Is it really a violation of H.I.P.P.A. law to share your concerns with the doctor?

[Alnitak7]

I was on a private home care case one time and I did not have the patient equipment I needed to give proper care to my patient. He badly needed a lift and it was impossible to transfer him without one.

He was badly agitated because I could not move him alone and he did not know why.

I called my agency supervisor who told me I would just have to deal with it. They are at least supposed to offer emotional support. With no other ideas left I decided to report this need for a lift and the patient's agitation to the patient's doctor. Well, my supervisor found out about it and I got a lecture from her. She said it was very inappropriate to call him and that I had violated H.I.P.A.A.

Another girl on that case told me to document that we needed a lift on the time sheet. Later on we got one.

I have studied health laws and I can't be sure if this really is a violation.

[LiteCandles]

I don't see how discussing the patient with his doctor is a HIPAA violation... I think your supervisor is mad you called the doctor and not listen to him and deal with it.

[nursel56]

It sounds like a policy and procedure issue rather than a legal issue. Your supervisor was probably upset that you disregarded what she said and called the doctor yourself. If she is the case manager she would normally be the point person to discuss the need for a lift with the doctor.

What's most bothersome to me is that there are people who expect nurses and caregivers to put their own health and ability to earn a living at risk followed by too many people who take on that risk for fear of losing their jobs. What she said to you was the result of that reality. We need lift laws!

[Alnitak7]

In years past I had agency supervisors who were sympathetic to my worries when I called them about an abusive,

agitated patient. They also were responsible about making sure we had the supplies we needed.

This one just turned a cold shoulder on me. I was trying to tell her it was not fair to the patient to be stuck on his bed

just because we didn't have a lift and she just seemed to want to ignore it as many days in a row as she could.

Someone I shared the case with suggested that they have ulterior motives when they do not order supplies.

It had something to do with saving money.

[nursel56]

When I first started working for home health agencies, I was really disheartened by some of what I saw and heard, and to what extent people will go to widen a profit margin. So far nobody has outright ignored me at the patient's expense, though.

Some agencies provide supplies and equipment themselves and some are ordered or rented directly from the supplier following the doctor's order. A competent and caring case manager makes all the difference for people working in the home, and I'm sorry this one ignored your concerns.

You advocated for the patient/client and now he has what he needs. Although you didn't say so, I'll assume the man has some cognitive issues that would make his opinion and/or consent to call the MD unclear, so that if a situation is such that the person is unable to do things that are part of his plan of care, like being out of bed in a wheelchair or walking a few steps, you have an ethical obligation to inform someone. Your supervisor just doesn't see how lucky she is to have someone like you.

[Alnitak7]

I think I had the option to contact D.H.S. when they would not bring equipment to take care of this patient. I guess I just called the doctor in a blind panic since I don't do very well with extreme agitation.

[TBlase]

The call was not appropriate, even if in you felt you were advocating for the patient, rather than complaining about the agency. You bypassed the velvet rope, the protocol. What does the plan of care state regarding transferring that patient? Who assessed that patient, since you feel it's unsafe without a lift? Your supervisor doesn't seem plan on getting the lift, so you may have set yourself up. If you otherwise like the job, and want to clear the air, you might think about eating some crow and apologizing to her, tell her you were just frustrated and acted in haste, you were not intending to badmouth the agency, then tell her why you think a lift is needed. Hash it out. Otherwise, things have a habit of stewing, then boiling over. But giving information to the patient's doctor of record is not a violation of privacy on your part- she told you that to put the fear into you, about 'bypassing the velvet rope'.

[nurseprnRN, BSN, RN]

Totally not a HIPAA violation. I hear you about wanting to advocate for your patient and being frustrated at your supervisor's unresponsiveness. You could have gone up the chain of command in your agency to get an answer as to why this equipment isn't being provided-- there could be other issues of which you are not aware. Who knows? But in answer to your concern, no, not a HIPAA problem.

[T-Bird78]

Not a violation discussing the pt with their own doctor.

[systoly]

well if that's a hipaa violation my employer is in deep trouble

they want us to call the doctor every time the pt. passes gas or sneezes (exaggeration)

[anothergrumpyoldRN]

The call was not appropriate, even if in you felt you were advocating for the patient, rather than complaining about the agency. You bypassed the velvet rope, the protocol. What does the plan of care state regarding transferring that patient? Who assessed that patient, since you feel it's unsafe without a lift? Your supervisor doesn't seem plan on getting the lift, so you may have set yourself up. If you otherwise like the job, and want to clear the air, you might think about eating some crow and apologizing to her, tell her you were just frustrated and acted in haste, you were not intending to badmouth the agency, then tell her why you think a lift is needed. Hash it out. Otherwise, things have a habit of stewing, then boiling over. But giving information to the patient's doctor of record is not a violation of privacy on your part- she told you that to put the fear into you, about 'bypassing the velvet rope'.

I think I missed the part where she "bad mouthed" the agency!?!

The post said she notified the MD of her assessment and need for lift assistance.

It is the responsibility of the HH RN or the PT to assess for those type of needs, in my long experience with HH.

I have never had to "clear" my recommendations to the MD with my supervisor before making the call. Is this a very new nurse who is not yet autonomous?

[Alnitak7]

The call to the patient's doctor was a reaction to my calling the agency office and being met with indifference when I was dealing with a hysterical patient. They're supposed to offer emotional support, not just tell you to "deal with it."

Not only were my feelings being ignored but I also think this was a violation of patient rights when I was being forced to keep him on the bed when he wanted to get up.