My father's health information

[Catcar1963]

My estranged father is in a health care facility after a stroke, and has no contact with me or my siblings (his choice). My brother's friend is a nurse at a facility my dad was at previously. Yesterday the nurse found my dad's psych eval, and gave it to my brother. Now my brother wants me to read it and tell him what it all means. At first I wanted to see it. Thankfully I came to my senses quickly, and told my brother I could lose my license if I got involved, and that what he and the nurse are doing is illegal and unethical. I want to report the nurse but I don't know who she is, and I'm in a different state. Should I do anything, or just forget about it?

[Catcar1963]

I'm glad you filed the complaint. Please keep us updated.

Thank you. I was beginning to feel like this thread was becoming more about my weird family dynamics instead of doing the right thing as a nurse.

[niccikatie]

You absolutely did the right thing and through the right channels. You are being an ethical nurse and your handling of your Father's other issues shows that you value ethics in all your relationships. It's a tough road and you're doing it well. Kudos to you as you're likely protecting other patients from having their information shared inappropriately as well. Using someones medical record to gossip about them is abhorrent and deserves severe consequences.

[NotAllWhoWandeRN, ASN, RN]

So you think I should tattle on my brother to my dad and then just back off?

If your goal is to deal with professional ethics, you don't need to tell your dad anything. I believe that reporting the HIPAA violation to the facility where it occurred and to a governing body (that another responder was kind enough to link) is appropriate and most likely to lead to disciplinary action against the employee who violated your dad's privacy and/or the facility where it occurred.

The facility may be obligated to inform your father that his privacy was breached, but then the drama stays about the facility and at most your brother. It doesn't need to come back around to being about you.

If you tell your dad yourself, that may just stir the pot with family trouble. Your story is your own, and it's ok to choose what you are willing to disclose to AN to provide context, but I think telling your dad yourself might cause more harm than good.

[NotAllWhoWandeRN, ASN, RN]

Speaking of moral obligations, do we not, as nurses, have an obligation to do something about a nurse's criminal activity?

You don't have a legal obligation to report illegal behavior that you encounter as a civilian, no. Would I personally feel a ethical obligation to report? Yes. There should be consequences for the nurse that violated a patient's privacy.

[macawake, MSN]

My "complicated reasons" have to do with a lifetime of physical, emotional and sexual abuse

I already suspected as much, but I'm still very sorry to hear that you've experienced that.

So now you can see why I didn't think it was appropriate to share that here.

Please note that I didn't ask you to share the details, I only pointed out quite matter-of-factly that it's hard to offer advice without all the pertinent information available.

My 4 brothers and I are very close, but we're not all in the same stages of healing.

I'm happy to hear that you and your brothers are close. The reason I asked if the dynamics between you and your siblings were in any way influencing your desire to advocate for your father is twofold. As I said I suspected that you might have had a difficult childhood and the emotional fallout can of course affect relationships between family members for years to come. Also, by explaining your brother's actions by calling him "nosey" you gave me the impression that you're upset or angry with him and at the same time I didn't see any anger directed at your father, only a desire to protect/defend him.

So you think I should tattle on my brother to my dad and then just back off?

I'm not sure if you're addressing this question to me or another poster. If you are asking me, I don't think that you should be the one who tells your father what your brother has done. (That's not what I meant when I said that I think that you should let your father advocate for himself.

Speaking of moral obligations, do we not, as nurses, have an obligation to do something about a nurse's criminal activity?

Normally, yes. But you're not primarily a nurse in this situation. You're the daugther and the sister in what you correctly labeled a very complicated situation/circumstance.

My father doesn't know his privacy has been breached, and considering the volatile family dynamics, I'd rather he didn't know, but he is likely to find out since I filed a complaint.

I think that you're right, he probably will find out and this is the exact reason why I don't think that you should be the one to spearhead the effort to protect your father's rights as a patient. If you think that you have a real chance to heal as an individual and as a family, that's what I'd focus on if it were me. I think that being your father's advocate (especially since he hasn't wished for/requested that), in this case will only serve to further complicate an already complicated situation.

This is just my take on the situation, you of course have to decide which path is the right one for you.

Best wishes!

[Catcar1963]

I agree wholeheartedly. I only said that because someone suggested that I should back off and let my father handle it.

