Privacy rules for reproductive history

Nurses HIPAA

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My friend was in the ER a few years ago and while there answered all medical history questions some with her mother present some on her own. (She is over 18). When her mother was out of the room she asked that her reproductive history be kept private and only her husband was able to know. There were no papers signed, just a verbal agreement. Later that evening the doctor spoke of her past abortion in front of the mother who did not know and then realizing what was said the doctor made a joke about it. Needless to say my friend was horrified, embarrassed and upset. She still talks about it to this day and says she will never visit that hospital again. Is this a violation of Hippa? Is it too late for anything to be done?

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Specializes in Nephrology, Cardiology, ER, ICU.

Was in after HIPAA became a law?

To be honest, if she is in the ER being seen why does she need both Mother and Husband present?

If you have visitors present when medical history is being taken, it is presumed they can hear what has to be said.

Although unfortunate, I think that this might be a live and learn experience.

As a provider, I make an effort to say to the pt: "is it okay to discuss your problem with your visitors present?" That said, if it is an emergency, I don't always have time to ask.

Goes back to don't take visitors into the exam room with you.

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Specializes in ER, Pediatric Transplant, PICU.

I agree with Trauma.... I'm not sure it would be a HIPAA violation simply due to the fact that she had the mother in the room with her. I know it's complicated because she said she didn't want her mother to know, but like Trauma said, that's one of those times that you just dont let your mother in the room if she didn't want her to know her history. I know it's a delicate subject, but we do try as ER nurses to be mindful of what you dont want to talk about, but that doesn't always get passed to the doctor.

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Ohhh, very sensitive subject...however I'm with Trauma & Kroger on this. She should not have had her mom in the room with her if there was anything she didn't want her to know. The doctor is there to do a job and address the issue at hand, and he/she certainly should not be expected to "beat around the bush" (no pun intended) during an evaluation and consult. Next time, if she really feels the need to have her mom present for company while waiting to be seen, she should tell her mom to excuse herself when the doctor enters the room. This is a lesson learned the hard way, but she'll never forget it, that's for sure!

- Amanda

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Specializes in family practice.

It is in violation of HIPAA as we were told that we should always ask the patient's visitor out of the room. Its not OK to ask the patient if it is ok for them to be in the room because the mother would be angry at the patient for asking them out.

My mother would have smacked me over the head (whatever the age) if i said i didnt want her there. I tell the visitor could you please give us a moment, and the patient could take a cue and say Oh its ok for so and so to stay.

Also its a violation because she has made her preference known, as for if anything could be done, i dont know

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I'm sorry to make this my first post here but I was struck with the comment the 'doctor made a joke about it'. What possible joke could he make about an abortion? Without discussion if pro life or pro choice, there is nothing about it for a doctor to make a joke IMO

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Specializes in LTC, Psych, Hospice.

When my sister was a freshmen in college, she had an abortion. Two years later she got married (not to the same guy) and when got pregnant again, she made the mistake of seeing a doctor where her sister-in-law was a nurse. When she told of her reproductive history, her sister-in-law told everyone in the family. Of course, my brother-in-law was aware of the abortion, but not everyone in the family. This was long before HIPAA was in effect. 30 years later and my sister still won't speak to her sister-in-law.

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In many respects, a trip to the ED is a world away from going to your PCP or OB/GYN, but in other respects it is no different.

You're going to be placed in an exam room and examined by a doctor, who is also going to take a thorough medical history. You will then be subjected to tests and procedures, and given a diagnosis. All of this can be very sensitive, personal, and some people may want their medical history and diagnosis kept confidential. If that is the case, then do not bring anyone into the exam room with you that you do not want to know your business!

I never understand the people that come in (excluding traumas and resuscitations, of course) that have their whole family in tow! Would you bring your whole family to your PCP or OB/GYN visit? I guess that could be a cultural norm for some, maybe.

I can understand wanting support in a time of stress, but I think it should be limited to only those who are close enough that they are allowed to know such intimate, personal information.

If you don't care if your Mom knows about your past abortion, by all means, bring your Mom. But if there is stuff you don't want her to know, she should not be in the exam room.

As far as whether this was a HIPAA violation, I don't think it's clear cut. It could be argued that the patient gave tacit permission for her medical information to be discussed in front of her mother by allowing her mother to be present in the exam room, and not asking her mother to leave the room when the doctor came in.

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I'm sorry to make this my first post here but I was struck with the comment the 'doctor made a joke about it'. What possible joke could he make about an abortion? Without discussion if pro life or pro choice, there is nothing about it for a doctor to make a joke IMO

Maybe the joke wasn't about the abortion, but rather, about putting his foot in his mouth in front of the mother.

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Specializes in ICU, PICU.

I think that unless it is a true emergency situation (i.e. we don't have time to get much information because this person is about to DIE), we should always ask to speak with the patient in private upon admission while obtaining our history (unless the pt is incapable of giving a history on their own)... Then allow visitors after the patient is stabilized. You said the patient was over 18, no reason to have mom around while getting her history...

As for the Doc, he should have followed that same rule. I was under the impression that this was common sense....

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my friend was in the er a few years ago and while there answered all medical history questions some with her mother present some on her own. (she is over 18). when her [color=lime]mother was out of the room she asked that her reproductive history be kept private and only her husband was able to know. there were no papers signed, just a verbal agreement. later that evening the doctor spoke of her past abortion in[color=lime] front of the mother who did not know and then realizing what was said the doctor made a joke about it. needless to say my friend was horrified, embarrassed and upset. she still talks about it to this day and says she will never visit that hospital again. is this a violation of hippa? is it too late for anything to be done?

i can't say if it violated or not, but it seems as if the doctor forgot about the previous conversation of privacy. at the time did the patient ever fill out a feedback form or anything letting the dr and hospital how she felt and why she wont be going back? there might even be something in her chart explaining what happened if in fact it was a violation and still within a time limit for complaining.

as a parent .. i usually excuse myself when the dr or nurse come in to see my children (23, 22, 20). if anything it gives me a minute to get a drink, bathroom, ect.

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When my sister was a freshmen in college, she had an abortion. Two years later she got married (not to the same guy) and when got pregnant again, she made the mistake of seeing a doctor where her sister-in-law was a nurse. When she told of her reproductive history, her sister-in-law told everyone in the family. Of course, my brother-in-law was aware of the abortion, but not everyone in the family. This was long before HIPAA was in effect. 30 years later and my sister still won't speak to her sister-in-law.

Geez that makes me beyond mad. People can be such malicious busybodies. Through the years, I have had various different people ask me just how important it is to report a history of a first trimester abortion to the obstetrician when they are pregnant and carrying to term years later. They don't want it on their record for the exact reason stated above. I never counseled anyone not to disclose their full history but always responded that a history of one first trimester TAB would not change their plan of treatment for pregnancy and delivery by the OB one iota, which is what they really wanted to know. I think most conveniently forgot to mention it after receiving that information.

Also, HIPAA may not have been in effect back then, but patients had a legal right to a reasonable expectation of confidentiality. I've never sued anyone but I would have been inclined to sue the pants off of the physician/nurse for breach of confidentiality/slander and have expected to easily win. However, I can understand your sister not wanting to do that as it would have just kept it alive within the family and made it even bigger and uglier than witch sister-in-law had already done.

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