Reporting meds to the Police when a patient dies....HIPAA?

carolinapooh, BSN, RN · Jun 3, 2013

When my husband goes out of the country to visit his family, there are entire bottles of Adderall in the cabinet, legally prescribed to my husband. They're not mine. Why not report that as well? It's literally the same thing - the person who is actually prescribed the drugs is not in the house and as far as the cops are concerned, the meds are in my possession and within my immediate control. If they came in with a warrant, they're in what's considered a common area: the kitchen.

That's ridiculous, and the average Joe Citizen would agree with me.

It's also an assumption of guilt. Possessing legally obtained, legal articles of an estate after the person dies is not a crime. SELLING or distributing them would be. So if the family does the responsible thing and takes them to a pharmacy for destruction (which is what we did when my dad passed away), are they committing a crime by having them on their person? ABSOLUTELY NOT. (Selling them on the corner OUTSIDE the pharmacy is another problem and is well within police jurisdiction to stop.)

Are they coming to get the guns licensed to the dead person that weren't specifically handed down to other members? Uh, no. Same exact thing. Owning an unlicensed firearm (certain types, certain states - I get that, but bear with me here) is a crime. If you're not the one holding the license....you see where this is going, yet no one is questioning it. They're not beating down the door to get the 0.9mm and the three shotguns Uncle Snuffy left in his cabinet when he was mowed down by a drunk driver and died last week unexpectedly.

This is preposterous and an overstepping of police boundaries. I'd be all over this.

RainMom · Jun 3, 2013

Let's say we have a hospice patient who dies in the home, and has opiates and other medications that remain after the death. The family prefers to do with the medications what they desire and sign our form releasing us from responsibility.
The medications do not belong to the hospice. They belong to the deceased patient and therefore his/her next of kin, just like all other things of potential danger and value. Maybe they are preppers and want a serious medication stash...I don't really know. Bottom line, the nurse at the death (or the MSW) have NO concerns with the safety of the meds or those in possession of them. The RN completes all things required for a death pronouncement by law AND notifies the local police of the family's possession of drugs XYZ in XYZ amount including name and contact info, as mandated by an administrator.
The police call the family then go to the home and request the medications for destruction. The family refuses and the police threaten them with the crime of possession of narcotics that are not prescribed for them.
Has that hospice generally, and that nurse specifically, violated the protected information involved in the case? Should the law enforcement have to request that information through the proper agency process for sharing patient information? Should the law enforcement have some credible suspicion of wrong doing before requesting such information? If the family sued, could the nurse be held professionally responsible on an individual level?

Seems to me, that hospice company would gain a pretty negative reputation if the families start getting visits from police because they report the presence of narcotics after the client passes. Doesn't take long for those kinds of stories to circulate in my small area.

carolinapooh, BSN, RN · Jun 3, 2013

Plus - SOMEONE JUST DIED. Somehow I doubt the first thing on people's minds is NARCS IN THE CABINET.

OMG.

Can you see this? Picture a funeral home.

Family mourning, deceased laid out, flowers, organ music, condolence book, creepy Funeral Director Guy walking around in a black suit handing out Kleenexes. :)

COPS.

What the...????

MunoRN, RN · Jun 3, 2013

By taking them. Not giving them an option to keep them.
Is a HIPAA violation? Like the other poster said, it's a family member not the person and they are in possession if drugs that are not prescribed to them.

I definitely would not just confiscate them myself. Imagine that scenario; family calls police and tells them "the Nurse went through all the medicine cabinets and took all the narcotics home for herself". It's a long, uphill battle to keep your license and stay out of jail after that.

Aside from that, if the medications were the property of the patient then you have no authority to confiscate them.

carolinapooh, BSN, RN · Jun 3, 2013

Exactly. It's theft of personal property - whether the pt is dead or not. You wouldn't swipe an iPod off the dining room table that belonged to that person and you certainly shouldn't touch drugs that have their name on the bottle.

Plus, what is the RN going to do with them? Why on earth would you want someone else's narcs in your possession?? Who in the h-e-double hockey sticks is the RN to tell a family member, 'hand over the narcotics or I'll report you'? WHAT? I'd tell the nurse she/he was out of her/his mind and that it was none of their business. I'd tell police the exact same thing, only caveat it with 'get a warrant'.

And I'd call the BON and a lawyer about my employer. Lawyers have to give out a percentage of free legal counsel - it's part of sitting on the state bar. I'd find out how legal of a seizure (and it's seizure, don't mistake that) it was and if I had the authority to do it (I doubt it) and I'd drop the local PD in some doodoo as well if necessary.

Sounds like some attorney's going to get some precedent case law before too long, because I cannot imagine that this is legal. Sounds like unlawful search and seizure by someone acting outside the boundaries of their jurisdiction to me - but that's speculation on my part. It does smell odd, though. REALLY odd.

