I work alongside this nurse in a 2 RN ER and to my eyes, she is one of the worst gossips I have ever met. I tolerate her because I have to if I want to continue working here. (And all in all, I really like where I am working so it is usually no big deal.) But a few days ago, I think she really crossed a line and it has stuck in my craw since then. I really want to call her out on it to the point that I want to report her to the state for violation of confidentiality.
A woman came to our ER via EMS who was the sole person in a one car MVA. She had bumps and bruises and a minor head lac. The attending MD ordered his routine labs, among them, an ETOH level. Her ETOH level came back at roughly twice the legal limit.
A police officer was in the ER doing the accident paperwork. As he was leaving, my 'partner' asked him about what he was going to do about her blood alcohol level. His reply was, "What do you mean?" She told him that her B.A.L. was 0.15. His reply was, "Well I guess I am going to have to arrest her for D.U.I. " Upon hearing that, I was absolutely flabbergasted.
I have always felt that as a nurse, my prime role is to be a patient advocate. In NO WAY do I see my role as an agent of the state. Unless I have objective evidence that a patient intends harm, or is a potential threat to themselves or others, any circumstance that brings them to my care is irrelevant and nobody's business save for those directly involved in their care. In that light, I just can't believe what that nurse did to her. I am so upset about this. That nurse could very well have ruined that woman's life from a legal perspective. At the very least, it will cost her about $5,000. How is that being a patient advocate?
It sounds like the BAL was run as part of the ED's trauma panel, and the nurse passed along the result to the policeman as an "FYI." That's far different than the policeman having a legal request for the BAL.
Just to clarify... I do not claim to know what's best for my patient by reporting her BAL to police. What I do want to assure by doing that is that she doesn't do it again. AND I DON'T CARE HOW YOU SPIN IT THAT IS ADVOCATING FOR HER! I am a FF/EMT and I have seen what drunk driving can do to people, not just the offenders but innocent people. Driving drunk just one time can change your life forever in ways you would never even imagine. Aside from the criminal issues, the psychological effects last for the rest of your life. If I didn't report something like this and this pt went out and killed herself or someone else... the next day, week or even year, I would have to accept some of the responsiblity for that because I did nothing to stop it.
Just to clarify... I do not claim to know what's best for my patient by reporting her BAL to police. What I do want to assure by doing that is that she doesn't do it again. AND I DON'T CARE HOW YOU SPIN IT THAT IS ADVOCATING FOR HER! I am a FF/EMT and I have seen what drunk driving can do to people, not just the offenders but innocent people. Driving drunk just one time can change your life forever in ways you would never even imagine. Aside from the criminal issues, the psychological effects last for the rest of your life. If I didn't report something like this and this pt went out and killed herself or someone else... the next day, week or even year, I would have to accept some of the responsiblity for that because I did nothing to stop it.
As long as you understand that your "advocacy" could carry serious legal and professional consequences for yourself. If you are not legally mandated to report, you could be in violation of HIPAA. All of your good intentions are going to fall flat if you're sued.
There's no need to scream at us. Many of us work in the ED and see the tragic results of DUI.
I slept on this, and I think she should be reported to the BON.
I can't help but think what other PHI she's volunteered to others without thinking. The way she told this officer seems gossipy to me.
Does she tell anyone who she thinks "needs to know" when patients have other drugs in their blood, and to what extent? That is my concern.
Maybe the board will slap her on the wrist, and maybe they won't. But I know that she would be more careful about what she says to whom in the future.
Check the laws in your state to find out if nurses must report this and HOW.....the latter of which I think is key. "Hey, What are you gonna do about her blood alcohol level," is hardly the right way to report someone IF you're mandated to report something like that.
I think any way you look at it, if there's no mandatory reporting law then it's a HIPAA violation. Which may very well ruin the life of the nurse reporting it inappropriately. Unfortunately much as I disapprove of drunk driving, if there's no supporting law, then there's no legal way to report it, IMO.
I thought that was the reason for the ETOH level being taken, to find out if that was the cause of the accident. It is illegal to drink and drive and she was lucky she only injured herself. As a nurse and person that drives and has family that drives, I want drunk drivers punished for risking other peoples' lives because of their selfishness.
This brings up an interesting question: why was the blood alcohol level measured? Was it really measured to determine the cause of the accident, or was there some medical or nursing reason for checking it. "To see how the accident was caused" does not seem like what I would think the doctor ordered a blood alcohol screening. I would think they checked it so they would know what kind of physical condition they were dealing with so that they'd know how to proceed with treatment??
Just because you want drunk drivers punished for the bad things they do doesn't make giving up information in their medical records (written or verbally) the right thing to do. Unless of course the state says nurses are mandated reporters of blood alcohol levels greater than [insert BAL here].
HIPAA is a federal law. And unless there is a state law that permits that nurse to do what she did, federal law takes precedence.
As far as I'm concerned, if it's the law, yes, I'll do it. But otherwise.....
I think any way you look at it, if there's no mandatory reporting law then it's a HIPAA violation. Which may very well ruin the life of the nurse reporting it inappropriately. Unfortunately much as I disapprove of drunk driving, if there's no supporting law, then there's no legal way to report it, IMO.
This has been an interesting thread. I've given the matter much thought and even googled to see what the laws are in my state. In Texas, there is NOT mandatory reporting - which means (as others have previously stated) that to report to the officer is a HIPPA violation.
