American Red Cross and Hipaa

[NurseBatzy]

Just curious if anyone else has experienced this:

A nurse in my unit received a phone call at work from a person identifying herself as being from the American Red Cross, and was calling to inquire about a patient in the unit. She stated that the patient's son was deployed overseas, and as a service to American military members, they will contact the son with an update on his condition. She wanted to know the patient's prognosis, if they were currently stable, and if the nurse felt that the family member should be present at the bedside. I believe they also wanted a diagnosis, but I'm not positive about this.

Has anyone else experienced this? What are your thoughts? I know in my facility we can acknowledge the patient's presence and condition if they do not specify otherwise, but would you give out a prognosis or diagnosis? My thought is that the family can contact the serviceman themselves, and I would be very cautious about giving out any further information over the phone.

[Esme12, ASN, BSN, RN]

I learn something new everday!

The reason I love AN!!!!!:[anb]:

[JustBeachyNurse, LPN]

I used to volunteer for ARC military services. I would get the call from a family member to locate a service member or from a base for verification of a family member's illness or death. Exactly what you were asked is what was needed. Prognosis, professional opinion as to whether the family member should be at the patient's bedside, specific diagnosis. And this is only provided for certain relatives (mother, father, sister, brother, grandparent, child, spouse) so if it were regarding a cousin ARC would not get involved. (I worked on call and would get a lot of strange requests as the answering service would try and filter out the bogus calls but couldn't refuse to page us.)

This is totally separate and different from disaster services; in fact "Armed Forces Emergency Service" (AFES) is a totally separate division of the American Red Cross from disaster services, health and safety (CPR & First aid training), and blood services. The relation of the patient to service member is established before the hospital or other medical facility is contacted for verification of patient status. No additional written authorization or consent is needed. Also if the hospital staff member answering the phone is unable to provide the information (whether primary nurse is unavailable or the supervisor needs to be called) there is always the opportunity to call back the red cross volunteer but it should be understood that time is of the essence as it can be a multistep process to notify someone on base or overseas then make travel arrangements home.

http://www.redcross.org/portal/site/en/menuitem.d8aaecf214c576bf971e4cfe43181aa0/?vgnextoid=7f26912c9973b110VgnVCM10000089f0870aRCRD&vgnextfmt=default

[rjflyn, ASN, RN]

Being a supervisor, I would in fact just confirm that it is in fact actually the Red Cross calling. I get calls all night long from people saying they are someone they are not, caller ID tags 90% of them, my instincts weed out the rest of the chaff.

[NurseBatzy]

Thank you all for your great responses!

rjflyn - How would you verify that it really is the Red Cross calling? We have caller ID, but it only shows a number, not a name. I wonder if they have a way of proving their identity? Perhaps a reverse phone number lookup might work here.

Thanks again everyone, this has been a great learning experience.

[JustBeachyNurse, LPN]

Take a name & a call back number. Call the local chapter of the Red Cross (all have after hours service numbers). The call center would have the name and number of person on call for AFES.

[brillohead, ADN, RN]

What I don't understand is why isn't it the patient's family/friend who relays the information to the Red Cross to be passed along to the service member?

It seems like it would be a rather rare occurrence for there not to be ANYone stateside who can provide the prognosis, etc., to the Red Cross. I mean, someone notified the ARC about the hospitalization in the first place, why isn't that same person also providing the rest of the information?

[wooh, BSN, RN]

Because they want an unbiased answer to the question, "Does the service member need to come home?" They're more likely to get that from hospital staff than from a family member.

[nurseprnRN, BSN, RN]

"how do you know it's the red cross?" was the very first thing that crossed my mind. ask to whom you are speaking, from what office the call is coming, say you will call back, and then look it up and call if it's genuine. other possibilities: newspaper, ex-wife, estranged parent, bill collector, stalker... i never give out personal info on the phone. some hospitals ask patients to choose a code word to share with family or whomever; this is put on the patient chart, and nobody who can't give that gets anything.

[JPNomad]

Hi Everyone,

I work for the American Red Cross, Service to the Armed Forces "SAF" division. I'm one of the people that call you to get a medical statement and then send out the Red Cross Emergency Communication Messages, also known as an "ECM". Let's see if I can answer some of your questions;

The Red Cross is mandated by Congress;

1. to fulfill the provisions of the Geneva Conventions, to which the
   United States is a signatory, assigned to national societies for the
   protection of victims of conflict,
   
2. to provide family communications and other forms of support to the U.S. military, and
   
3. to maintain a system of domestic and international disaster
   relief, including mandated responsibilities under the National Response
   Plan coordinated by the Federal Emergency Management Agency (FEMA).
   