Gentleman_nurse, MSN · Jun 3, 2013

Interesting conversation I want to find an answer for my own knowledge. Here is what I found straight from the US Department of Health and Human Services:

Law Enforcement Purposes. Covered entities may disclose protected health information to law enforcement officials for law enforcement purposes under the following six circumstances, and subject to specified conditions: (1) as required by law (including court orders, court-ordered warrants, subpoenas) and administrative requests; (2) to identify or locate a suspect, fugitive, material witness, or missing person; (3) in response to a law enforcement official’s request for information about a victim or suspected victim of a crime; (4) to alert law enforcement of a person’s death, if the covered entity suspects that criminal activity caused the death; (5) when a covered entity believes that protected health information is evidence of a crime that occurred on its premises; and (6) by a covered health care provider in a medical emergency not occurring on its premises, when necessary to inform law enforcement about the commission and nature of a crime, the location of the crime or crime victims, and the perpetrator of the crime.³⁴

http://www.hhs.gov/ocr/privacy/hipaa/understanding/summary/index

In my opinion, I take this to mean the police will need documentation from the court (1) unless they present proof of an active bonafide investigation, arrest, or homicide involving the deceased patient's medication (3, 4, 5, 6)

tyvin, BSN, RN · Jun 3, 2013

I don't give the family an option to keep the meds. The family should never be given an option to keep the meds of any type.

If it's a hospice patient then the only people who come out are the funeral people to retrieve the body and the hospice nurse or team and a call to the doc. If it's a hospice case there is no 911 or police investigation (not in my state), everything's already prearranged. Only if the person was non-hospice do the authorities come out and investigate.

About reporting them to the police if the person was on hospice....no way! When did this start and don't the police have anything else to do but bother families whose relatives have just passed. I don't see a business in unused narcs from hospice patients; I just don't see it. Who are the masters behind this crime? Give me a break.

I can just see it. Officer in route to house of deceased person. Hospice Nurse waiting to report the medications the deceased person was taking...yes, this is an urgent call. Nurse may destroy meds and go on with her life before we get there. If nurse destroys meds before we get to the scene of the crime arrest said nurse for obstruction, and collusion with a South American drug lord.

The family has a contract with the hospice team...it would seem like a violation of contract if police came in and upset things when there is no reason. Reporting deceased people's meds doesn't sound like a good reason. Tain't right. :no:

Are you sure it's a hospice case and not a home health case in which case the police would be called?

tewdles, RN · Jun 3, 2013

I don't give the family an option to keep the meds. The family should never be given an option to keep the meds of any type.
If it's a hospice patient then the only people who come out are the funeral people to retrieve the body and the hospice nurse or team and a call to the doc. If it's a hospice case there is no 911 or police investigation (not in my state), everything's already prearranged. Only if the person was non-hospice do the authorities come out and investigate.
About reporting them to the police if the person was on hospice....no way! When did this start and don't the police have anything else to do but bother families whose relatives have just passed. I don't see a business in unused narcs from hospice patients; I just don't see it. Who are the masters behind this crime? Give me a break.
I can just see it. Officer in route to house of deceased person. Hospice Nurse waiting to report the medications the deceased person was taking...yes, this is an urgent call. Nurse may destroy meds and go on with her life before we get there. If nurse destroys meds before we get to the scene of the crime arrest said nurse for obstruction, and collusion with a South American drug lord.
The family has a contract with the hospice team...it would seem like a violation of contract if police came in and upset things when there is no reason. Reporting deceased people's meds doesn't sound like a good reason. Tain't right.
Are you sure it's a hospice case and not a home health case in which case the police would be called?

All deaths in the field...HH or Hospice.

The administrator mandates the reporting to law enforcement even when there is NO concern on the part of the professional.

I have no idea what law enforcement actually does, but I know what they told me they do....

they told me that if we indicate that the meds were destroyed they call the family to discover if they have found others they would like to dispose of, if the meds were retained they call the family or go to the home and request the meds for destruction while stressing that they may be committing a serious drug related crime by simply possessing them...all from the lips of the post's captain in a phone call to me.

MunoRN, RN · Jun 3, 2013

HIPAA continues to protect patient information after death. The death itself is public information, but other than that we still have to follow the same HIPAA rules that protect the patient's information, including what medications they are/were taking. That can take a back seat to a clear and imminent threat to the patient or others, so if a family member said "I'm going to kill myself by taking all of grandma's pills at once" then that could be reportable, otherwise it would seem HIPAA still applies. We can encourage family to appropriately dispose of the meds, but reporting them to police would seem one step too far.

tewdles, RN · Jun 3, 2013

And so, if you are a nurse working for this employer, what would you do?

allnurses Guide · Jun 3, 2013

Refuse.

carolinapooh, BSN, RN · Jun 4, 2013

Police captain above is seriously overstepping his bounds, and he wouldn't be entering my home without a warrant. Once you've been a cop, you realize how much garbage cops will spout on the phone to sound as though they're more powerful than they actually are.

And no magistrate is going to give that yahoo a warrant for that.

As I said, if this were accurate, then when my husband (or I, for that matter - I have prescribed narcs in my cabinet for knee pain that occasionally - very, very occasionally - I will take at night if I've had a particularly hard stretch at work and I'm off the next day) leaves the country, they could come get me/him.

BS.