HIPAA between patients?

[EMTSNA]

Hello everyone.

I ran into a situation at work the other night and I wanted to get some input.

I work at a major ER and had the unfortunate pleasure of sitting with 4 patients in for psych eval.

Day after thanksgiving and we were overloaded so these patients were lined up in a busy hallway.

We had a series of traumas come in that had to be wheeled right past my patients to get to the trauma bays.

One of the physicians allowed one of the psych patients to use the telephone, and this gentleman immediately began telling his mother in law that he thought knew one of the traumas and what he thought had happened to that individual.

The patient was asked in a very calm and professional manner both by myself and a nearby RN to refrain from speaking about other people in the ER.

Unfortunately the patient took this as a major insult and the incident almost lead to the patient assaulting staff and being restrained.

Kind of long winded, but my question is. To what extent is patient privacy protected by the law against other patients?

Does this guy have a right to say whatever he wants because he is not an employee?

If not what can be done? I understand if blackmail, slander or libel become involved then this is another issue. What about simple protection of privacy? I'm sure this is not just an issue in the ER.

Thanks

[HeartsOpenWide, RN]

Hippa is for medical staff as far as I know. If some one sees me in the doctors office, who is to stop them for telling some one else they saw me there when they ran itno that person. Hippa is not 100% or else each client would have to be brought through a secret passage to get to their room, or a secret tunnel for each E.R. bed. Its just going to happen.

[traumaRUs, MSN, APRN]

Yes, the patients can talk as they like - HIPAA does not cover them. However, I would be concerned (from an administrator standpoint) as to whether privacy for the trauma pts was compromised by having other patients in the hallway.

[KellieNurse06]

This kind of reminds me of when we were at clinical rotation caring for a patient in a double room..........the patient not being taken care of by us usually talks about something that occurred with the roommate who is the patient being cared for, even if they weren't being spoken to when something was asked medically .......and it's been the elderly patients who are the ones doing it usually......we were told by one of our instructors last year during a rotation that we are to just reply to the person/other patient that "it is inappropriate & violates privacy as well as HIPPA to discuss any information regarding another person who is a patient"...end of story, and if it continued to get the instructor or the nurse manager to have a talk with them. It has worked well I have to say........ I am not sure about the er situation though because if you think about it...how private is an er room really....all that seperates the patients really is a lousy curtain...unless of course it's a trauma room that treats one person alone........:uhoh21:

[EMTSNA]

So I get that HIPAA doesn't cover other patients.

Does anyone have any policies at thier institutions for interpatient privacy?

Such as upon addmission the patients could sign a statement that they will not share personal information. This could be done at registration and provision of care would not be dependant on compliance.

As an EMT, I regularly provide patients with a privacy information pamphlet along with the statement that thier personal information will not be shared with anyone that is not involved in thier care.

Should that little privacy spiel include a disclaimer that it is actually impossible to completely protect privacy. I know i'm playing the devils advocate. It seems like this is probably a dead end alley.

It is often difficult if not impossible to protect people's information. How many hospitals use big white boards for patient assignments. Double rooms, hallways etc... My hospital is finally using initials to call people up to triage.

I'm just wondering if anyone has found this to be an issue worthy of being

addressed by a policy.

Thanks for the responses

[Melina]

I volunteer in the ED, and frankly, I don't see how much of this kind of thing could be prevented. All we can really do is give as little opportunity as possible for patients to hear each other's business, but in our ED there are several double rooms, and all the rooms face the nurse's station (and the computer monitor). We can always ask pts. to be respectful, but they are under no obligation do do so.

We are getting better, though. One of our security guards was telling me that there used to be a big monitor for the psych hold room camera in the hallway, facing the entrance to the dept. Now they have the camera hooked up to a notebook at the security station.

~Mel'

[EricJRN, MSN, RN]

I agree with Melina that things are getting better and that there is a limit to how much we can do. I remember only a few years ago when the whiteboards in ER's (with pt's full name, room number, and complaint) were often out in common areas, in public view. I don't see that kind of thing anymore, at least where I am.

Regarding the original situation posed by the OP, it is sad, but I think you have to keep in mind that if a patient (especially one with psychopathology) hasn't acquired some sense of decency this late in life, you probably aren't going to be able to teach it to him within a few minutes.

[BSNtobe2009]

I probably would have been insulted to, if I were the patient, but I undersand at the time, you weren't sure what to do.

A 'patient' isn't employed by the hospital and therefore, not "bound" by anything. Anyone can tell anyone else anything they directly witness in plain view.

I respectfully disagree with Eric...I don't think it has anything to do with decency...what if that was one of your closest friends? Do you know if his mother has a relationship with that person?

I think it's wrong to assume that the patient was just gossiping, and he could have been expressing genuine concern for someone "he thought he knew".

I have a neighbor that is an older single lady, that I don't know very well, that has a 6 year old adopted son. I woke up in the middle of the night to see an ambulance over at her home. I got up, put on my bathrobe, and walked over there. If I were to stop the story there, you would think I was being nosy. If a neighbor saw just that, it would look like I was being nosy.

I wasn't being nosy...I thought something had happened to the older lady and was going over there to see if I needed to bring her son over to my house until I could get ahold of one of her relatives to take him. It turned out it wasn't her, but the boy that had a problem with seizures and it was him they were taking to the hospital. She probably didn't even know my name and gave me a hug for being so concerned....and agreed that if it had been her, she most certainly would have needed someone's help with the child because her adult son lives an hour away.

You just never know what someone's intentions are.

[gonzo1, ASN, RN]

We are lucky. Our new rooms have sliding glass doors and curtains. We try to keep pts and the family in the rooms as much as possible and just explain to them it is for everyones privacy and safety. You never know what might go flying around the ER. Most seem to accept this. Of course when there is an unruly pt everyone comes out to see what the ruckus is and not much help in preventing this.

[EricJRN, MSN, RN]

I think it's wrong to assume that the patient was just gossiping, and he could have been expressing genuine concern for someone "he thought he knew".

That's a good point. It doesn't explicitly say that the trauma victim and the psych patient's mom were not good friends. I may have assumed too much.

[flashpoint]

The hospital I did my paramedic training in had little pictures of bumble bees all over the hospital. Every floor had an explaination that the bees were to remind people to "bee alert" that while they or their loved ones are in the hospital that they may see or hear things that should be considered confitential in nature. It went on to ask everyone to not talk about things they see or hear and to remember that if they were in the patient's situation, they would not want everyone to know their business. I don't know if it helped, but at least they were trying.

[new er nurse, BSN, RN]

We've had a problem in our ER with this. Not only the patients in the hallways but family members of people in rooms. While they wait (test results, CT scans etc) they wander out into the hall. Some can tell you what complaints those around them have. They also direct family members of others in the direction they need to go (belly pain in that room, ear pain in that room). We try to discourage it but some patients especially older ones almost seem to enjoy what they see as concern for them. When patients are discharged they not only say goodby to us but others around them and wish everyone luck with their ailment.