Given that, I would NOT report to the officer, because I do value that privelege.
So then I thought, well, there needs to be a law change, because we should be required to report this. Then, I thought, well....what if we then have to report someone that has amphetamines in their system, but we all know it's because they take Adderall? What if we have to report someone who came in in an MVA because they have marijuana in their system but they smoked 2 weeks ago? It does become a big old can of worms, really.
I think the only real way to handle these situations is to have the police subpoena the information they believe they need, otherwise, we really do run the risk of violating someone's privacy (like my Adderall example above).
And just as a side note, I can think of several reasons to check someone's BAC that has nothing to do with knowing whether alcohol was a factor in the accident - drug interactions, bleeding problems, changes in LOC.
To the OP, your gut is correct, unless the laws in your state mandate reporting.
In our ER it is indeed up to the investigating officer if they suspect drinking to request a legal alcohol level.
Often ETOH levels are taken by the MD and not the police and countless drunk drivers get away with it. It's a sad state of affairs that we use labs to treat a patient, but it's inadmissable in a court of law. Or when the family of the person they injured gets the record, the ETOH level the hospital took is not "legal".
So we know the patient was drunk, caused harm to him/herself and others and there's nothing we can do about it. I guess it's not our job, but it's frustrating nonetheless.
As someone stated, unless the officer suspected, obtained the information legally, it was not the nurses place to go tell the police.
I was thinking more of the line that it was reportable when I was giving kudos to the nurse. Given my obvious frustration with the system, I would mind my own business and not report this nurse to the BON. What she did may be wrong, but it's not dangerous and personally again, as unethical as it is, I don't care if the patient suffers any because of his/her drunk driving in this case. My bad.
I guess confronting the person directly that you know she did a HIPPA violation, asking her to not do it again, and could get in trouble is out of the question. It just seems a bit vindictive to run to the state board, because you're tired of her constant meddling and gossiping.
Given my obvious frustration with the system, I would mind my own business and not report this nurse to the BON. What she did may be wrong, but it's not dangerous and personally again, as unethical as it is, I don't care if the patient suffers any because of his/her drunk driving in this case. My bad.
I guess confronting the person directly that you know she did a HIPPA violation, asking her to not do it again, and could get in trouble is out of the question. It just seems a bit vindictive to run to the state board, because you're tired of her constant meddling and gossiping.
Basically, you're saying the OP should do nothing and turn a blind eye to the situation.
I think you could use this logic (the bolded) from the drivers perspective too....one of the reasons we have HIPPAA as it is today in fact. The nurse is definitely not minding her own business UNLESS she's a legally mandated reporter. What the nurse did IS dangerous to the respectability of our profession and the legal checks and balances in place for all citizens. Also in the same vein, why should we care if her actions cause her to suffer (lose her license, go to prison, pay a fine)?
I hope I never walk into that ER for treatment if that nurse is on duty. I think this goes beyond just regular old meddling and gossiping. As the OP said, a line was crossed in this situation. It's one thing to participate in "harmless" gossip about what Jane and Bob did, and then it's something else to give up part of someone's medical record to the police.
Drunk driving is bad. People should be punished for drunk driving. But in this case for sure, the end does not justify the means.
I really don't see what the big deal is here. If you're not mandated to report, and in most states you're probably not, then you shouldn't... it's confidential information. Whether or not it should be is a separate question. But really, the police aren't these inept fools that can't do their jobs unless you sweep in and save the day by violating patient confidentiality. Let's give them a little more credit than that. They have a lot of tools at their disposal and if they need that info they'll obtain it the right way. Anything they get inappopriately won't be allowed in court anyway.
Find out what the policy is and follow it. If the policy is not well known or understood then advocate for its discussion. If you directly witness someone violating a known policy, report it. It's as simple as that. The complicated question is: what should the policy be and should I work to make a change... there's your debate.
Basically, you're saying the OP should do nothing and turn a blind eye to the situation. ....
Drunk driving is bad. People should be punished for drunk driving. But in this case for sure, the end does not justify the means.
I wasn't saying that at all. I was saying I wouldn't report to the BON. That to me is vindictive because the op doesn't like the nurse and their history together. I would definately report any activity that puts a patient in danger, Even then, I would first follow the chain of command established at my facility and not call the BON directly unless the chain of command failed and patients are in danger.
Do the nurses here report every HIPPA violation they see to the BON? Is there any nurse here who can honestly say they haven't inadvertantly violated HIPPA? If every HIPPA violation got reported to the BON, what a mess that would be.
Why is it that so many people run behind someone's back first? I think first the nurse should confront the person and take it from there. Ideally this should have occurred at the time of the violation. If eventually it leads to a report to the BON it should be management doing the reporting not the coworker. As it stands now this coworker has no idea that what she did is being held in such disgust by the op.
I admit the coworker was wrong. I also admit I don't feel sorry for the poor patient whose confidentiality was broken and she was forced to deal with the crime she committed. Forgive me, that's my human side coming out. I'm not saying nurses should turn their patients in and violate HIPPA.
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PANurseRN1
1,288 Posts
It sounds like the BAL was run as part of the ED's trauma panel, and the nurse passed along the result to the policeman as an "FYI." That's far different than the policeman having a legal request for the BAL.