Who am I, the HIPPA police?

[ICRN2008, BSN, RN]

"Protecting private health information is not just good practice, it is the law!"

I heard this slogan during one of my many HIPPA trainings, and I really took it to heart. Apparently, some of my co-workers did not. As some of you know, I am a medical technologist. In my position, I have access to laboratory results for patients throughout our entire health system. I was working alone in the lab today, and one of my co-workers put me in a very compromising position. Here is my story; please hang in there because it is long...

A nurse called me while I was busy (getting platelets ready for HER patient) and asked me to look up some labs. I told her I was busy at the moment and would call her back; I assumed the results were for one of her patients and related to that patient's care.

When I called her back and asked for the medical record number, she said she didn't have it and proceeded to give me HER OWN NAME. She said "the nurse practitioner and I have been trying to look up the results and we can't find them in the computer". I told her that I could not give the results to her, nor could I release them to the nurse practitioner because the NP was not the ordering provider and was not directly involved in that nurse's (patient's) care. She snapped back "Well then, who do I have to ask, God?" and proceeded to give me attitude in general. I calmly told her that if she was interested in her lab results, she would have to fill out a request and submit it to the medical records department or call her physician's office on Monday.

About an hour later, I received a call from the ED physician. He requested the lab results on a patient, and proceeded to give me the SAME NURSE'S NAME. I didn't realize it until we hung up because I was involved in other tasks, but when I did figure out what was going on I immediately called him back and told him that since he was not the ordering physician he could not have access to those results (this is the policy of our laboratory). He stated that this nurse was now under his care as his patient. I had a strong feeling that he was lying to me because the nurse had not been admitted as a patient to our hospital, but I could not prove that he wasn't telling me the truth. At this point, with this being a gray area and the physician obviously being a lot higher than me on the power ladder, I gave in. I printed a copy of the results and sent it to him. I also made a note in the computer that I had done so in case I am questioned in the future.

How dare this nurse put me in such a compromising position! It makes me absolutely furious when people expect me to break the rules for them just because they are employees of the hospital!!!!! The thing that upsets me the most is that they are asking me to RISK MY JOB and sometimes VIOLATE THE LAW because they can't be inconvenienced to follow proper channels.:angryfire

There was another circumstance a few months ago when the charge nurse from the ED brought in a throat swab from her SON and requested that we run a rapid strep "off the books". This is absolutely a violation of laboratory policy, not to mention ethical standards. Why should she receive a free test just because she works here? And for her family member, no less! I told my co-worker that he should not make promises like this in the future, and if he did to make sure not to involve me. My co-workers have run numerous free pregnancy tests for their "friends" (fellow employees) on the floors.

Just to make sure I am absolutely clear, I am not bashing nurses (obviously, since I am in nursing school myself). The physician deserves equal responsibility in this incident. So please do not flame me as singling out nurses. I am in fact criticizing all health care workers who violate policys and laws.

We as members of the health care team should be above reproach. This means following proper procedures when accessing private medical records, obtaining a valid order for all tests run in the laboratory, and paying for all of the care we receive. How can we expect our patients to respect us if we do not hold ourselves to high ethical standards?

I am not looking for a debate, just a bit of support. Thanks for listening :)

[Town & Country]

Sorry, you won't get any sympathy from me...HIPPA be *******, it was her results, it wasn't like she wanted info on someone else.

Most nurses I know work sick, unable to even get into a physician's office, including myself....I need medicine right now, I'm starting a new job and trying to wait until I get insurance to go to a doctor.

Working twelve-hour shifts is likely the reason for all those labs for co-workers....not saying that part is right, but do you work 12-hour shifts?

Give her a break, if this is the most annoying thing you have to put up with I'd say you have it pretty easy. JMO.

[lsyorke, RN]

How would you be violating Hippa by giving her her own blood results? Yes, she should call the doc if that is the hospital policy, but I don't believe it's a Hippa violation. She would be the only person who could claim a Hippa violation.. doesn't sound like this was the case.

[ladytraviler]

You are absolutly right. We, as nurses, know the law. To ask a co-worker to put their livelyhood on the line is totally out of line. I have had this problem myself. I am a travel nurse. When one of my family members is in the hospital, we put a pass code on the chart so I can call and get updates. This way we don't put anyone at risk. The code can always be revoked by the person. I am thankful this is a way I can stay in the loop.

Hold your ground. You are in the right.

[canoehead, BSN, RN]

I think giving someone their own results is probably against hospital policy, but it isn't a Hippa violation. I would say damn the hospital if I wanted my own lab results, even though I understand the reason the policy exists. I have a right to my own health information, no matter what form it's in, and especially if I have paid for the service.

