HIPAA privacy question

kool-aide, RN · Mar 23, 2011

Sounds like it to me, unless the nurse asked the pt if it was okay to have her mother in the room for the exam and the pt said "yes."

and may I say, YIKES! :eek:

**canoehead, BSN, RN** · Mar 23, 2011

If an adult brings another person into an exam room with them, they can expect personal questions to be asked in front of them. If they mention "don't ask me about birth control in front of my mother " while checking in, their privacy will be respected.

navyguyhm3 · Mar 23, 2011

Being that the patient is over the age of 18, the mother has no business in knowing the medical needs of her "child". The patient would have to express verbally and in writing that mom can be present. If it were a younger child, different story, but this is a consenting adult patient and therefore, all matters medically are for the HCP and patient ears only, however, if patient didn't want parent to hear anything, shouldn't have had them in the room, and if the patient didn't specifically express any requests (don't mention..??? in front of..) then really it's the patient fault, but it would fall on the nurse because he/she didn't follow privacy laws. It's a little gray tho. But my money is on a hippa violation.

canesdukegirl, BSN, RN · Mar 23, 2011

This one is a toughie. Granted, the pt is a legal adult and can consent for herself. However, if the pt is unwilling or uncomfortable speaking up for herself, she may have consented to having her mother in the room to avoid a fight/tense situation by excluding her mother from being in the room. Does that make sense?

It is always more safe to err on the side of caution in situations like these. The nurse COULD have diffused the situation entirely by only permitting the pt in the room, and thus taking the "blame" off of the pt if the mother gets miffed by not being permitted in the room. On the other hand, the nurse was giving the pt control of her own decision by giving her the choice. It could be viewed two entirely different ways.

I would have only let the pt in the room, performed the interview and THEN asked the pt if she would like to have her mother in the room after explaining that her medical information would be discussed in front of her mother. That way I am confident in knowing that my pt understands that her mother would be privy to information that she may not want her mother to know, thus giving her the choice.

**canoehead, BSN, RN** · Mar 23, 2011

Isn't it realistic to expect that if you are walking into an exam room, someone is going to be talking about your private health information?

Almost as mind boggling as people requesting antibiotics but not remembering which one they are allergic to. (We'll just try one and roll the dice...not.)

Horseshoe, BSN, RN · Mar 23, 2011

I would have only let the pt in the room, performed the interview and THEN asked the pt if she would like to have her mother in the room after explaining that her medical information would be discussed in front of her mother. That way I am confident in knowing that my pt understands that her mother would be privy to information that she may not want her mother to know, thus giving her the choice.

That would be a perfect way to handle it and would have completely avoided the situation described in the OP.

OldNurseEducator · Mar 23, 2011

This one is a toughie. Granted, the pt is a legal adult and can consent for herself. However, if the pt is unwilling or uncomfortable speaking up for herself, she may have consented to having her mother in the room to avoid a fight/tense situation by excluding her mother from being in the room. Does that make sense?
It is always more safe to err on the side of caution in situations like these. The nurse COULD have diffused the situation entirely by only permitting the pt in the room, and thus taking the "blame" off of the pt if the mother gets miffed by not being permitted in the room. On the other hand, the nurse was giving the pt control of her own decision by giving her the choice. It could be viewed two entirely different ways.
I would have only let the pt in the room, performed the interview and THEN asked the pt if she would like to have her mother in the room after explaining that her medical information would be discussed in front of her mother. That way I am confident in knowing that my pt understands that her mother would be privy to information that she may not want her mother to know, thus giving her the choice.

Totally agree with you! :twocents: :nurse:

flashpoint · Mar 23, 2011

Being that the patient is over the age of 18, the mother has no business in knowing the medical needs of her "child". The patient would have to express verbally and in writing that mom can be present. If it were a younger child, different story, but this is a consenting adult patient and therefore, all matters medically are for the HCP and patient ears only, however, if patient didn't want parent to hear anything, shouldn't have had them in the room, and if the patient didn't specifically express any requests (don't mention..??? in front of..) then really it's the patient fault, but it would fall on the nurse because he/she didn't follow privacy laws. It's a little gray tho. But my money is on a hippa violation.

