Privacy violation??

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The clearance was rescinded and that provider contacted the parent to make the referral to the specialist.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

Specializes in 8 years as a school nurse.
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.

Exactly! Damned if you do, damned if you don't! At least it will be summer break soon.í ¾í´·*♀️ I don't want to wish bad news on them, but if they do go to the specialist (4 hours away) and find out it's nothing serious, they'll just be even more pissed.

Specializes in kids.

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!!! You did the right thing. Picture yourself in court if the child had been injured as a result of playing with a condition that YOU KNEW about...

Ya! You were were right!! I hope your administration backs you!

Specializes in Pediatrics Retired.
Exactly! Damned if you do, damned if you don't! At least it will be summer break soon.������*♀️ I don't want to wish bad news on them, but if they do go to the specialist (4 hours away) and find out it's nothing serious, they'll just be even more pissed.

Kinda like the parent who gets mad that their kid doesn't have a fracture after you send them out for an injury eval.

Specializes in ICU/community health/school nursing.

And are we (schools) HIIPA covered entities??

Technically not. There is a broader privacy issue in schools (need to know) but if you're communicating with a doctor's office about a mutual patient (and the doc is willing to do so, because his/her view of HIPAA is what OD and KKEGS posted) then it's a lot of storm, signifying nothing.

If you shared patient information with some random teacher with no need to know, it's a privacy violation. But you did no such thing.

The district is liable if you knew something and didn't do something. The district is not liable if, after your meticulous documentation, the kid still got hurt because the parents believe there is "nothing wrong" and insisted that sweet baby play ball.

So if questioned, say (loudly) "The district is liable if I knew something and didn't do something."

Head up, shoulders back, breathing deeply!

Specializes in School Nursing.

I'm just sitting here nodding along with everyone else's responses.

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

That was my first thought when reading this!

Specializes in School Nursing.
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??

Schools are a HIPAA covered entity when they bill Medicaid for nursing services rendered at school under the Third Party Billing system. But regular health records are covered under FERPA. I believe a sports physical falls under the school health record category.

I think you could argue that this was an emergency in that you had knowledge of this student that put his health and safety at risk. There is a reason that he failed the medical clearance for sports.

I feel like this qualifies as calling for clarification. If I received a physical form that listed NKA, but I knew that the student had a life-threatening peanut allergy, I'd be asking for clarification for sure!

I think you absolutely did the right thing.

Specializes in School nursing.

I just love physicals that list a student as having no known medical conditions when I have another letter from a specialist stating otherwise. And the physical occurred after the specialist appointment. Doesn't the PCP likely need to do the referral if the student has an HMO? (And many of my students do.) UGH, this frustrates me to no end.

Specializes in Pediatrics Retired.
I just love physicals that list a student as having no known medical conditions when I have another letter from a specialist stating otherwise. And the physical occurred after the specialist appointment. Doesn't the PCP likely need to do the referral if the student has an HMO? (And many of my students do.) UGH, this frustrates me to no end.

I just LOVE the physicals done "enmasse" at the field by the local chiropractor for "one day" only for the low price of 20.00. Now get out there and start bumping heads!!

I just LOVE the physicals done "enmasse" at the field by the local chiropractor for "one day" only for the low price of 20.00. Now get out there and start bumping heads!!

In Missouri we are not allowed to accept physicals from Chiropractors for sports. It is a MSHAA rule.

Specializes in Pediatrics Retired.
In Missouri we are not allowed to accept physicals from Chiropractors for sports. It is a MSHAA rule.

I like that...

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