Who dropped the ball here, the police or the hospital? - page 3

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  1. by   dawngloves
    Quote from firefightingRN
    given the nature of the injury and the fact that the patient could be very moblie, i'd say the police dropped the ball. When I worked in orthopedics, the police brought be a prisoner with 2 broken legs from an accident and told me they were leaving him there without any monitoring as it would have been hard for the patient to leave without someone noticing.
    I had a little old man who suffered a massive MI while being arrest for a relatively minor crime. He was on MSO4, dopamine, not really concious and he had one arm cuffed to the rail and two officers there at all times.
  2. by   lamazeteacher
    Quote from cursedandblessed
    just my ignorant student nurse opinion, if the police wanted him they should have stayed at the hospital. i don't mean to be overly naive, but would calling the police at discharge violate the hippa?
    simply, no!!!!

    when people sign hippa, they're agreeing to allow information to be given to, among many others, any government agency!!!!

    read the small print!!!!!
  3. by   NurseLite
    Our officers MUST stay with detainees. Unless they are non-violent (like a transient arrested for trespassing), then they can write them "notice to appear" ticket and release them. At that point the detainee can make a decision to AMA or receive treatment (most likely for BAC over 0.3).
  4. by   Riseupandnurse
    I was given the impression with our "call the police when released" people that the reason they weren't arrested beforehand is if they were, then the hospital care then became the expense of the city or the state, along with the cost of guards. If they didn't want a patient too terribly bad, it paid big bucks to wait until discharge to arrest them.
  5. by   Orca
    i am thinking it would only be a hipaa violation if YOU took the initiative to call, not if the patient was already under arrest.....
    I am a DON at a state correctional facility, and we run into this issue all the time. We send an inmate to the hospital, then the nurses refuse to give us information when we call for updates on the inmate's condition, citing HIPAA. I try to politely explain, usually with no success, that HIPAA does not apply to inmates. One hospital whose personnel never seemed to gain an understanding of that despite several conferences no longer gets our business.
  6. by   pricklypear
    Quote from Orca
    I am a DON at a state correctional facility, and we run into this issue all the time. We send an inmate to the hospital, then the nurses refuse to give us information when we call for updates on the inmate's condition, citing HIPAA. I try to politely explain, usually with no success, that HIPAA does not apply to inmates. One hospital whose personnel never seemed to gain an understanding of that despite several conferences no longer gets our business.

    I know this is diverging from the original subject... but I can't help it....why does HIPAA not apply to inmates? What kinds of "updates" are you trying to get? And for what reason? All the correctional facility really needs to know is when they're getting out, and in what condition. I've cared for lots of inmates, and never once had a call from the facility asking questions other than general status. And no, I wouldn't give anything other than very general information if I was asked. I don't even tell the guards anything.
  7. by   Orca
    Because we need to coordinate transportation, we need to know whether the inmate will be admitted or will be returned the same day. Also, knowing what has been done helps to plan for post-release care, as most inmates returned from the hospital are held in the infirmary for a period of time after they return. It is important to know what medications they are returning on, and what the diagnostic findings were to determine the course of care after return.

    The following passage regarding HIPAA is quoted from the policy of the University of Texas Medical Branch, and it sums things up pretty concisely:

    Inmates. If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release your PHI to the correctional institution or law enforcement official under specific circumstances such as (1) for the institution to provide you with health care; (2) to protect your health and safety or the health and safety of others; or (3) for the safety and security of the correctional institution.
    We don't call just to be nosy. We will be providing followup care and the more information we have, the better care we can provide post-release. If we have some advance notice, we can obtain medications or equipment we may not have on hand otherwise, if they are needed for the inmate's care. It also gives us time to arrange substitutions in the medication regimen if necessary. If the inmate will require followup care with a specialist, it allows us to begin the process of getting the necessary approvals so they can be in place when needed.

    If we call on an inmate who has been hospitalized for a while, generally what we are looking for is projected discharge date, along with any information our physicians request to begin planning their plans of care.
    Last edit by Orca on Jun 7, '09
  8. by   pricklypear
    I see your point regarding follow-up care. However, "updates" are one thing, discharge instructions are another. I still would not provide detailed information over the phone regarding any patient, unless it was discharge instructions. We used to have poison control call all the time about overdose patients. We would have to take a name and call them back at the poison control number. The position that hospital nurses are in is dangerous in regards to HIPAA. I just don't think stating "HIPAA does not apply to inmates" is entirely correct.
  9. by   Orca
    We had a meeting this week with the case management staff of a local hopsital regarding an exclusive contract for inmate care. One of the primary reasons we are entering into this contract is the difficulty we have had getting information from other hospitals. This one apparently has no problem with it, and is even setting up mechanisms to ensure that we get the information we want whenever we request it. The other will lose our business entirely - services that they could be assured would be paid for.