Our 19 year old daughter is still on my husband's insurance plan...we pay the premium, we pay the deductable, we pay the pharmacy bill...we have every "right" to know our daughter's medical history.

If an adult has another adult with them in the exam room, they should be able to reasonably anticipate that there may be disclosure of protected health information. The HIPAA law actually recognizes this fact. The HIPAA law also allows for minimum disclosure as long as it relates to the current problem. If I take my neighbor to the ER because she has a laceration and she asks me to stay with her, the staff can assume that she has no issue with me having knowledge relating to the current problem. As long as she says I can stay in the room, the staff can ask whatever questions and disclose whatever information relates to the current situation. They probably should not ask questions like, "How are things going since your overdose?" or "Have you been retested for syphillis since you finished the antibiotics?"

I usually ask everyone except the patient to step out while I do my assessment...if the patient says, "Please let them stay," I let them...if not, I direct them to the waiting room.

OldNurseEducator · Mar 23, 2011

Our 19 year old daughter is still on my husband's insurance plan...we pay the premium, we pay the deductable, we pay the pharmacy bill...we have every "right" to know our daughter's medical history.
If an adult has another adult with them in the exam room, they should be able to reasonably anticipate that there may be disclosure of protected health information. The HIPAA law actually recognizes this fact. The HIPAA law also allows for minimum disclosure as long as it relates to the current problem. If I take my neighbor to the ER because she has a laceration and she asks me to stay with her, the staff can assume that she has no issue with me having knowledge relating to the current problem. As long as she says I can stay in the room, the staff can ask whatever questions and disclose whatever information relates to the current situation. They probably should not ask questions like, "How are things going since your overdose?" or "Have you been retested for syphillis since you finished the antibiotics?"
I usually ask everyone except the patient to step out while I do my assessment...if the patient says, "Please let them stay," I let them...if not, I direct them to the waiting room.

I don't think the fact that she lives under your roof and you pay her medical insurance makes her any less of an adult with adult privileges, like right to privacy. I say that in all honesty and fairness to both you and your daughter. I remember when my sons both turned 18 (they're both in their 30's now) before HIPPA, they (the office staff) encouraged me to not go into the room with them. I respected that. Just my :twocents: . It would be interesting to hear where a person in your daughter's situation legally stands. Any RN/JD's out there?

heron, ASN, RN · Mar 23, 2011

Our 19 year old daughter is still on my husband's insurance plan...we pay the premium, we pay the deductable, we pay the pharmacy bill...we have every "right" to know our daughter's medical history.

No, you don't. I understand that you feel you have a right to know what you're paying for ... I tended to feel the same way when my son was growing up. But your daughter is legally an adult and has an overriding right to determine for herself what medical information is to be shared and with whom.

The question came up a lot when I worked in women's reproductive health settings. In fact, I have met adolescent health specialists that make it clear to parents that they will not divulge information that the child has asked them to keep private - usually this kicks in around the age of 14 or so.

It's a risk/benefit decision. Many decide that it's worth the risk of p-----g off the parents to make sure the kid isn't hiding something important for fear his/her parents are going to find out.

But for an adult child, the issue is clear, at least to me ... parents' dollars do not trump the right to privacy and self-determination.

flashpoint · Mar 23, 2011

I don't think the fact that she lives under your roof and you pay her medical insurance makes her any less of an adult with adult privileges, like right to privacy. I say that in all honesty and fairness to both you and your daughter. I remember when my sons both turned 18 (they're both in their 30's now) before HIPPA, they (the office staff) encouraged me to not go into the room with them. I respected that. Just my . It would be interesting to hear where a person in your daughter's situation legally stands. Any RN/JD's out there?

I don't go into the exam room with her, but I do think I have a right to know what I am paying for. When the hospital bill comes to me, should I simply pay it without knowing what it is for? I also pay the pharmacy bill...should I just pay it because it arrives? Should the pharmacy simply send me a bill for $175 and not itemize the bill? My daughter agrees that as long as she lives in our house and we pay the bills we have a right and obligation to know.

Also...I think it is important to have someone else who knows a person's medical history. If she is traveling out of town and somehow ends up in the ER, isn't it important that someone knows her history, medication, etc in case she cannot speak for herself? I'm much easier to track down at midnight than her clinic chart is.