I Feel Like My Privacy Was Violated

[RNGuy12]

I need some perspective on a situation that occurred recently please!

Until recently, I worked in a NP owned clinic. There were 2 NPs in the practice, one of whom is the owner while the other is just employed there. For over a year now, my healthcare has been overseen by the employee NP because I trust her and respect her clinical judgment.

I recently put in my notice d/t pay and benefit issues. The day after I put in my notice I had an appt with the employee NP. The next day, the employee NP found me and informed me that our employer called her in for a meeting because she had seen my name on the schedule and subsequently went through my personal medical chart and disagreed with the course of treatment decided between my chosen provider and myself.

Citing clinic "protocol" the owner strongly implied it would be in the professional best interest of the employee NP to run expensive lab tests that I couldn't afford d/t never being offered the opportunity to receive the company insurance (one of the deciding factors in my leaving the job). Needless to say, I ended up strong armed into having the tests done and now am being dunned for a large bill.

Then later that same day the owner called me in to her office and told me to clock out as my services would not be required for the remainder of my notice period.

I'm not concerned over having to leave the job sooner than was originally planned d/t it being a very toxic workplace and the boss being very difficult to work with. What I am having trouble with is that I feel like my privacy was violated because a person who had nothing to do with my healthcare accessed my information and then intimidated my chosen healthcare provider into performing expensive labs she and I had decided that while they would be good to have, were not expressly necessary at the time and could wait until I had better means to pay for them.

Does this sound like something I need to address with the Office for Civil Rights?

[dansamy]

Regardless of the violation, you relented & consented to the tests. You owe the bill.

Depending on how the practice is run, it may or may not be a hippa violation. You could certainly report it & that will at least trigger an inquiry.

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[RNGuy12]

The bill is not the point; it's just an unfortunate part of the situation. The point is my medical chart was accessed by a provider who had nothing to do with my care. I don't feel like that was right or in keeping with HIPAA standards. Can you explain what you mean by depending on how the practice is run?

[jadelpn, LPN, EMT-B]

If the NP owner oversees the clinical judgements of the employee NP, or say that the employee NP was unavailable and you needed to be seen and had to be seen by the owner NP, then every clinician has access to your record. I see it as you were a patient of the practice, not necessarily of the one NP. Which if the owner NP makes it a habit of reviewing the charts of the employee NP, this is where this came to light.

And add to the mix if you were seen as a professional courtesy, as opposed to being billed for the visits (and I can only assume that is why they don't offer an insurance plan).

It is really creepy that the owner NP was so "interested" in your medical situation that she took it upon herself to research your record, and seeminly then used it against you. However, when one signs consents of any nature (when you became a patient of the practice, when you went and had bloodwork) that essentially gives a tremendous amount of permission than perhaps you were comfortable with.

Additionally, everyone is afraid of liability. And conceiveably, you could have come back to the practice stating that you were suffering from a condition that the NP was not effectively treating you for, or was treating you for a condition that was a guess--no testing to confirm this. Hence why in some facilities, it is a fire-able offense to ask a provider for a prescription without being seen or tested for same ("hey I have a sore throat, can I get a prescription for an antibiotic" stuff).

It really does stink, but in the future, I would think about having a health care provider that is not directly in your place of work.

[dansamy]

The pp summarized quite well what I meant.

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[T-Bird78]

If it's standard policy to have both NPs review all cases, then no. If not, then the minimal information rule should apply. Your NP needs your info, but the NP not treating you has no reason to access your chart.

[BlueDevil,DNP, DNP, RN]

I don't know what "dunned" means. You were dunned for a large bill? I don't understand that expression. In any event, you said you don't really care about that, but I agree with the previous posters who said you are stuck with it since you consented.

As for the rest, some above posters are incorrect. Because the other NP is the practice owner and the Respondeat superior, s/he owns the charts (owned work product) and is entitled to read any content at any time. As such, no, your privacy was not violated. If the recommendations complied with guidelines for the standard of care, then there is no ethical complaint either. If the tests were outside the standard of care, and could be attributed to maleficence, then you may have an ethics complaint with the board of nursing.

[jadelpn, LPN, EMT-B]

I don't know what "dunned" means. You were dunned for a large bill? I don't understand that expression. In any event, you said you don't really care about that, but I agree with the previous posters who said you are stuck with it since you consented.

As for the rest, some above posters are incorrect. Because the other NP is the practice owner and the Respondeat superior, s/he owns the charts (owned work product) and is entitled to read any content at any time. As such, no, your privacy was not violated. If the recommendations complied with guidelines for the standard of care, then there is no ethical complaint either. If the tests were outside the standard of care, and could be attributed to maleficence, then you may have an ethics complaint with the board of nursing.

One could argue Hipaa and the "need to know" aspect of same. However, in most practices, one is a patient of the practice, and not of a specific provider. Although a patient may prefer to see a certain NP, that is not always feasible.

Still a tad creepy that the other NP owner would take it upon herself to look at this one particular chart, however, maybe the NP owner does chart checks, maybe the other NP asked for another opinion, you never know.

And they who are the malpractice insurance owners of the the practice itself, in this day and age it is almost always a good idea to review charts.

[Bortaz, MSN, RN]

dun ¹ (dn)tr.v. dunned, dun-ning, dunsTo importune (a debtor) for payment: a dunning letter.

n.1. One that duns.

2. An importunate demand for payment.

I don't know what "dunned" means. You were dunned for a large bill? I don't understand that expression.

[BlueDevil,DNP, DNP, RN]

No, one can not logically argue HIPAA. Well they couldn't but they would be completely wrong. As the other NP is the practice owner, he is the Respondeat Superior, and has an implied duty to review charts. HIPAA does not apply.

[BlueDevil,DNP, DNP, RN]

dun ¹(dn)tr.v. dunned, dun-ning, dunsTo importune (a debtor) for payment: a dunning letter.

n.1. One that duns.

2. An importunate demand for payment.

truly do learn something new every day

[Balder_LPN, LPN]

HIPAA always applies. There is no exception for the "owner" of the records. Read about covered entities in HIPAA. Both NPS and the practice itself are covered entities and the minimum info rule applies. The CEO at a hospital can't access your records just for a look see.

Contact a lawyer that specializes in HIPAA of a Nurse legal specialist.