Privacy violation??

Specialties School

Published

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The clearance was rescinded and that provider contacted the parent to make the referral to the specialist.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

In MA, physicals can only be completed by MD, DO, PA, or NP.

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

We can't accept any orders from a chiropractor either. We're actually having a heck of a time with a poor kiddo dealing with chronic Lyme's disease. The traditional MDs he has seen don't believe in chronic Lyme's but this kid has missed so much school because of his symptoms. Mom finally found a homeopathic provider who is willing to treat him. They want us to administer medications at school but we can't. I forget what this provider's exact license or title or degree is. It very well might be a chiropractor but basically we can only accept orders from an MD, NP or DO.

Specializes in School Nurse. Having conversations with littles..
In Missouri we are not allowed to accept physicals from Chiropractors for sports. It is a MSHAA rule.

Queen- I like this too, but I am afraid that Chiropractors can perform Sports Physicals in Missouri. Check the signature line on the Examination Form. "Signature of Physician: (MD/DO/APRN/PA/Chiropractor)

I just wanted to give you a head's up-trying to keep you from having to get yelled at by a parent about it.

Sports Physicals are a big nightmare for me.

Specializes in School Nurse. Having conversations with littles..

To address the original question about Sports Physicals. Check the Manual of your state's high school athletics governing body- there is probably a Q and A addressing this type of scenario. IF they don't want to follow the guidelines mandated by that governing body- I guess their little snowflake doesn't have to participate in sports. I bet your AD will give you some guidance on this.

Specializes in Psych, Corrections, Med-Surg, Ambulatory.
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.

Exactly. The whole reason for medical clearance is to reduce the chance that a child will drop dead while participating in sports. The parents are really missing the point on this.

Specializes in NCSN.
I would think the law trumps policy.

I agree but if her district has a similar policy in place that the parents find on the school's website, then they have more fuel to their fire.

I absolutely think she did the right thing, because as others said it's kind a darned if you do and don't kinda situation and I believe covering your own behind should always be a top priority.

Specializes in Med/Surg/Infection Control/Geriatrics.
Don't worry about it...the parents need to worry about CPS visiting them for medical neglect.

You got that right!!

Specializes in Med/Surg/Infection Control/Geriatrics.

You did the right thing. As for HIPAA, I agree with Old Dude. This was shared appropriately on a "need to know" because it involved the student's (pt.'s) care. The parents should be ashamed!

If they refuse to do anything to help their child and it's serious, they could be brought up on charges of medical neglect. And if he were successfully pushed into sports, child endangerment.

Specializes in Varied.

Blows my mind that they do not want to get the child checked out. I would be mortified.

You were acting as a student advocate. You did your job!

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."

Are the Admin personnel not en loco parentis, therefore entitled to be made aware of students' health issues?

For OP - for your peace of mind and a totally correct and thorough answer, you need to talk to a couple of lawyers to find out exactly where you stand with HIPAA in this case. Or doesn't your supervisor, HR, somebody up your chain of command know the answer?

Why are you, a nurse, involved with sports physicals? Seems like the coaches or someone more directly involved with the sports at school would be tasked with these clearances. In this case, since you are involved, maybe you can just let the coaches and school Admin know that the student is not cleared, you will not be able to do any further follow-up, and they should feel free to get in touch with the parents. Again, I don't know why a school nurse has to deal with sports physicals but maybe some districts/schools do it that way. Good luck.

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

Except that it was the school nurse informing an outside doctor, not the other way around.

+ Add a Comment