The Health and Human Services realized that HIPAA might cause a problem so they made an exception, "45 Code of Federal Regulations (CFR) 164.510(b)(1)(2)&(3)" It's pretty boring so below is a link to the HHS.gov website FAQ's and a short paragraph on HIPAA and the Red Cross. May a doctor or hospital disclose protected health information to a person or entity that can assist in notifying a patient

Any Service Member from all the branches, including the U.S.Coast Guard and DOD employees, Oh I forgot, the Merchant Marines too, get to their duty stations, including ships, they are told the only way they can go on Emergency Leave is if an American Red Cross Emergency Communication Message (ECM) is sent and received by their command. The main reason for this is the Military Command uses the Red Cross to Verify there is an emergency. The Red Cross case number is even part of the Emergency Leave paperwork and is not filled out completely until the Red Cross case number is put on it.

Question: "Why doesn't the family just call the military command with the info?" The command cannot just take the word of a person that it is a true emergency. Believe me I've had wives call up and say they are a nurse or a doctor or that Dad just had a MI just to get their husband home from the Middle East. I feel for them but that's why the command relies on the Red Cross to verify the emergency with a third party; e.g. nurse, police office, coroner, etc... The command will tell a service member that they cannot go on leave until the Red Cross has verified the emergency and the ECM is received

Military commands are not HIPAA exempt, the Red Cross is. See above.

The Red Cross has direct communications with military base around the world. Even Submarines, (we send the ECM's by secure link to the Pentagon and it is sent via military satellite to any ship or sub, even if they are under the ice caps. We call bases around the world 24hrs a day 365 days a year. Today I just happen to look at our call volumes for the last month and it was 32,000 incoming calls and 28,000 outgoing.

Question: "How do I know it's the Red Cross calling me?" Good question. You can look at the caller ID. It will have either 877-272-7337 or 800-926-6001, but that might not show up especially if we have been transferred a lot. You can always call us back but that serves another problem. There are 4 Emergency Communication Centers in the world. San Diego, Ca; Springfield, Ma; Louisville, Ky and Ft Sill, Ok. When you hang up and call us back, more than likely you will not get me. I then have to log in the case notes that you refused to give any info and place the case back into a Verification Queue. Then my phone line becomes free for another call. When you call us your call is routed to the next Emergency Case Worker, which could be on the other side off the country. What I have done in the past that works well is, I give the nurse the Red Cross Case number and my name and where I'm calling from, have the nurse place me on hold and have he/she call the Red Cross, You can call any one of those above numbers or even the 1-800-REDCROSS number (just make sure you follow the prompts for "Service to the Armed Forces" I think it is option 1.) When you get to an Emergency Case Worker have them pull up the case and my name should be on the case, actively working on it, or you might just happen to get the Emergency Communication Center I'm call from. You have now verified I am who I said I was.

Question: "I don't understand how this all works."

Let me show you an example: A service member's father had a CVA and was sent to the hospital. The spouse calls us and gives us the service member's name, rank, ssn, deployed address and other vital info, including where we can verify his illness or hospitalization. We then call the hospital and ask the 5 questions the military command wants from us; Diagnosis: What's wrong with the patient? Is it just a hang nail or something else? Prognosis What's the expected out come? If the patient is fine and being discharged in 30min, the military probably won't send the service member home. Current Condition: stable, poor, grave, terminal. Life Expectancy: This is a hard one and we know it, but this is what the military wants. They have to figure out how they are getting the service member home. Are they going to wait until they pull into a port or are they going to helicopter him/her off the ship. Finally, does the doctor/health care provider recommend the presence of the service member? We take all that info and place it in a message and then contact the command. Let's just say it's Germany for example. I would call the staff duty officer of their unit and relay all that info to them. They will ask questions sometimes but for the most part they know we have vetted all the info. The command will then contact us back when the service member has the message. We then contact the spouse stating they are in receipt of the message. This might take some time as they might be in the middle of nowhere in a foxhole communicating via a low power vhs radio. Speed is of the essence. It might take the service member two days just to get to a town with a road. Meanwhile Dad is slipping away. Service members on emergency leave have priority on military flights and can be bumped to the top of the list for standby on commercial flights, if they show their leave paperwork. Sometimes we get calls from the airport just wanting to confirm the Red Cross message.

If you have any questions you can ask me or email me and I will try to answer them for you

I hope this helps

Jay Parker

Emergency Case Worker Specialist

American Red Cross, Service to the Armed Forces.

[email protected]

[NurseBatzy]

Wow Jay, thanks for the fantastic information. It surprises me how few of us health care workers know this, and I will be sure to take your post into work with me and educate our staff. It is a time when we are constantly told "no,no,no" about giving out any information on anyone, and this statement really helps.

Thanks again!

[JPNomad]

Updated Email Address Jay.Parker at redcross.org