Is this a for real "HIPAA" violation????

[mom2michael]

I work in a very rural hospital with maybe 2 or 3 patients on the floor at a time. My son LOVES to visit me at work and walk down to the laundry with me or walk to the kitchen to pick up supplies, however I don't let him in the ER with me if we have patients there for many reasons.

A couple weeks ago he asked if he could read to the swing bed patients on the floor. I thought that was sweet (he is 7) so I talked to the social worker who was more than happy with the idea. We then ran it by the Administrator of the hospital and he was also thrilled. Then it reached the DON. She said there was no way he would be allowed to do this because it violates HIPAA. She gave me about a million reasons why it violated HIPAA but I'm confused because my son isn't going to be in there talking about the patients medical history he is going to read them a book.

It's my understanding (and please correct me if I'm wrong) if the patient signs the PIH form, it's not a violation to state that a patient is in the hospital (assuming they checked "yes" to the directory), however it is a violation to discuss with others the medical aspect of the patient. However, just acknowledging the fact they are present and accounted for in the hospital doesn't violate HIPAA or the Privacy Laws right????? Because this is what she states I would be violating by allowing him to come in and read to the patients, despite the fact we would be getting permission before he even stepped foot in the room.

I was also told by the DON that I was violating a million things whenever I allowed my son to walk to the kitchen with me or to the laundry room for supplies, even though we do not cross any areas where patients are located????

Please, someone help me make sense of this madness

[RNOTODAY, BSN, RN]

I agree with the DON. The adult volunteers at least are of age and sign confidentiality agreements. A 7 year old? Not possible. What if he saw someone in a grocery store one day and said........"I remember you from the hospital" and they didnt want anyone to know........it seems kind of silly, but it is a legitimate concern. And the liability? Thats another story.... LOTS of liability. The hospital I worked in didnt even allow children under 12 to visit unless it was pre arranged.

[TypicalFish]

I must disagree with the others. Unless you share specific information with your 7-year old son a la diagnosis, specific identifying patient information then it would not be a violation of HIPAA. In other words, there is nothing for him to keep confidential if you don't share it with him in the first place. They have a better case for the liability issues although to be honest, that is paper thin also unless your son is being unsupervised during these sessions.

But also think-you are walking down the street of your town, and even after you've explained to your son not to, he shouts out suddenly "look, mom, there's that lady who was at the hospital" or "look, there's the man who had the operation"-oops, Hippa violation.

[SharonH, RN]

But also think-you are walking down the street of your town, and even after you've explained to your son not to, he shouts out suddenly "look, mom, there's that lady who was at the hospital" or "look, there's the man who had the operation"-oops, Hippa violation.

He could have just as easily have been visiting someone else at the hospital, or have seen them in the same room even (semi-private) and have seen the lady that way. He could have been in the lobby even when the patient is wheeled out and have recognized her from there even. HIPAA does not guarantee anonymity only that private medical information remain confidential.

[Works2xs]

Gawd, this law is like one of those urban myths. It keeps growing and growing. While I'm sure some lawyer(s) are making mints interpreting this particular law and it's ramifications, it generally ticks me off to no end how much of the emphasis gets placed on the wrong end of the equation. Why do I say that? "Sherman, set the way-back machine...."

Health Insurance Portability and Accountability Act 1996- "To amend the Internal Revenue Code of 1986 to improve portability and continuity of health insurance coverage in the group and individual markets, to combat waste, fraud, and abuse in health insurance and health care delivery, to promote the use of medical savings accounts, to improve access to long-term care services and coverage, to simplify the administration of health insurance, and for other purposes." [emphasis added]

For those that remember, correct me if I'm wrong, but at the time this law was enacted was when there was a great national debate revolving around anything having to do with the delivery of insurance and the impacts of such efforts on health care, especially where it related to cost. Where the thrust of this came in was with regard to the ability to move individual health care information from insurance company to insurance company for the purpose of continuation of coverage. Other benefits included providing the legal protections that would allow providers to quickly move critical data from one area to another.

The big worry was that private information would be exposed to the ravages of the information age, possibly revealing information that some other user (other than your health care provider) could scarf up and use against you. Example: life insurance carrier finding out you have a genetic marker for some disease and then using that data to deny coverage. Other scenarios were batted about, like pharmaceutical companies learning what drugs you were using so they could target advertisments at you on an individual basis. You get the idea. So to protect us from the scourge of unscrupulous data miners, this law was put together.

As with any law, the intent seems to get lost in the mists of time. We now get saddled with some anal retentive bureaucrat micro managing every syllable that might, in some extravagant way, reveal patient data. The OP's story is a perfect example. I'm sure Boris and Natasha are waiting in the shadows to pump this little seven year old for crucial patient data... NOT. While I'm all for the intent of this law and the idea of protecting patient privacy, the very notion that someone even has to wonder whether it's a violation for a kid to read stories to someone because it could lead to an inadvertent violation just makes me want to gag. Just makes me wonder how much the person putting the kabosh on the kid's charity is worrying about "little" stuff... like people logging into patient databases and then walking away from the terminial...crappy password security...vulnerabilities associated with wireless networks... etc, etc.