    I believe that the passage I quoted in my previous post sums it up, and I stand by my analysis.
    Last edit by Orca on Jun 9, '09
  10. by   pricklypear
    If it actually falls within the 3 categories or circumstances, such as: special medical/equipment needs upon discharge, medication needs, and communicable diseases- fine, ON DISCHARGE. . Whether they're stable, unstable, expected discharge, etc... is fine. But the facility still does not need to know the day-to-day details of an inmate's care.

    Furthermore, stating that HIPAA "does not apply" to inmates is ENTIRELY incorrect. The basic tenents of HIPAA apply to EVERYBODY receiving healthcare. Believe it or not, convicted criminals actually do retain SOME of their rights. If it doesn't impact or affect the facility or its other inmates, you don't need to know unless the inmate wants to tell you.

    I'm sure the hospitals who will lose your "business" won't miss it as much as you assume they will.
  11. by   Orca
    But the facility still does not need to know the day-to-day details of an inmate's care.
    And we don't ask for them. Perhaps I haven't stated my case as well as I could have. What it boils down to is that we call hospitals to find out whether an inmate will be admitted (if sent to ER, so we can arrange 24-hour officer coverage if needed), when an inmate might be released back to us (if already admitted), what equipment and medications we might need when that happens (along with any special recommendations), and what test results might be relevant to the care we deliver once the inmate returns. The hospital in question (the one we are leaving) has repeatedly caused problems by leaving us in the dark on these things, not even sending documentation with the inmates when they discharge. Perhaps a more accurate statement for me to have made is that HIPAA does not apply to inmates when it comes to information necessary for planning their continued care after release. After giving your statements considerable thought, I will concede that point. Thanks for making me think.

    As far as how much the first hospital will miss our business, all I can tell you is that their administration was pretty desperate to meet with us to work out our differences once they found out about the exclusive contract with the other hospital on the horizon. The problem has been that they showed little interest before we decided collectively to walk, and the attitudes of their line staff and doctors indicated that they had rather we not send inmates there at all. Several of our inmates received substandard treatment at this facility, and too many were returned from their ER untreated. This hospital treats a high proportion of people who are unable to pay, and we were guaranteed income for them. Believe me, they will feel the bite, and I believe that their administration realized this - albeit too late. The new agreement includes three correctional facilities with a total of almost 6,000 inmates.
    Last edit by Orca on Jun 9, '09
  12. by   pricklypear
    Well, that explains a lot, Orca. I can totally understand how frustrating it would be to receive an inmate back from a hospitalization without some follow-up documentation.
  13. by   Orca
    After reading the responses I thought I needed to clarify. It wasn't just the reporting of information that caused us to leave this facility. The lack of information was just one of a litany of things that caused my agency to take our business elsewhere - which is a shame, because the first hospital is the closest to my facility geographically (and ironically, I worked there before coming to the Department of Corrections). While I did play a role in the decision to enter into the exclusive contract with the second hospital, the process was initiated at a level well above me because our medical director was very tired of the repeated issues with this facility. This has been an ongoing problem for more than two years.

    The difference in attitudes was staggering. The first hospital was only interested in dialog once they found out they might get no more business from us. We had approached them numerous times about correcting problems. They paid lip service to fixing things but nothing ever really changed. Virtually every nurse in my institution has stories about negative interactions with personnel at that hospital. The second hospital actively solicited our business. They even showed us a small unit (eight beds) that has been closed for some time, that their administration is considering reopening solely for inmates. Their attitude was, "Tell us what you need and when you need it, and we will make it happen." They have even designated a specific group of doctors we will always deal with, who fully understand the realities of treating inmates and what we can and cannot do when these people return to us. Whenever possible they will stick to medication in our formulary so that we won't have to change meds when inmates come back to us. I was impressed with their attention to detail and their willingness to accommodate us.
    Last edit by Orca on Jun 11, '09

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