HIPAA Violation?

[moni rn]

note: same post as in general nsg discussion

this past friday, i had a severe migraine (nausea, vomiting, something "popped" in my head = my usual migraine). my insurance does not cover shots in the physician's office, but it does cover a much more expensive trip to the ed. *shaking head in disbelief* however, i did not want to go to the ed, because i was there about a week ago with the same thing. (can you tell it is finals time? *lol*). i called my doc to get a shot in his office, and i would pay out of pocket for it. the nurse said sure & to come on in. my father drove me over. then, we found out my doc does not have the med i need, and my only option is to go over to the er. i cried (i was already in tears from the pain) & begged not to go, because i knew what they would think. the doc & nurse said to scr*w what they think. you are in pain & vomiting. you need the medication now.

to make a long story somewhat shorter, my dad took me to the ed. after going through triage, filling out/signing insurance forms and vomiting 3 times in an emesis basin in the middle of the waiting room, they took me back to fast-track. i didn't care that i was vomiting in the middle of the waiting room at that point. i was in too much pain.

per my father, the doc & the nurse pulled him out in the hall to discuss the medication that i was taking & the fact that i was just there a week ago. they felt they needed to let someone know that this medication is highly addictive. excuse me, but can you say, "hipaa violation!" they should not be discussing my care and history at that hospital with anyone else. my father didn't tell me until we got to his home. one might say that i was incapicitated, but i was able to sign for my insurance & privacy rights. at that time, i had not yet received any meds from them. they had absolutely no right to discuss my information with my dad! i was absolutely livid!

my question for y'all is: do i have a right to be upset? one of my classmates said i need to call the director of the hospital & tell them what happened. i think someone should know that they severely violated hipaa. what do y'all think?

thanks!

[chris_at_lucas_RN, RN]

It's a HIPPA violation for sure--but it was a violation of your privacy and confidentiality before HIPPA even existed.

A right to be upset, yes. Are you dependent upon that ED for treatment in the future? Sounds like it.

The path of lesser resistence might be to talk to your doc the next time you are in, let him know what happened, and maybe next time (and with those HA's, there surely will be one), tell them at the outset to call your doc--that ought to take care of the "what they think" part.

And if it doesn't, just ask them, between pukes, if they know of any med or alternative treatment that can stop the HA's because you are concerned about the addictive characteristics of the meds....

And some people are just asses, and some of them unfortunately work in the ED....

[kevro1013]

This is a very sensitve issue. Just my two measly cents.

Did the Physician discuss these aspects of your care to you as well or only to your father in private? I understand you were in a great deal of pain and were to be medicated with narcs (both situations difficult to hold a conversation with on a serious topic) I would like to think the Doc discussed this with your father out of concern for you knowing that chronic pain sufferers are at high risk for addiction. ED staff (as myself ) sometimes become jaded in the day in day out routine of seeing addiction rear its ugly head and claim another victim.

I am by no means calling you an drug seeker with only two visits to the ED for a legit cause. For there to be a hippa violation (IMHO), there must be a leak of info to someone you did not give permission to receive that info.

Did your father know why you were there? Did you not want him to know what was going on? Maybe the MD thought you were in too much pain to discuss this at that time.

We were encouraged in Nursing school to include the family in teaching and to focus on the family because the patient was usually too overwhelmed by the pain or medication to take notes on what we were trying to teach or express concern about.

Was this the time and place (and person ) for this discussion?

Probably not-

After only two visits to the ED (for a legit cause) it was both unprofessional and inappropriate for them to discuss that with your father.

I would have delt with it differently but thats just me!

-Just my thoughts

-Good luck!

[moni rn]

thank you so much for your responses! :)

to answer some of your questions:

1) the physician did not speak to me about addiction. my physician has filled out a card that i take into the er when i go. i also have a prescription for imitrex injections, phenergan & stadol, but they did not work for this migraine. i usually take dilaudid w/no drowsiness side effect, but if i take demerol or morphine, they just make me incredibly loopy. also, they don't get rid of the pain. my doc knows that i am fully aware of the effects of dilaudid. he has seen me on both demerol and dilaudid, and he is amazed at the completely different effects they have on me. he knows that i am seeking other forms of treatment, except meds. i have been receiving accupuncture treatments, attending relaxation technique classes and locating homeopathic remedies. also, i believe that a lot of my migraines are because of tmj & stress. my tmj is so bad that my bite is off, so every once in a while during chewing, i will bite a chunk out of my lip and/or cheek. i have attempted mouth guards (bite right through them while sleeping), braces (didn't work, but i have straight teeth now), and even cortisone shots (didn't work). my next option is jaw surgery, but i wanted to wait until i was done with nursing school.

2) my dad is aware of most of my medical situations. my dad is a chf patient & type ii diabetic, and my mom is a breast & lymphatic cancer survivor. in my opinion, they have enough to worry about. i don't want to bother them everytime i went to the er. my husband usually takes me, but he was stuck at work.

3) my migraines only get bad enough to go to the hospital about once a month. if my "wonderful" insurance paid for in-office shots, my doc would start carrying dilaudid. he only has demerol. i told him that i would start paying for the shots out-of-pocket. he said that he wanted me to still go to the er when i pass out during the migraines, which happens about 30 - 40% of the time. my insurance only covers ct scans, and they won't cover mris. can you believe it? my doc even mentioned that maybe next time when "something pops, the pressure changes in my head and i pass out" he was going to admit me, so they would pay for it. i love insurance!

4) my doc has also given me strict instructions to put off anymore school until these things are under control. i was planning on starting my msn next fall. he has put a halt to all of that.

5) during my last clinical rotation, i spent several days down in this ed. they even offered me a gn positon. during my time there, i pretty much worked with this one nurse. i had mentioned my migraines, how i respond to them and my concern to work at the place where i have to go for treatment for them. she said it wouldn't be a problem. this nurse was my nurse friday night. when she came back to check on me after giving the med, i was perfectly lucid (no vomiting since). we even talked about my clinical experience and, hopefully, my upcoming graduation. why didn't they mention it then?

6) the previous time i was in there for a migraine, they recognized me and asked for my card. this was another nurse that i happened to work with during my clinical. they took me straight back, and i gave them my card. she gave me my shot and discharged me. she said there was no reason for me to sit out there. if this migraine is like my others, she said lets just give you your shot, and you can get home to rest.

7) my husband's family has a lot of physicians, so i specifically requested that no one knows that i am a patient at that facility & that my husband is the only person that should be notified and/or informed.

8) i have the upmost respect for emergency nurses, that is why i chose to work in ed after graduation. i believe y'all are the most informed & prepared nurses out there! you have to deal with everything and keep your wits about ya. i believe if you can make it in ed, that you can make it anywhere in nursing. you are awesome to put up with what you do and to handle it so well!

sorry for the long rant! i just wanted to make sure that i answered all of y'all's questions.

thank you again for taking the time to respond! :)