Well I"ve waited a bit to post, so give me your expert advice on this hot mess.
Had a patient, with a sexually transmitted life threatening disease that ended up on my ICU after they coded. Death was around the corner going full speed and a parent agreed to pull life support and let the patient pass peacefully.
NOW, the family demanded we not tell the fiancee what was wrong with the patient and why they were going to die, although the lack of knowledge would be life threatening for the patients partner... and future partners. The significant other had no idea how at risk they are.
So... other than alerting risk management and trying to get my peer to talk with the parent to share the info... what can you legally do? The fact that the parent would be willing to allow others to die like their child when it isn't necessary was astounding.
I'm all for HIPPA, but there needs to be circumstances in death... and preferably before then when it may be to late to intervene! No this is not a standard reportable STD, and I obviously can't say more.
any thoughts or experiences? I simply want to prevent more suffering and death. Why does it have to be so complicated... argh:mad:
I've also seen docs hide behind HIPAA because "I don't want to get into the middle of a mess." Much better to let the poor woman come to terms with her loss, find love again, and then find out she's given her partner or future child HIV....
When I started out as a nurse many years ago, what I did or didn't do was measured against this question. "What can I live with" It still works for me. I would have a hard time living with myself if I allowed an injustice such as you describe to occur. It is complicated. I'm glad I'm not wearing your shoes.
Well I"ve waited a bit to post, so give me your expert advice on this hot mess.
Had a patient, with a sexually transmitted life threatening disease that ended up on my ICU after they coded. Death was around the corner going full speed and a parent agreed to pull life support and let the patient pass peacefully.
NOW, the family demanded we not tell the fiancee what was wrong with the patient and why they were going to die, although the lack of knowledge would be life threatening for the patients partner... and future partners. The significant other had no idea how at risk they are.
So... other than alerting risk management and trying to get my peer to talk with the parent to share the info... what can you legally do? The fact that the parent would be willing to allow others to die like their child when it isn't necessary was astounding.
I'm all for HIPPA, but there needs to be circumstances in death... and preferably before then when it may be to late to intervene! No this is not a standard reportable STD, and I obviously can't say more.
any thoughts or experiences? I simply want to prevent more suffering and death. Why does it have to be so complicated... argh:mad:
Parent's demands are not equivalent to HIPAA nor relevant state/federal regulations.
In many locations it's required by law to share STD information with sex partners.
You have a duty to help prevent the spread of disease.
And if the patient codes, you tell everyone arriving that they've got HIV and take extra precautions.
And, as the fiance's attorney, if you had documented information that was not conveyed to a known contact, well, someone's gonna' pay.
In a way, we all would pay by encouraging the spread of infectious disease in favour of a misinterpreted law.
As a sidebar, how many times do you check the ID and marriage certificate of someone who shows up and says, "I'm the spouse?" Huh? We take their word on it. And then we give out all of the information they want. And then the real spouse shows up the next day and the fun begins.
Specializes in Recovery (PACU)-11 yrs, General-13yrs.
I am aghast that this patient had a fiance/e and DIDN'T tell them of this huge risk to health. How close to you have to be to a person before you tell them? And the parents have no conscience either.
See reporting isn't so simple... this person has known for many years and the health dept. does not follow up with them each week to see whom they are sleeping with. This person was in their teens when it was discovered and remained the "dark family secret". So none of the family, except mom knew... not even this future husband. The patient has refused to take the needed meds all along. And no agency has kept up with her, she's fallen through the cracks... so the usual reporting doesn't apply here. sorry should have been more specific, but you have to be careful how much you say, this is close and far enough.
So patient is about to expire, mom sends everyone home and only has limited family around... can't say much more, but part of it is to limit our contact and conversations (my belief anyway). So instead of using this opportunity to save others... she allows it to continue because this has been a long learned and ingrained never tell secret.
I'm terrified the partner has been exposed and could use some more specific advice when this is not a new diagnosis. We passed it on to risk management, but I can't be sure, and doubt that it is enough.. I thought about contacting the department of health, but if I get some idiot on the phone and assures me it's OK then I could be making a huge legal but not moral mistake. Make sense? Thanks all!
Specializes in Developmental and Peds with disabilities.
I certainly would not personally tell anyone. That could endanger your license and career. I have been in the family situation where it was "a deep, dark secret" when my uncle had HIV and I was told it was leukemia until I was 14, six years after he passed away. But keep in mind that you don't know the whole situation. The partner may know and just doesn't want the mom to know that he is in on the secret. Maybe the partner has the same disease. I have heard there are a lot of public support groups where people meet and fall in love. Also, if the patient is a female and the partner is a male, males are less likely to get certain STD's from females, but i wouldn't bank on it. I would take it to the nurse manager and then if nothing gets done there take it to the Ethics committee who would have the power to rectify the situation in a way where as few people as possible get hurt (I say this because it seems there is a possibility where someone may have already been hurt). But if it were me, i would not be able to stand by idly and have this on my conscious. I would approach the situation cautiously and go up the chain of command until you have resolved the situation. I wish you the best of luck.
