am surprised that so many seemed to not think my mistake rose to the level of a formal write up, it felt kind of good, actually, to hear this.

    But, i am no longer employee of that facility, and this error happened 8 years ago, anyway. I eventually did accrue 3 mistakes, and was let go. #1, was hipaa violation, which caused a ding onto entire facility i think,

    #2, was a tardiness thing i had for a while, cuz of change in my living situation, having to drive a family member to school each day, only a few minutes here or there, but, the timeclock is the timeclock, and i was messing up there for a while, but, i did correct it, and got the hang of how to accommodation my new morning routine into time frame.

    and #3 was a bag of d5lr hanging on a postop patient, (hung by the CRNA, in the OR, not by me) which i never took down, nor even questioned, which i should have asked, do we really want d5lr hanging on a diabetic? When i reported his 1st post op glucose was then at about 280, and got insulin order, i did NOT mention, that d5lr was infusing. I guess i spaced that out. Unlike me to space something out, especially about diabetics, but, there you are, i did.

    I only had the patient for about an hour, and turned patient to another nurse, as i was rotated to other duties elsewhere, as was commonly done there, moving staff around to accommodate patient census moving through depts. I sometimes wonder, if i had had pt for a bit longer, if it would have dawned on me, that there is d5lr hanging on a diabetic, but, who knows, i may have not ever noticed it for whatever reason, even if i had kept the pt all day.

    This patient ended up with blood sugar of 400, and had to be given insulin, and ketp several extra hours to stabilize that sugar, and everyone had to stay late, til that patient ever could leave out outpatient surgery center,
    but, the IV bag only has about 1 teaspoon of sugar in it, and i suspect, stress of surgery also contributed to high blood sugar, and the fact the pt was kinda all over the map sugar-wise pretty frequently, even on non-surgery days. But, there is no doubt, that the d5lr did contribute to the 400 glucose level.

    Lol, the nurse i turned patient over to, was exact same nurse who had written me up for HIPAA violation all those years prior, but, in this case, she had no choice but to write up an event paper on this error. I was not seen as the sole cause of the problem, since CRNA hung the IV, but, i should have questioned it, and mentioned it, when i called doc to report that first post op glucose. I ws only seen as part of a multi-person error, but, i was a part of the error. It wasn't seen as grave error, but, since i had so many other dings already in my file,
    it was seen as enough, like last straw kinda thing.

    so, i then had 3 dings, over many many years, and finally, i was out, i was so bummed, as i loved that job. so perfect, no nights, or only very few nights ever, no weekends, no holidays.

    These things can happen.Actually, it was 4 dings, as in some previous year, i had been asked, twice, to quit using only my initials to sign notes, as they had previously allowed us to sign each line with our initials, and at bottom of page, write JM, rn = Jean Marie RN, in boxes at the bottom of notes,
    but, then, they'd decided each line has to be signed with full name, but, i had trouble remembering that, and often had to go to medical records, to write out my name in full on each line. That got old for them, to always be sending me notes "go to medical records and sign your full name on each line" over and over, got old for them til i finally got the hang of that.

    so yeah, it was actually 4 dings, over about 6 years there, which IS almost one ding per year, is kinda excessive.

    btw, the "full name" one, was not seen as having that much weight at the time, and wasn't listed as one of the "3 dings" which were req'd to fire someone. Well, it was "employee at will" but, the place preferred to get 3 dings to fire someone, so they won't have to pay any unemployment, lol,
    even though, they had right to fire someone whenever, for no reason. (but then, they risk having to pay into that person's unemployment, a person fired for no reason, might qualify for unemployment, but a person fired for just cause, does not get unemployment, i found out later. who knew?)

    My boss told me, it wasn't just any ONE of the 3 dings, but, the totality of all 3 put together, was getting to be 'too much'. I was floored at the time, as i always had great employee reviews, (with the exception of the 3 or 4 dings} but, have since gotten used to their decision.

    also, the economy was falling apart by this time, and our business had slowed way back, as no one had jobs, so no one had insurance, so most ppl were going without healthcare,
    and we didn't quite have enough business, that might have been a factor on some level, too, who knows. Business was slowing way way down, we weren't really pulling a full 40 hours, being sent home early all the time, all the time.

    so yeah, no chance i can eradicate this HIPAA mistake from my file, lol, now i do not work there.
    Last edit by somenurse on Dec 4, '12
  11. by   BostonTerrierLoverRN
    Oh good! I'm glad you got out of there! If you never heard anything else when being hired on somewhere else- I seriously doubt there was any "Federal" write-up beyond the file at your facility. All I check for in hiring Legal wise is a FBI/Local background check, an I9, a citizen US thing online, license verification, and the Medicaid/Medicare Fraud.
  12. by   alwaysglad
    I'm a new nurse and find HIPAA to be more of a challenge than most people think it is. I've made mistakes I thought were really harmless too and thankfully haven't gotten in trouble for it yet. Now I see, a HIPAA violation is a violation indeed.
  13. by   jadelpn
    I was actually spoken to because my best friend's s.o. had surgery, she called me and asked to come check on him as he wanted to be sure that he did his dressing correctly, (and was quite proud of himself and wanted to "show off" lol) and it somehow got back, and of course, I was "taking business away" from the home health department, the outpatient clinic for follow ups, etc etc......I was a bit shocked. So my new rule is "If I know you and love you like family, you will be someone else's patient". We all instinctively protect and want the best for those we care about. And it is just automatic that we would "make plans" for that person as far as checking up on them, etc. To avoid any conflict of interest--and I live in a small town where one knows just about everyone--if I know OF you, then game on, however, anything beyond that and I can not care for you. "I love you, but I don't need to know your business."