Patient threat and HIPAA

[sistrmoon, BSN, RN]

Based on a true story but I'll try to vague it up. Patient gets angry at a nurse, threatens his/her life(specific believable threat. Calls gang friend on phone and describes nurse.) Nurse is freaked out, talks to manager, manager says she/he doesn't think the patient is serious, does nothing. Nurse calls their(the nurse's) family member. Family member calls police. Police had warrants anyway for past violent crime, come and arrest him.

Did the nurse violate HIPAA in this situation?

[ktwlpn, LPN]

Does not sound like the nurse shared any protected medical info.

[BCgradnurse, MSN, RN, NP]

Nope.

[KatieMI, BSN, MSN, RN]

No, it doesn't. Even if some sort of information would be disclosed (it is unclear from OP's post if it was or not), threats for life/personal safety overrun HIPAA.

[sistrmoon, BSN, RN]

Well, she shared the patient's name and that he was there. I've always been told any identifying information at all even without names was subject to it. I had the same reaction as you, but another person aware of the situation said she should be fired(wow.) and that if she had called the police directly, it wouldn't have violated it. I'll post the parts I found that were pertinent.

[sistrmoon, BSN, RN]

"© Acknowledging the presence of patients: Responding to requests.

(1) The presence of an identified patient in a facility or component of a facility which is publicly identified as a place where only alcohol or drug abuse diagnosis, treatment, or referral is provided may be acknowledged only if the patient's written consent is obtained in accordance with subpart C of these regulations or if an authorizing court order is entered in accordance with subpart E of these regulations. The regulations permit acknowledgement of the presence of an identified patient in a facility or part of a facility if the facility is not publicly identified as only an alcohol or drug abuse diagnosis, treatment or referral facility, and if the acknowledgement does not reveal that the patient is an alcohol or drug abuser."

[sistrmoon, BSN, RN]

"45 CFR § 164.512 Uses and disclosures for which an authorization or opportunity to agree or object is not required...

(2) Permitted disclosures: Limited information for identification and location purposes. Except for disclosures required by law as permitted by paragraph (f)(1) of this section, a covered entity may disclose protected health information in response to a law enforcement official's request for such information for the purpose of identifying or locating a suspect, fugitive, material witness, or missing person, provided that:

(i) The covered entity may disclose only the following information:

(A) Name and address;

(B) Date and place of birth;

© Social security number;

(D) ABO blood type and rh factor;

(E) Type of injury;

(F) Date and time of treatment;

(G) Date and time of death, if applicable; and

(H) A description of distinguishing physical characteristics, including height, weight, gender, race, hair and eye color, presence or absence of facial hair (beard or moustache), scars, and tattoos.

(5) Permitted disclosure: Crime on premises. A covered entity may disclose to a law enforcement official protected health information that the covered entity believes in good faith constitutes evidence of criminal conduct that occurred on the premises of the covered entity."

[sistrmoon, BSN, RN]

So I wondered if this counted as an actual crime(threatening to harm) and my attorney husband said probably not. I guess probably after the manager blew him/her off next step would be our security, maybe the manager's boss and/or HR? But the pt said someone would be waiting when the nurse got out of work so were it me, I wouldn't be wasting a bunch of time. And sorry to any hospital security folks out there but one escorting me out and maybe encountering a gang person wouldn't really make me feel protected.

[RiskManager]

I make these reports to law enforcement and others all the time based on explicit threats of violence from a patient. Below is the Federal statutory language allowing this. In my opinion, this is not a HIPAA violation.

Sharing Information Related to Mental Health | HHS.gov

Finally, the Privacy Rule permits a covered health care provider, such as a hospital, to disclose a patient's protected health information, consistent with applicable legal and ethical standards, to avert a serious and imminent threat to the health or safety of the patient or others. Such disclosures may be to law enforcement authorities or any other persons, such as family members, who are able to prevent or lessen the threat. See 45 CFR § 164.512(j).

[KatieMI, BSN, MSN, RN]

Yet another time:

- threats to self or other's personal safety overrun HIPAA (and, basically, everything else) from the moment they hit the air.

Where I work, such situations are quite common and we never hesitate to call security or even city police if patient who is A, Ox4 even utters something threatening for the staff. Whether he was "just kidding" or was in "not to name" list is not significant from that moment on. Only one question that remains is his mental status, because a few times there was a threat toward nurse supported by calling buddies in KGB through shower head. That would be another story for certain.