I work in L&D and recently took care of a 15yr old who's boyfriend and his family along with her mother brought her in because of her unusual behavior; she was talking to her self, saying that the voices were telling her to hurt the baby, if she wasn't crying she would have a blank stare, something was obviously going on with this girl, and she was incoherent when in came to asking her any questions, we did a drug screen and it tested positive for barbituates and TCA's, because she was is such a poor mental state and her mother spoke no english at all, the boyfriend/his family seemed to be doing most of the care, standing at her bedside, and very concerned for her, I asked the pt in front of the family member if she was being seen by any other doctor for any medical condition like depression or any thing else, she did not respond but the boyfriends family told me that she has no medical problems and what is going on with her right now just manifested about 3 days prior; I then asked the pt if someone had given her any pills or had she taken any thing other than her prenatal viatamins, she did not answer again, so I explained to her (in front of the family) what showed up in her urine specimen, the family began to ask me questions, the pt still not responding to me, I just simply asked them if they knew of anyone who would have given her anything, I was just simply trying to figure out what was going on with this poor girl, the family thanked, me they even asked me if I could be her nurse when she went into labor, they did not change any of their attitudes towards her; however I charted this converstion as well as all other converstatins with this pt in hopes that it would help with her psych eval; one of the nurses on the unit read my charting and turned it into the nurse manager, now I am being suspended until further notice and possibly going to lose my job, because it was a violation of HIPPA, has this ever happened to anyone else, do you think I am wrong for what I did??? Again the family/pt did not complain it was another nurse, and my manager decided to take it to the attention of HR.
Jan 5, '06
A 15 year old who is pregnant is responsible for her medical decisons. Since she was not able to provide information or answer questions her mother would be considered her next of kin and would be the one to make medical decisions. Since mother did not speak English then you should have gotten a spanish speaking translator. To disregard her entirely is not only illegal, but culturally insensitive. The information given by the boyfriend can be considered for the assessment but you gave detailed medical information to people not directly responsible for her care and that is a problem. Even if the patient or the family did not complain does not mean you were not in violation, nor does it exempt you from litigation. (i.e - is a med error only a med error if the patient has a negative reaction?) With HIPAA, when in doubt, shut your mouth. She tested positive, inform her doctor, prepare to have the baby tested, watch for complications, and leave the rest to CPS and the police, period. Best of luck in the future, live and learn.
Jan 5, '06
I'm afraid I have to agree with hyperstudent; although you meant well, what you did was clearly a HIPAA violation, and the penalties can be quite severe.
Jan 5, '06
Hate to say it, but I agree. If she wasn't emancipated her parent could have been informed about the positive drug screen, but the BF and his family had no business knowing about it without the girl's express consent.....which, since she was pregnant, she was legally allowed to grant or deny. And since she was pregnant it's even doubtful that her mother had a right to know about it without the girl's permission.
Jan 6, '06
Sorry, but I have to agree with the other posters. You should not have released that sensitive information with her boyfriend and his parents. You should have called a translator so you could speak to her mother who probably knows her the best. Nothing should have been told to the boyfriend and his parents.
I am truly sorry about the situation you are in. I don't wish it on anyone. You meant well. I'm pessimistic but now that the boyfriend's parents know she had drugs in her system they could fight for custody of this baby.
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