[tcdtx]

I'm sorry, but I don't understand how releasing a person's medical information to THAT person is a HIPPA violation.

Yes, the "running labs off the record" is a gray area.

[MultipurposeRN]

I agree. Any of us should be able to call and get our own results. I had ovarian cancer testing and had to wait 2 weeks to find out because I had to make an appointment to see the doctor and that was the soonest I could get in. Well, believe me, in a situation like that, you don't want to wait! I think hospitals could at least give their own employees results that they are paying for without giving them a bunch of crap about it or making them go through hoops.

BTW..my mom works in the lab, and thinks it's ridiculous that they can't get their own results either. It's ironic that you can access any patient in the hospital's results EXCEPT your own. It's sad when a self pay or Medicaid patient can have their results looked up and given to them but we, employees, can't. I'm not bashing self pay or medicaid people, just pointing out the irony.

[LPN1974, LPN]

I'm confused.

You wouldn't release the results to the person who the labs were on, but you did release it to someone else {the physician who called you} not knowing for sure whether he had really assumed her case.

I would have understood your point if you had stuck to your guns in the first place. I thought you were right to start with to tell her to call her physican's office on Monday, but then when you actually released the results to someone OTHER than her, without proper request and authorization, then I suspect you may have violated HIPAA.

[ICRN2008, BSN, RN]

Sorry, you won't get any sympathy from me...HIPPA be *******, it was her results, it wasn't like she wanted info on someone else.

Most nurses I know work sick, unable to even get into a physician's office, including myself....I need medicine right now, I'm starting a new job and trying to wait until I get insurance to go to a doctor.

Working twelve-hour shifts is likely the reason for all those labs for co-workers....not saying that part is right, but do you work 12-hour shifts?

Give her a break, if this is the most annoying thing you have to put up with I'd say you have it pretty easy. JMO.

I have in fact have worked 12-hour shifts on a number of occasions. I also go to school for up to 5 hours and then spend the next 8.5 at work multiple days every week. So I definitely know what it is like to have very long days. This nurse was not working a 12-hour shift as far as I know, and even if she was this does not give her license to break the rules. There is a 24-hour urgent care nearby if she was in need of care after her shift.

In my health system's training it states plainly that is against the rules to give out any laboratory results that are not explicitly for the purposes of providing care to our patients. This means that we cannot look up a co-worker's results, or even our own for that matter. This may be my employer's interpretation of the federal or state statutes, but it is nevertheless policy and all employees learned this in training (including this nurse).

My point is this: When people ask me to break the rules, they are asking me to risk my job, my reputation, and the livelihood of my family. They should know better than to ask in the first place, and if they do they should learn to accept it when I refuse to comply with their request.

[ICRN2008, BSN, RN]

I'm confused.

You wouldn't release the results to the person who the labs were on, but you did release it to someone else {the physician who called you} not knowing for sure whether he had really assumed her case.

I would have understood your point if you had stuck to your guns in the first place. I thought you were right to start with to tell her to call her physican's office on Monday, but then when you actually released the results to someone OTHER than her, without proper request and authorization, then I suspect you may have violated HIPAA.

I had to take the physician at his word because I would not prove that he was not telling the truth, I only had a hunch. If he was in fact legitimately treating this nurse as his patient, he could have had a case for filing a complaint against me. I am not saying that I made the best call in this case, only that this was a very compromising situation that the nurse should not have put me into in the first place.

May I add that the nurse was right there with the physician, so she gave her verbal permission to him to obtain her record. I sincerely doubt that the nurse would file a complaint against the physician for doing exactly as she requested.

[ICRN2008, BSN, RN]

You are absolutly right. We, as nurses, know the law. To ask a co-worker to put their livelyhood on the line is totally out of line. I have had this problem myself. I am a travel nurse. When one of my family members is in the hospital, we put a pass code on the chart so I can call and get updates. This way we don't put anyone at risk. The code can always be revoked by the person. I am thankful this is a way I can stay in the loop.

Hold your ground. You are in the right.

Thank you for your support.

[Really An Actress]

You did the right thing. You could have lost your job if you had given the nurse her own test results. If it's true that neither she nor her nurse practitioner couldn't access this information (a claim I find doubtful), then that's her problem, not yours.

As for giving the information to the doctor, you did this in good faith.

I would report this nurse for attempting to violate HIPPA before it falls back on you. This nurse also needs to learn she's not above the law as she seems to think. And this is a dog eat dog profession, so I would make sure I covered myself.

Good job.