see reporting isn't so simple... this person has known for many years and the health dept. does not follow up with them each week to see whom they are sleeping with. this person was in their teens when it was discovered and remained the "dark family secret". so none of the family, except mom knew... not even this future husband. the patient has refused to take the needed meds all along. and no agency has kept up with her, she's fallen through the cracks... so the usual reporting doesn't apply here. sorry should have been more specific, but you have to be careful how much you say, this is close and far enough.
so patient is about to expire, mom sends everyone home and only has limited family around... can't say much more, but part of it is to limit our contact and conversations (my belief anyway). so instead of using this opportunity to save others... she allows it to continue because this has been a long learned and ingrained never tell secret.
i'm terrified the partner has been exposed and could use some more specific advice when this is not a new diagnosis. we passed it on to risk management, but i can't be sure, and doubt that it is enough.. i thought about contacting the department of health, but if i get some idiot on the phone and assures me it's ok then i could be making a huge legal but not moral mistake. make sense? thanks all!
i think mom should and can be sued or criminally prosecuted. has anyone spoken to her, chaplain maybe, to try to get her to warn the fiance?
of course, how do you know the fiance doesn't already know? or isn't already hiv + himself? or maybe he gave it to your patient! i guess if he's sick, he'll eventually see a doctor anyway. i know that sounds callous but i don't mean it that way. it's just that i don't know what else you can do.
who is responsible, according to your manager and your risk management manager for reporting hiv? usually it's the md, isn't it?
i think mom shoulda and can be sued or criminally prosecuted. has anyone spoken to her, chaplain maybe, to try to get her to warn the fiance?
of course, how do you know the fiance doesn't already know? or isn't already hiv + himself? or maybe he gave it to your patient! i guess if he's sick, he'll eventually see a doctor anyway. i know that sounds callous but i don't mean it that way. it's just that i don't know what else you can do.
who is responsible, according to your manager and your risk management manager for reporting hiv? usually it's the md, isn't it?
korky.... i'm with you. mom should be sued or demanded to tell now that the patient has died. all i know is that this patient has had a deadly disease and the future husband is not the one to give it to her... it happened years ago when she was a teen. testing for various reasons as you might assume was done and it has been a secret since.
i've told everyone i can think of intafacility....and doubt that any follow through will happen. it's too easy to let it go, and too complicated to pursue. i don't even know this guys name.... but i feel the need to act but have to do so in accordance of law as mom will have my ass in court if i proceed wrongly. i just can't wrap my head around any options and i need the groups ideas.... please
This is absolutely disgusting that the mother would risk illness and death to someone else to keep a ridiculous secret. Did you ask the doctor if he reported it? Usually the doctor does the reporting and they contact people at risk from there. Talk to the doctor and see what they say. I would be tempted to make an anonymous call to her from a pay phone in a town a few over from where I live. This is a life worth saving.
korky.... i'm with you. mom should be sued or demanded to tell now that the patient has died. all i know is that this patient has had a deadly disease and the future husband is not the one to give it to her... it happened years ago when she was a teen. testing for various reasons as you might assume was done and it has been a secret since.
i've told everyone i can think of intafacility....and doubt that any follow through will happen. it's too easy to let it go, and too complicated to pursue. i don't even know this guys name.... but i feel the need to act but have to do so in accordance of law as mom will have my ass in court if i proceed wrongly. i just can't wrap my head around any options and i need the groups ideas.... please
i'm glad you realize that you probably shouldn't openly report it. i ask again, though, what do your boss, your risk manager boss, the doctors, etc. say? what is the law in your state about this? if your facility receives federal funds, maybe fed law supercedes state law? you probably need a lawyer to advise you on all of this.
i still wonder how you know the facts you've stated - that this happened when she was a teen, that the fiance does not know and isn't already + and maybe even getting treatment already, that no one has reported this to the public health dept., etc. is this gossip or did the patient tell you or do you know these people outside of the hospital or what?
the best advice i know is to follow up on the leads i've listed above. doesn't the fiance ever come to visit? how is it that he never talks to the doctors? is your patient lucid and verbal? maybe she can be led to tell the fiance.
Disclosure of a patient's confidential information is done on a need to know basis only. If the patient died of a reportable disease, it is up to the hospital to report it to your state's DOH. You can do nothing. You have neither a legal obligation nor the right to tell the fiance, or indeed anyone else, about the patient's diagnosis regardless of how you feel about the patient's mother or the perceived shortcomings of the public health system. Don't let your outrage blind you to your responsibility to preserve confidentiality.
nerdtonurse?, BSN, RN
1 Article; 2,043 Posts
I've also seen docs hide behind HIPAA because "I don't want to get into the middle of a mess." Much better to let the poor woman come to terms with her loss, find love again, and then find out she's given her partner or future child HIV....