HIPAA and Demanding Family Members

[Taiin]

When someone is discharged from the facility I work at, all we're allowed to tell someone later is that the patient is no longer here. No details on where they go.

Today an especially demanding family member kept trying to get information on a patient who'd been discharged last week. Said nobody in the family knew where the patient went.

I apologized to the person for not being able to share the information they sought, but stuck to my guns. All I could tell them was the patient was no longer here. The family member became quite nasty and belligerent, so I asked her to hold and spoke with my charge nurse. My charge believed my answer was correct, but asked me to confirm the the nursing supervisor that my answer was correct, that we couldn't give that information. It isn't like it was a worried parent looking for a child, but a far more distant relative looking for an A&O adult. Yep, supervisor told me what I'd said was correct, so I got the person off hold. Once again, I apologized, but told them I couldn't release that information.

The last thing I was told was that they'd be calling administration before they hung up. I just hope I don't get in trouble. I don't think I am in the wrong, by not violating HIPAA. But it has been bothering me. I'm always quite clear with my name on the telephone and readily repeat it if they need to write it down. I know my name will come up if this person does indeed call a complaint.

Usually the charge nurse handles things like this, but the charge was focused on a patient going downhill fast. Stabilizing a patient is far more important that a phone call, unless it is a call from an MD about the patient she is assisting with.

What is the best way to handle situations like this? I am sure it'll happen again.

[Lunah, MSN, RN]

You handled it well, and appropriately. Unfailing politeness and calm in the face of rude and demanding behavior will always put you beyond reproach. Nice work.

[Susie2310]

Could the family member have been authorized to receive Protected Health Information? Does your facility ask this question when you receive calls such as this?

[RainMom]

You handled it fine. Hopefully they DID call admin & were told again that information could not be released. Was your manager around at this time? Those are the types of calls I would forward to them or forward to the supervisor rather than just confirming that you were correct. That way the obnoxious caller can hear it from 2 of you.

Could the family member have been authorized to receive Protected Health Information? Does your facility ask this question when you receive calls such as this?

But after a pt is discharged, I wouldn't think staff could open that chart to check without violating HIPAA themselves. The pt is discharged; no one should enter the chart to browse for family contacts, POA, etc. If they were such close family, they would know where the pt from last week went.

[Taiin]

We do have a system for admitted patients to provide a code number to family members who the patient wishes to receive information. Or if someone is unable to consent, the first emergency contact, spouse or closest relative, or POA-HC decides who to share it with. But when someone is discharged? I'm not sure how that might work.

I don't think I'd feel comfortable delving into the chart of a discharged patient. Especially one who has been gone so long. I did check the date of discharge, but no further.

Alas, the nursing manager is gone on the weekend, plus our manager is on vacation beyond the holiday weekend. All problems are to be fielded to the nursing supervisor. I do agree a second person taking the call would have been a great idea, something to implement if this happens again in the future and the charge is tied up.

[Here.I.Stand, BSN, RN]

You did just fine. You can't break the law regardless how big a tantrum they throw.

I was actually advised by my charge once (also a clear cut can't-give-you-that-info situation) to repeat myself once, and then to end the conversation. Actually I think he said "hang up." Federal law is federal law, and we need to be caring for our pts. Not reasoning with unreasonable people who can't have info anyway.

[MunoRN, RN]

Responding to an inquiry about whether or not a specific person is in the facility is not a HIPAA violation, HIPAA specifically allows for this information to be disclosed. It also allows for specific inquiries about the disposition of the patient at discharge to be disclosed so long as the patient was not transferred to a mental health facility. There is no HIPAA violation in looking up or telling a family member that their mom/dad/whomever was transferred to such-and-such nursing home. How would any of you feel if you called to check in on your mom or dad and was told they aren't there any more but they aren't going to tell you where they are? That's fine as long as there is a legal requirement to do so, but no such legal requirement exists.

[TriciaJ, RN]

Responding to an inquiry about whether or not a specific person is in the facility is not a HIPAA violation, HIPAA specifically allows for this information to be disclosed. It also allows for specific inquiries about the disposition of the patient at discharge to be disclosed so long as the patient was not transferred to a mental health facility. There is no HIPAA violation in looking up or telling a family member that their mom/dad/whomever was transferred to such-and-such nursing home. How would any of you feel if you called to check in on your mom or dad and was told they aren't there any more but they aren't going to tell you where they are? That's fine as long as there is a legal requirement to do so, but no such legal requirement exists.

Suppose you are the next-of-kin and mom or dad really did get discharged to an undisclosed location. Then you would calmly go to the administrative office and ask for help locating your loved one. Getting belligerent with a floor nurse is not the behaviour of a reasonable person. This is someone trying to use intimidation to get what they're not entitled to.

OP, blow this off. You followed procedure, you sought input from a charge nurse and a supervisor. If there is a complaint, it won't have validity so don't give it a thought. When you are in the right, you can stand your ground and let the chips fall.

[Lunah, MSN, RN]

That's fine as long as there is a legal requirement to do so, but no such legal requirement exists.

But it does sound like a facility policy, according to the first part of the OP's post.

[heron, ASN, RN]

Responding to an inquiry about whether or not a specific person is in the facility is not a HIPAA violation, HIPAA specifically allows for this information to be disclosed. It also allows for specific inquiries about the disposition of the patient at discharge to be disclosed so long as the patient was not transferred to a mental health facility. There is no HIPAA violation in looking up or telling a family member that their mom/dad/whomever was transferred to such-and-such nursing home. How would any of you feel if you called to check in on your mom or dad and was told they aren't there any more but they aren't going to tell you where they are? That's fine as long as there is a legal requirement to do so, but no such legal requirement exists.

Since you usually know what you're talking about, I'll take your word for it. But I would still have concerns about it since there's no way to identify the person on the phone when I receive such a call. Anyone can claim to be a relative whether they are or not.

Perhap, between my experience as a women's reproductive care provider and an AIDS nurse through the 80s and 90s, I'm a little oversensitive to such matters. I think the OP did the right thing. I would have suggested that the caller get in touch with the immediate family or the hospital administrator's office.

[TheCommuter, BSN, RN]

Moved to the HIPAA forum for more responses.

[doctorwhofan]

In the state I work in, the next of kin must sign family members into their facilities prior to their arrival, even if the patient is of sound mind.

It sounds as though this person needed to call another family member to find out the information. Perhaps it would've been helpful if they had visited while the patient was admitted, as discharge plans are usually not secret and patients are rarely stolen in the night by ninjas.

If that is your facility's policy, you did the correct thing. Maintain a professional tone and move on.