[MunoRN, RN]

OP, I understand that you are in a difficult situation. A couple of points for consideration:

Your brother is your father's next of kin. Unless your father has previously identified in writing someone to act as his healthcare POA/proxy -- it is not inappropriate for the facility caring for your father to be providing information on his condition. In the midst of a health crisis, it is not possible for the care team to make judgements about ongoing family dynamics. Next of kin - spouse, child, parent, sibling - is next of kin, unless otherwise specified. If your father is not currently able to direct his own care and your brother is the only family member present ... can you see why your brother is being provided updated information.

Regulations regarding the accessibility of psychiatric care records can be different, and can vary from state to state. It would be advisable to have some concrete information about what was accessed and shared, in what form, when, by whom, and in what context. Confirmed HIPAA violations *can* incur civil or criminal penalties, but please do not get the impression that someone is going to be "arrested".

That's never been how it's worked in my experience. Next of kin are the default decision makers because without contradicting information, it can usually be assumed that next of kin is who the patient would want making decisions and who would be familiar with what the patient would want. If we're aware that the neither of those two things are probably true, such as the case of a long estranged family member, then deferring to or even just giving information to estranged family members wouldn't be allowed. If it's more of a gray area then we'll investigate further, but in the end what we can glean of the patient's wishes is what we're obligated to follow.

[Altra, BSN, RN]

That's never been how it's worked in my experience. Next of kin are the default decision makers because without contradicting information, it can usually be assumed that next of kin is who the patient would want making decisions and who would be familiar with what the patient would want. If we're aware that the neither of those two things are probably true, such as the case of a long estranged family member, then deferring to or even just giving information to estranged family members wouldn't be allowed. If it's more of a gray area then we'll investigate further, but in the end what we can glean of the patient's wishes is what we're obligated to follow.

This is my experience as well, and I believe I stated as much. I'm sorry if it didn't come across clearly. I inferred that OP's brother was physically present, or at least in direct contact, with her father's care team, and so it logically follows that they are providing him with information on the father's condition and treatment. But that would not prevent information being given to other family members as well. Unless a patient has specifically indicated a proxy/POA, or has specifically requested that we do not provide information to a certain family member, it is impossible to determine who "should" or "shouldn't" get information. A perfect example is the OP's case of 5 siblings, each of whom has a different personal relationship or level of contact with the father.

[Anonymous865]

The OP states that a nurse at a facility where her father had been a patient in the past found her father's psych eval and gave a copy to her brother.

This is not the case of the treament team discussing their current patient with a concerned family member.

It has been my experience that no one except medical records is allowed to give a copy of any part of the medical record to anyone including the patient. HIPAA does not require this, but every hospital I've encountered has required this, because privacy laws are very complicated.

Even with a current patient, every place I've been restricts staff from discussing PHI with anyone w/o the patient's permission.

[Catcar1963]

Let me clarify a few things...the nurse who gave my brother the report is a good friend of his, and is VERY aware of our family situation and my father's wishes concerning his privacy. My father explicitly told the hospital that they could not even tell us he was there, let alone give my brothers ANY information.

Second, my father was discharged from that hospital in December. My brother said she mysteriously "came across" my father's chart and offered it to my brother without his asking. (I do realize that could be a lie.)

Third, he DOES have a health care proxy, and that brother is not it.

Fourth, if a nurse can't determine who should/should not have the information, he/she should not give it out until he/she verifies the validity of the request.

[Catcar1963]

The OP states that a nurse at a facility where her father had been a patient in the past found her father's psych eval and gave a copy to her brother.

This is not the case of the treament team discussing their current patient with a concerned family member.

It has been my experience that no one except medical records is allowed to give a copy of any part of the medical record to anyone including the patient. HIPAA does not require this, but every hospital I've encountered has required this, because privacy laws are very complicated.

Even with a current patient, every place I've been restricts staff from discussing PHI with anyone w/o the patient's permission.

THANK YOU! Just what I was trying to say.

[xxMichelleJxx]

Are you and your siblings listed in his contacts? In a nursing home I used to work at, there was a sheet in the front with a list of contacts and saying that they could receive medical information regarding the patient. We were told to always check before releasing and pt information. Make sure you guys aren't listed. You don't want to unnecessarily get the nurse in trouble, especially if she isnt at fault. Get all the facts before you act. Thats how I see it.