This incident happened recently, and I would like to know what you all think.
It is unknown why this gentleman was in the ER at a Texas hospital other than he drove himself there one afternoon. One of the tests ordered was a BAC level. By the way, according to the ER nurse, he smelled of an unknown alcoholic beverage. A little over an hour had passed, and he decided to leave. The ER Nurse tries to convince him to stay, but he tells her that his fiancé will be meeting him in the parking lot. The Nurse follows him, and she sees him getting into the driver’s seat of his pickup. There happened to be a Sheriff’s Deputy in full uniform that was working extra as hospital security that day in the ER. The Nurse tells the Deputy that she believes the gentleman is intoxicated. The Deputy asked the Nurse what led her to believe he was drunk. The Nurse said, “he has a strong odor of an unknown alcoholic beverage, and his BAC is .367.
Do you think the Nurse breached patient confidentiality? I think it’s safe to assume the Nurse was trying to keep the patient and the community safe; however, how many of us believe she didn’t need to disclose his BAC level?
Specializes in Medical-Surgical, Physician's Office, Clinic & LTC.
I understand that, but I feel that the nurse could have just told the officer that she suspected he had been drinking and then let the officer use his own judgement on what to do next. I suspect the officer would approach the person and then proceed as they normally would in this case had it happened anywhere else. My understanding is that an officer was already on scene at the facility. Perhaps I misunderstood.
I don't think there is a right or wrong answer when it comes to opinions and everyone has a valid point. @Norubit15 I do agree with you. We are not policemen. Our job is to care for and protect our patients.
Do you feel that not giving relevant information is protecting the patient in question?
15 hours ago, Norubit15 said:
The patient did not give consent.
Consent is not needed for this type of disclosure.
15 hours ago, Norubit15 said:
I understand the nurse was concerned for the patient and the community, however she could have just stated that she suspected the patient of drinking alcohol.
The patient didn't give consent for that either. Would you think consent is necessary for a disclosure that the nurse "suspects" the patient has been drinking alcohol?
This is the conclusion. The officer at the hospital had to call for another officer since he could not leave his post at the hospital. The gentleman passed the field sobriety test, which included the horizontal gaze nystagmus. They placed him under arrest anyway because of the BAC that the nurse volunteered.
I understand that, but I feel that the nurse could have just told the officer that she suspected he had been drinking and then let the officer use his own judgement on what to do next. I suspect the officer would approach the person and then proceed as they normally would in this case had it happened anywhere else. My understanding is that an officer was already on scene at the facility. Perhaps I misunderstood.
Totally agree with this approach. I would have done the same. I would hope that if an officer sees the nurse in uniform saying she suspects the person may be UTI that that would be enough.. IDK
This is the conclusion. The officer at the hospital had to call for another officer since he could not leave his post at the hospital. The gentleman passed the field sobriety test, which included the horizontal gaze nystagmus. They placed him under arrest anyway because of the BAC that the nurse volunteered.
Oh wow! So then this definitely becomes an ethical issue
Oh wow! So then this definitely becomes an ethical issue
Not necessarily. We are also bound to protect a patient and/or society from harm, to the best of our ability. Think: a teen comes to the ER in the middle of the night on Saturday, under the influence, also stating they plan to shoot up the school on Monday or Tuesday. Do you tell the police or not...hmm, no brainer...
This genius that just drove off could kill someone: you, your loved one, or a total stranger. HIPAA is tricky to some, but that's because management and admin have made it so. For most of us, the reality is pretty straightforward. In this case, the nurse is performing within the guidelines of public safety with an objective, not subjective, finding. It's not like someone called the media and said to report on the front page that John Smith came in BAC of 0.23 and left.
I almost thought this may be a homework assignment. In my hometown, back a couple of years after HIPAA went into effect in 96, an intoxicated driver left the hospital like in this case, and a BAC had been drawn. It wasn't reported due to fear of HIPAA fines, etc. The intoxicated person hit and killed a pedestrian, and tried to flee the scene, hit some parked cars and passed out on scene. The driver got vehicular manslaughter, and died in prison (he was in his late 60s), the family of the pedestrian sued the living daylights out of the hospital and won an undisclosed (assumably large) amount. The driver had stated in his DUI case that he must've been okay to drive, because he'd been to the hospital and they'd let him leave, knowing that he drove himself. When that came out, the judge determined that nurses and MDs are supposed to be administrators of personal (patient) and general public safety. The ISBON never argued otherwise.
I know that was almost 30 years ago, but I'd say that stance is likely the same
Interesting. Hopefully this doesn’t become a legal issue but there are also some pretty tricky lawyers out here who want nothing else than to sue the pants off of any and all hospitals and us hospital employees. And you’re right it seems like a no-brainer but in this day and age of smoke and mirrors, nothing appears as easy as it seems.
And you’re right it seems like a no-brainer but in this day and age of smoke and mirrors, nothing appears as easy as it seems.
It kind of is, though.
Anyone can sue anyone for pretty much anything.
Just my experience, but the ONLY people I (or any nurse I know personally) have had questions from re HIPAA/privacy practices are the HIPAA police who wander around hospitals looking for something important to do with themselves. And none of their inquiries and wayward "concerns" has ever been so significant that I or my manager didn't take care of by telling them to buzz off. They are the ones who scare everyone unnecessarily and muddy the waters with their overgeneralizations and seemingly ridiculous (lack of) understanding of the law and various aspects of patient care. Real people getting into real trouble for taking appropriate and legal action in a patient's best interest are a lot harder to come by.
On 10/14/2022 at 8:23 PM, 0121Mednurse said:
They placed him under arrest anyway because of the BAC that the nurse volunteered.
This doesn't change anything; the action the nurse took was not prohibited, it was done for a legal reason and therefore the outcome is irrelevant as far as deciding whether the action was right or wrong.
The BAC was a confidential part of the medical record. Confidential information can be disclosed when necessary for patient safety. Was it the intention of this nurse that the deputy stop the patient from driving and harming himself or that the deputy or an associate arrest the man for drunken driving? Intentions are VERY important. If the intention was to prevent harm, can you prove that in a court of law if you or your facility is sued? What is the facility policy?
My advice would be to not disclose the BAC. Urge the deputy to take action based on observations that anyone could make: the odor of an alcoholic beverage, slurring speech, lack of coordination etc. By mentioning information only discoverable in the medical record you place yourself and your facility at risk.
I haven't done any reading up on HIPPA or Texas law for this one. So, this is an off the cuff response.
HiddenAngels
1,089 Posts
Mannn, he could have killed somebody! Yea I’m calling the cops.