Hipaa Violation

[catlady376]

For the sake of such a serious topic, may we all treat this senerio as hypothetical.

Scene: 2nd year adn student, first clinical of the semester with a first time clinical instructor.

So the student only had one patient and decided to do a complete medical history project/interview with his/her patient during the day. The student had all the patient's information but included no identifying factors on any of the papers that he/she worked on (only initials and not full room numbers, approx. twenty pages of info total). Halfway through the day the instructor passed out printed pt. records (two pieces paper stapled together) that had the instructors name and pt. info at the top (name, DOB, account #, rm #) along with the student's name written in pen and circled. The student had never requested this information and never needed it since the student had access to the computer. The student was also taught by other instructors to never print out patient information.

The student forgot about the information and at the end of the day headed home. The student andn a friend got lost in the hospital searching for an ATM to pay for parking and the student's binder got left on top of the ATM. The bind was found by hospital staff.

The student was contacted by the instructor about an hour later (this is still hypothetical) saying that it was found. There would have been no hipaa violation except for the two pieces of paper that the instructor gave to the student.

I am a hard-A and would say the instructor and student should both be dismissed. The only reason I would consider not dismissing the student is because the student had no identifying pt. information on his/her paperwork, the paper that did have info. was obviously printed by the instructor with intent to give to the student w/o first blacking out information...and although it is also the student's fault for not doing that his/herself, it is ultimately the instructor's liscense and in this case 2 wrongs = Hipaa Violation.

My two questions are: 1.) Would the instructor be let go? 2.) Would the student be kicked out of NS?

Thank you!

[ImThatGuy, BSN, RN]

I wouldn't let go either. I think that's silly. It's not like it jeapordized national security or anything.

I've supervised a lot of people, and I've been a teacher. A quality of both a good supervisor and a good teacher is to understand when people make mistakes, and when they've learned from them. Why make an example of them?

I also guarantee I'm much more of a "hard-A" than you are.

[dudette10, MSN, RN]

Considering I've seen PHI sheets spread all over a conference table after a case conference--when there is a secure disposal can a few feet away in the hall--I would say dismissing both is over the top for this particular situation.

There was no intent here; there was no willful disregard here (e.g. PHI sheets on a conference table). It was a brain-fart situation that had no adverse outcomes on a patient's health status. A serious discussion with the instructor and with the student is needed to ensure that it doesn't happen again. If the student or instructor made a bunch of excuses and didn't take responsibility for his/her actions, I might step up the consequences, though. Anyone who makes an error in standard of care needs to take responsibility and think about how to prevent it from happening again.

[ejm99]

I'm agree while it is a HIPPA violation. Printing anything w/ a patient identifer on it is a NO NO in my program, I know that nurses sometimes print info that they feel will be helpful in our paperwork and give it to students for their use. Are they supposed to? NOPE. We are not allowed to accept it either but it still happens.

My thinking is who walks away and leaves their binder on top of an ATM machine knowing how important their paperwork is...I don't even like leaving my bag w/ my folder/papperwork in the nurses lounge, I certainly don't drag it around the hospital.

Neither should be dismissed. Both should be reprimanded, verbal warning.

[coast2coast]

I don't see any responsibility on the part of the instructor here. Once the student took possession of the papers it became their responsibility.

It looks pretty bad for the student. If this was a brand-new student I'd say it wasn't worthy of dismissal, but a second year? There should be consequences (still not sure it should be dismissal though - would depend on previous track record).

[TheCareerStudent]

I agree with Eim99, I think they should be reprimanded but definitely not dismissed. I think that would be really harsh.

But then if I look at it from the patient's side: If my medical history was on top of an ATM for all to see I would be pretty upset. Depending on what was on there I could be really really really upset. But do I think I would want the person responsible fired if it was an honest mistake that they owned up to, no I don't think so.

[kgh31386, BSN, MSN, RN]

lol there's a difference between "hard-a" and just obnoxious. Why dismiss an instructor over something a student did AFTER clinical? It sounds like the instructor gave the students a census sheet of the floor to remind them which patient they each had(quite common). Our census sheets have the patients MRN and other numbers on them. You didn't say the 2 sheets had any kind of health history on it, but you did say the student's careplan did. The instructor may have told the student to not take the info home or even off the floor...and once clinical is over, it's on the student to empty their binders and pockets. And like they said, who leaves their binder on top of an ATM? It seems like the student is forgetful...hypothetically. If I go home and forget to waste a narcotic or shred my census, etc...that falls on me, not my charge nurse or PCC.

Sidenote, it sounds like this is more than just a hypothetical situation. Either it happened to you and you're scared of getting in trouble, or you know someone and want to tell on them. Bottom line, the instructor should get no punishment due to the fact clinical was over and the student did something. Student should get a stern talking to and be watched much more closely in clinical. As an instructor, I'd also make note of it during evals of the student. It's something to learn from.

And please for the sake of being reasonable, if this happened to someone else and you wanna tell on them..just let it go.

[Nurse SMS, MSN, RN]

Once it is in the student's possession, it is the student's responsibility to dispose of it responsibly, period. I am not sure how anything otherwise could even be argued.

I won't even comment on the discipline part of the scenario. We all know the policies about HIPAA violations. Even if the instructor was wrong, once it left her hands, the responsibility for it passed to the person now in possession of it. That's the way it works in the working world of nursing, not just in school. The only person anyone can control is themselves. What does it matter if the instructor is "punished" or not and how would the student even know what reprimand was handed down?

There is zero arguing that it is a HIPAA violation, plain and clear. What one sees or doesn't see all over the hospital has nothing to do with the law in existance and the responsibility of the hospital and the school to honor that law in any given scenario. To point at it and say 'but they didn't enforce it in this other case so they shouldn't in this one either!" is just silly. They should enforce it all the time without exception. Failure to do so in one instance doesn't give precidence to fail in this one. If anything it should serve as a lesson that they need to be more stringent. This hypothetical situation was careless.

[valsalvamanuever2]

I would say that whatever the clinical site/school has as written policy would be expected follow-through. At my school in particular, the hypothetical situation would be grounds for dismissal from the program.

In my mind, once PHI falls into my or anyone else's hand, it is the responsibility of whoever is in possession of the information to safeguard it, whether they wanted it or not.

I wish my A were hard.

[coast2coast]

I wish my A were hard.