Question about HIV and patient confidentiality

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I'm working in the lab of a large hospital while waiting to start the nursing program at my local community college this fall.

I was on phlebotomy tonight and before one of my draws the patient's RN pulled me aside outside the room (in the hall) and told me to "be careful because she's HIV positive." Another phlebotomist related that the RN had also advised him of the patient's HIV status before he drew the patient earlier in the evening.

As a phlebotomist, you'd have to be point-blank stupid not to approach every draw as if the patient had a blood-borne pathogen. That's why we have things called personal protective equipment and universal precautions. A patient's HIV status is and should be irrelevant when it comes to drawing blood since you should be taking the same degree of precaution with every draw that you do.

I believe that the RN needlessly compromised the patient's right to confidentiality, especially with such a highly confidential diagnosis. In addition to what seems to be to be a serious breach of ethics on the part of the RN, it also sounds like a big, glaring HIPPA violation.

I'm not even in RN school yet and it's setting off alarms with me. Am I off base in my assessment of the situation? I'm seriously considering reporting it to our compliance officer, my motivation not being to "nail" the RN, but rather to take advantage of the situation as a teaching opportunity for the RN, and also advocate for the patient who probably has no idea that her confidentiality was breached.

Any thoughts from you seasoned professionals would be most appreciated!

Specializes in Cardiac Telemetry, ED.
You're part of the care team, it is okay for you to know this information. I don't think it is a hipaa violation.

PS: If you do take this to CC and they find some sort of violation happened, they will not just issue this nurse a warning. They will terminate him/her. That's the kind of lesson you'll be teaching her. There's no slaps on the wrist for this kind of stuff.

If it's not a HIPAA violation, and you have the right to know, then why would CC find that a violation happened? Either it's okay or it's not.

Just goes to show that folks should know what their state's law and their facility's policy is on this issue.

if it was 'criminal' for the nurse to talk to the op wasn't the op also a criminal for talking it over with a fellow worker

shouldn't she have told the rn at the time of the occurance that she didn't want to know and that she was going to report nurse to police and to board of nursing

why should the entire floor be painted with the same brush, if she was right to report it then she should have gone back and found out the nurses name and tell everyone what a horrible person she was

maybe when she is a nurse she will have more respect for fellow nurses

Specializes in Emergency & Trauma/Adult ICU.
If it's not a HIPAA violation, and you have the right to know, then why would CC find that a violation happened? Either it's okay or it's not.

Just goes to show that folks should know what their state's law and their facility's policy is on this issue.

Folks are arguing that although disseminating information r/t a patient's HIV status is a HIPAA violation under current law, it *should not be*, in their own opinion.

BTW, HIPAA is not a state law but a federal one, and violations are considered civil rights violations.

http://www.hhs.gov/ocr/hipaa/

Because of the perceived seriousness of civil rights violations under HIPAA and the potential for large criminal and civil monetary penalties, many facilities have "zero tolerance" policies for violations and terminate employees found to have committed HIPAA violations without prior written warnings or other forms of progressive discipline.

Specializes in Cardiac Telemetry, ED.
if it was 'criminal' for the nurse to talk to the op wasn't the op also a criminal for talking it over with a fellow worker

Not if the patient's identity was protected.

shouldn't she have told the rn at the time of the occurance that she didn't want to know and that she was going to report nurse to police and to board of nursing

It sounds like the OP was not clear on the legalities or ethical nature of the situation. It would have been jumping the gun to make such a statement under the circumstances.

why should the entire floor be painted with the same brush, if she was right to report it then she should have gone back and found out the nurses name and tell everyone what a horrible person she was

maybe when she is a nurse she will have more respect for fellow nurses

If this practice of revealing protected health information in this manner is occurring facility wide, and this goes against state law and facility policy, then the issue needs to be brought up on a facility wide level and staff educated, so that individual nurses can protect their license and their jobs. To single out an individual and label them a "horrible person" would be not only unprofessional, but could be construed as harassment, and as potentially damaging to the individual's professional reputation, slander.

Specializes in Cardiac Telemetry, ED.
Folks are arguing that although disseminating information r/t a patient's HIV status is a HIPAA violation under current law, it *should not be*, in their own opinion.

BTW, HIPAA is not a state law but a federal one, and violations are considered civil rights violations.

I know. But HIV status confidentiality laws vary from state to state. I think it's important to be familiar with the laws of the state in which one practices.

I also agree that what is legal is not always ethical, and vice versa. I understand that some are arguing that while it may not be legal to divulge this information, they consider it to be ethical. I disagree. I feel that the right of the patient to keep that information confidential outweighs the "right to know" in order to use "extra precautions". Since HIV is transmitted via blood and body fluids, then standard precautions are warranted for ANY situation in which one might encounter blood or body fluids. It is inappropriate to single HIV+ people out for "extra" precautions.

Specializes in Emergency & Trauma/Adult ICU.
Since HIV is transmitted via blood and body fluids, then standard precautions are warranted for ANY situation in which one might encounter blood or body fluids. It is inappropriate to single HIV+ people out for "extra" precautions.

I agree. It is not only ethically inappropriate, it is also without scientific basis.

Specializes in Medical.
If this practice of revealing protected health information in this manner is occurring facility wide, and this goes against state law and facility policy, then the issue needs to be brought up on a facility wide level and staff educated, so that individual nurses can protect their license and their jobs. To single out an individual and label them a "horrible person" would be not only unprofessional, but could be construed as harassment, and as potentially damaging to the individual's professional reputation, slander.
As the OP reported happened in her facility - no individuals named or disciplined, no staff labelled as snitches, no involvement of any authorities (and until now nobody mentioned the police so I don't know where that came from), just education of the faculty's staff.
if it was 'criminal' for the nurse to talk to the op wasn't the op also a criminal for talking it over with a fellow worker

Actually, I'd like to clarify this very point as it has been mentioned by several other members here.

I never discussed it with my fellow phlebotomist until AFTER the draw. Before we go up on the floors to draw, we go over each other's draws to make sure we don't have duplicate orders, get advice on where to draw a patient if they are a difficult draw and the other phlebotomist successfully drew from that patient earlier, etc.. He never mentioned this patient's HIV status when we were reviewing our draws.

AFTER the draw and after returning to the lab, I asked my phleb partner if one of the RNs had approached him to warn him about a patient's HIV status. The patient's name was never mentioned. He said yes, and that's where he and I left it.

So don't worry, people...I'm not holding this RN to any higher standard to which I'd hold myself.

Specializes in Cardiac Telemetry, ED.

AZO, if it's any comfort to you, I think you handled the situation appropriately.

Specializes in Cardiac Telemetry, ED.
As the OP reported happened in her facility - no individuals named or disciplined, no staff labelled as snitches, no involvement of any authorities (and until now nobody mentioned the police so I don't know where that came from), just education of the faculty's staff.

I was just replying to Chatsdale.

As the OP reported happened in her facility - no individuals named or disciplined, no staff labelled as snitches, no involvement of any authorities (and until now nobody mentioned the police so I don't know where that came from), just education of the faculty's staff.

That indeed is an accurate recap of the situation, Talaxandra. Oh yeah...and just for the record, the OP is a HE, lol! :chuckle

Specializes in Medical.
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