FERPA/HIPAA Question

[ohiobobcat]

Another nurse just came to me with an interesting issue. The "Smith" family in my school district is being investigated by DHHS (CPS).

My coworker (fellow school nurse) came to me with a legal/ethical question. The principal of her school is asking her to print a record of every nurse office visit of a member of the Smith family for the DHHS investigation (this student is seen multiple times a week for an ongoing medical condition). My coworker has been involved with this student/family since the beginning of the school year and has filed multiple reports to DHHS regarding her observations and concerns for student Smith.

My coworker does not feel it is necessary for other staff to have every record of every visit student Smith has made to the nurse's office. She has spoken to DHHS and they have the information she feels they need. The principal "agrees and understands", but then tells my coworker that the tech department can go into our electronic documentation system and print off the nurse visit records if my coworker refuses. "The documentation software is district property, therefore, we can access any records we want." The superintendent of the district is telling my coworker to print the nurse visits.

My coworker has attempted to contact our state school nurse liaison for guidance with this issue with no success.

Our state school nurse handbook has no answers.

Any thoughts? Does my coworker have a leg to stand on refusing to print the office visit records?

[OldDude]

I think the superintendent can come up with as many reasons he/she should have access to the information as your coworker can come up with to not have access; superintendent trumps school nurse. The nurse has informed those involved that this is confidential information. If that information is used inappropriately or obtained in an alternative manner then those perpetrating the action are responsible - not the nurse.

[NutmeggeRN, BSN]

I guess my response would be that when DHHS asks for it, and it is relative to the investigation, then I will print it then. (f the principal wants to do that, the digital trail will not point to you). A gentle reminder of the HIPAA and FERPA regulations we all operate under don't allow for indiscriminate dissemination of sensitive information.

[Spidey's mom, ADN, BSN, RN]

I think the superintendent can come up with as many reasons he/she should have access to the information as your coworker can come up with to not have access; superintendent trumps school nurse. The nurse has informed those involved that this is confidential information. If that information is used inappropriately or obtained in an alternative manner then those perpetrating the action are responsible - not the nurse.

I agree here.

One of the confounding parts of this job is the deliberate violation of privacy - medical and educational (HIPAA/FERPA).

We are outnumbered.

I wouldn't give them ALL the information unless DHHS/CPS got a court order.

When I make a CPS report, I give them my assessment and report. But that's it.

[Wave Watcher]

If the principal says the tech department can go in the records and get what they want.....tell them to go for it! I don't take well to bully tactics and whether you think your principal is understanding....he/she is not. They will do what they want to do. Period. Stand your ground.

[ohiobobcat]

Thanks for all of your responses. This whole HIPAA/FERPA thing is one of the most confusing things about being a school nurse. I get HIPAA. Throw FERPA into the mix and everything I thought I knew about protected health information is out the window!!

It makes the hairs on the back of my neck stand up to think administration can have access to any health information they want.

I will reassure my coworker that if the digital trail doesn't point to her, then she hasn't disclosed any private health info (which she was concerned about).

[mycsm]

Can you also document electronically on the students file, WHO and why the request is being made. just in case you get asked why you gave it away

[chasinRT]

I think that if administration has access to the information, then they can print it off. I would be hesitant to share personal health information that is likely not relevant to the investigation. An audit trail run on the records will show exactly who accessed the record and who printed it off, so it will be documented in the system that you were not the one who violated HIPAA.

[Flare, ASN, BSN]

that sounds odd to me... i've had plenty of requests from cps over the years - and not once have they been interested in the humdrum day to day visits for children in question. They usually just ask me to kindly provide them with any documentation that would be of interest to them. But maybe that's how things are done in your neck of the woods...

[ohiobobcat]

Flare, this is the principal of the school requesting this information, not DHHS (CPS), although this info request is for a DHHS investigation. My coworker has reported to DHHS multiple times this year regarding this student (I know because she has picked my brain about this situation a few times) so they are aware and have the info they need regarding the student in her school. It gets even more complicated because there are multiple students of different ages in this family who all attend different schools in our district, and they all have different issues going on.

Again, thanks for your replies.

[SnowyJ, RN]

In our school the Principal is considered the building administrator and as such as a right to see school records, even f they are medically related. A lot of times, health visits will tie in with academic and psychosocial issues. As long as the Principal follows confidentiality policies. it shouldn't be an issue.

[SnowyJ, RN]

FYI:

Does the HIPAA Privacy Rule apply to an elementary or secondary school?