I guess I could be optimistic and think that if this person is so concerned with a child's impact on info security, then they must be equally concerned about the other stuff. Unfortunately, having recently retired from a computer information security operation, I know better. But that's a thread of a different color. The really, really sad part is that the person who made this call is probably acting on valid legal concerns. grrrrrrrrrrrr

/rant off.

[KuteNurse, LPN]

i don't see a thing wrong with it. if the patient's are asked first for permission, why not? it would be good for all. the heck with hippa...lol what happened to the old nursing where we as nurses are there to cheer patients up??? it is healthy for children to see sick people. a learning experience for them as well as having a satisfaction of knowing they are doing something good for others. i really think we have to move back to this. afterall, we no longer wear starched white uniforms and hats. things have laxed in nursing to suit the needs of our patients. i say go for it! great opportunity for all.

kn

[TazziRN, RN]

I don't agree with the majority here. It is no more a HIPAA violation to have him read to the residents than to have an adult volunteer read. At 7 he may be incapable of keeping a secret (the residents' medical conditions) but that information should never be discussed in front of a volunteer anyway. And you are correct that a pt's presence in the hospital is not a secret unless the pt specifically requests that.

The liability issue....well, yes, there could be a problem there. But your original question was about HIPAA. Nope, no violation.

[sirI, MSN, APRN, NP]

I still must agree this is a HIPAA violation. The patient to whom he reads may give permission, but others may not give permission. And, those patients' privacy/confidentiality can be breached.

As for discussing the information in front of a volunteer, this does not have to directly occur. Only overhear, or be witness to events.

IMHO....

[ljds]

I wouldn't want my 7 year old on our floor! Urgh, I can just imagine what she would come into contact with, or what germs she could bring in to immunocompromised pts!

It sounds like your floor is much, much different; more like a rehab floor and not as acute or ill. If you really want your son to be able to read to the pts, and if your son really wants to be able to do it, go to your hospital auxillary or endowment association and start the program yourself. Get his class involved.

However, from my own experience of having two young ones (and homeschooling one for th eearly elementary age), if I just got back from surgury, and someone's 7 year old wanted to read to me, I'd decline. I'd probably run away. And if the nurse came in and said "MY SON would like to read to you," I'd be like WTF? If I say no, is she going to "forget" to bring my pain medication? Remember, we as parents often thing every little thing our kids do is sugar and cream, but as an ill person, I don't think I'd want the nurse's son anywhere near me. I would also have the feeling that, no matter what she says, I'd have to let her son do whatever, because I woudln't want to make her angry. I would also have the feeling, no matter what, that her primary focus would be her son, not me, her pt.

When our family volunteers, we like to do it all together. If my kids were going to participate in a reading to residents/pts program at my facility, I would want to come in and participate with them on my days off; not while I was at work.

Just my two cents. I don't think that HIPAA is necessarily the issue here, though in certain circumstances it could be I suppose. I think the main issue here would be having your son with you at work (when you are NOT on your break). Especially if there is no established program. I think the solution would be to establish a volunteer program for minors. That, I think, woudl take care of the issue of HIPAA (as the children would receive "training"), and it would also make the participation more "official" not just at the whim of a nurse or her son. As wonderful as that whim may be, as a pt, I would find it unprofessional and would worry about what impact it woudl have on my care if I told my nurse no, I don't want your son in here.

[traumaRUs, MSN, APRN]

I agree with Siri but for different reasons. I would not want to expose my child to the hospital for infection control reasons. I am always amazed at the number of children that visit hospitals and feel that this is way too much. There is no reason to expose a child to a hospital environment unless necessary. There are other options if you would like to provide other social/volunteer outlets for your child: continue the nursing home visits, look for shut-ins at your church.

[mom2michael, MSN, RN, NP]

Ok, once again, let me clarify. We have an average of 2-3 patients on the floor at a time in private rooms. 80-85% of our patients are swing bed patients, they are not acute. They are simply buying time until Medicare or private insurance cuts them off and sends them home or to LTC. Basically they are too sick to be alone but not sick enough to require actue care.

The service I wanted my son to provide was to those patients. These people are lonely. Most of these people are bed bound (thus a huge reason they can be considered for swing bed status), have little to no contact with the outside world and honestly, do not receive services even comparable to acute care, because they are not acute care patients.

Since 99% of our swing bed patients return to the LTC facility that he is going to be volunteering at - I guess my problem is solved. However, as I said earlier - I still find it sad that my son is so willing to give his heart to these patients and try and do something nice and it's devestated him that people won't let him. Try and explain that to a 7 year old.

[RNMISTY362b]

I understand your good intentions towards the paitents however what do you truly know about their back grounds. You are allowing your 7 year old son to be alone in a room with a bed bound paitent who could still possibley harm him. If your Husband is present than you are violating HIPPA. Please remember not everyone whom is nice to your child will not have other motives

[mom2michael, MSN, RN, NP]

I understand your good intentions towards the paitents however what do you truly know about their back grounds. You are allowing your 7 year old son to be alone in a room with a bed bound paitent who could still possibley harm him. If your Husband is present than you are violating HIPPA. Please remember not everyone whom is nice to your child will not have other motives

Actually, I have to disagree with that statement about my husband violating HIPAA. He agreed to attend the necessary training that all volunteers must go through, as well as sign the confidentality agreement. Management had no issue with my husband, the issue was with my son.