Privacy violation??

[nursekoll, BSN, RN]

I really value the support and knowledge that is shared on this group. I think I might be in trouble though.

Sorry this is long.

In my state, all students who participate in athletics are required to have a physical every year clearing them for sports. I had one kid who wasn't cleared because the initial physical provided at school showed a potentially serious issue that required further evaluation.

I notified the parent on the provider's request that the student would need to see a specialist before he could participate in sports. The parent was not concerned at all, denied there was a need for it and got angry with me. I provided a copy of the physical to the parent to get it evaluated by the specialist as recommended by the initial provider.

The parent claims to not have received it and asked the secretary for a blank one which was then taken to a different clinic (not specialist) where the initial serious concern was not disclosed to that provider. That provider did not find any issues and cleared the student on a second physical form.

Upon receipt of the second cleared physical in the school office, the student was asked by the school secretary if the initial issue was checked and the student said no. I was concerned that the initial issue hadn't been properly evaluated and called the office of the second provider to ask if the initial issue was addressed.

This provider was unaware of the original failed physical and issue. Told me if it had been known, the second physical would not have even been done, as it needed to be a specialist to clear it.

The clearance was rescinded and that provider contacted the parent to make the referral to the specialist.

The parent then called me very upset and verbally abusive to me for "going behind their backs".

This whole time I had kept my administration informed of the situation. The parents then took the student back to the first provider's office demanding that the student be cleared "because there is no problem" and they want the student to be able to play no matter what.

That provider contacted me to tell me how belligerent the parents and student were in the clinic and warn me that they are "out to get someone over this". The parents are now accusing me of a confidentiality violation in contacting the second provider and sharing information about the first physical.

They met with the administration.

I feel I was acting in the best interests of the student and was in no way intending to harm or gain anything by checking in with that second provider. Help. Advice. What do I do now? Anyone dealt with a similar situation?

[OldDude]

6. Where the HIPAA Privacy Rule applies, does it allow a health care provider to disclose protected health information (PHI) about a student to a school nurse or physician?

Yes. The HIPAA Privacy Rule allows covered health care providers to disclose PHI about students to school nurses, physicians, or other health care providers for treatment purposes, without the authorization of the student or student's parent. For example, a student's primary care physician may discuss the student's medication and other health care needs with a school nurse who will administer the student's medication and provide care to the student while the student is at school.

https://www2.ed.gov/policy/gen/guid/fpco/doc/ferpa-hipaa-guidance.pdf

[OldDude]

Don't worry about it...the parents need to worry about CPS visiting them for medical neglect.

[nursekoll, BSN, RN]

Thank you, thank you. I now feel like I maybe didn't screw up!

[OldDude]

Thank you, thank you. I now feel like I maybe didn't screw up!

You didn't...you were being a student advocate...unlike the parent.

[KKEGS, MSN, RN]

So take this information with a grain of salt because I am not an attorney BUT I think you may be okay here. Health records maintained by a school nurse are not covered by HIPAA because schools are generally not considered HIPAA covered entities. Those health records are also considered educational records not true health records. Schools are covered under FERPA and FERPA allows for a few exceptions to needing parent permission to share information in those health records. This is an excerpt from a document from the US Department of Education. Here is the full link:

https://www2.ed.gov/policy/gen/guid/fpco/doc/ferpa-hipaa-guidance.pdf

The part I think may apply here is bolded. Hope this helps!!!

"Parents have a right under FERPA to inspect and review these health and medical records because they are "education records" under FERPA. See 34 CFR §§ 99.10 - 99.12. In addition, these records may not be shared with third parties without written parental consent unless the disclosure meets one of the exceptions to FERPA's general consent requirement. For instance, one of these exceptions allows schools to disclose a student's health and medical information and other "education records" to teachers and other school officials, without written consent, if these school officials have "legitimate educational interests" in accordance with school policy. See 34 CFR § 99.31(a)(1). Another exception permits the disclosure of education records, without consent, to appropriate parties in connection with an emergency, if knowledge of the information is necessary to protect the health or safety of the student or other individuals. See 34 CFR §§ 99.31(a)(10) and 99.36.

[WineRN]

I agree with what those above me put BUT our district doesn't allow me to do what you did. I need to get the parents to sign a consent form allowing me to communicate with the doctor. As long as your district doesn't have a similar policy I think you are ok

[nursekoll, BSN, RN]

Not an emergency per se, not sure if we have a policy on this. Honestly I didn't call the parent first because I didn't think they would be honest with me about the information they did or did not disclose. I have called these clinics in the past to clarify medical information on students, or share suspicions of parent dishonesty with me and thought this was no different.

And are we (schools) HIIPA covered entities??

[Windchaser22]

I agree with what those above me put BUT our district doesn't allow me to do what you did. I need to get the parents to sign a consent form allowing me to communicate with the doctor. As long as your district doesn't have a similar policy I think you are ok

I would think the law trumps policy.

[caliotter3]

They went behind your back to get the second clearance and then got angry at you for going behind their backs? How astounding. At least you were doing your job watching out for the student's best interests, as well as those of your employer, the school district.

[JenTheSchoolRN, BSN, RN]

Echoing everyone above. I talk to health care providers without contacting parents every once in a while if needed. Law-wise, I know I can and sometimes I am asked by admin to do so because they know law-wise I can. I can, however, not always disclose the discussion to admin, which frustrates them a bit.

But these parents sound like ones that would also sue if their LD was injured while playing said sport because of the undisclosed medical issue, saying "the school should have know better."

[caliotter3]

But these parents sound like ones that would also sue if their LD was injured while playing said sport because of the undisclosed medical issue, saying "the school should have know better."

This thought also occurred to me. They would be at the attorney's office before the injury-resulting play was called on the field of play.