Tuesday, September 18, 2012

A HIPAA and ethical conundrum


Do you know anything about HIPAA?

Here’s a scenario for you.

Patient A comes in from the parking lot of a doctor’s office and said to the nurse, “I just saw a patient leave here and when she was backing out of her space, she hit another car. Then she just drove away.” Patient A was able to accurately describe the perpetrator and said she would sign a statement saying she witnessed the incident.

The nurse finds out that the car that was struck belonged to Patient B. Patient B then asks the nurse to tell him who was driving the car that struck his.

The nurse, knowing exactly who the hit-and-run driver was, said, “I can’t tell you that. It would be a HIPAA violation.”

Patient A and Patient B appeal to the doctor. What would you tell the doctor to do?

19 comments:

webhill said...

I don't know much about HIPAA at all but I thought it had to do with keeping health care information private. Just being in a doctor's parking lot isn't protected information, is it? I mean, hell, the person driving the car (henceforth Driver X) that hit Patient B's car could have been delivering a pizza, fixing the air conditioning, stopping by to ask for directions, anything really. Telling a third party that Driver X was actually Jane Smith does not reveal any private or protected information about Jane, does it? If this is really a HIPAA violation then that is a much more ridiculous law than I thought. I had kind of had the feeling that really HIPAA wasn't as much of a big deal and that hospital administrators and pharmacy interns just use it as an excuse for all kinds of ridiculousness (like telling me it is a HIPAA violation to answer a drug-related question at the pharmacy counter while someone is standing next to me. I call bullshit. It is my information and if I'm ok with someone standing next to me, and authorize the release of my information in the presence of that person, then they should go ahead and answer my question. But I digress....)

Skeptical Scalpel said...

Thanks for commenting. I agree that HIPAA is misunderstood by most people. They go overboard for fear of getting into trouble.

I guess I didn't make the story clear enough. Driver X was a patient leaving the doctor's office. In order for the nurse to tell Patient A or B the name, the nurse would have violated the privacy of Driver X.

Anonymous said...

I would tell Patient B to file a police report.

MSIV said...

The right action and the legal one don't always coincide. The right action is to divulge the information. As to the legally correct action, I'd suspect that it is a violation to disclose a patient's name to a third party not involved in that patient's care. But I agree the law is horribly misunderstood. I used my phone to snap a photo of the clinic schedule the other day as the copier was down. I was immediately swarmed by a small army of shouting nurses who accused me of a HIPAA violation. I was berated into deleting the photo and apologizing (I'm a med student and have found it more useful in rotations to capitulate to nurses).

Anonymous said...

Step one is to simply notify patient A that they need to make things right. HIPAA was not designed to let people get away with things.

goingtomedschool said...

I would let the matter be handled by karmic law. Essentially giving away the information would incriminate them which would be embarrassing for the patient. People's cars get bumped every day in parking lots. My trunk was broken because of it, but these things happen. I would recommend the doctor not volunteer the name. Besides, if they did hit the car and didn't leave a note, surely an equivalent punishment awaits...

Skeptical Scalpel said...

Thanks for the comments. All of them are reasonable suggestions. I wish karmic law was a reliable solution, but in my experience it doesn't always work.

Anonymous said...

How about the most simple solution. The doctor (and receptionist KNOW the identity of the perp..It isn't a violation of ANYTHING to have one of them call the violator and say something like "you were observed hitting a car in our parking lot on a certain date…We have a policy that states that you should contact the driver of this car. (just like they were in a Walmart parking lot). Assuming you have some sort of video surveillance (or PRETEND you do) ask what they would intend to do about it.

Anonymous said...

I agree with Anonymous. I would call the person known to have hit the car and ask them to make it right. Meanwhile, the person that got hit should file a police report, and get an official signed statement from the witness. If the other person doesn't choose to fess up, I imagine that there is some sort of process to get a court order for you to disclose the information, but frankly, I wouldn't do it without one. Someone willing to hit and run may also be willing to sue for a HIPPA violation completely unrelated to healthy. Remember, they WANT to get away with this, and they will be pissed if they don't, so make sure that they have no legal mechanism to take out their frustration on you.

Anonymous said...

It could also be a violation to call the driver and tell them they should contact Patient B as that would reveal Patient B's identity as a patient.

Todd J. Scarbrough, M.D. said...

Doctor & office & Patient A should report the incident and info (and names) to the local police. They will handle it. That way, no HIPAA violation. It is not an ethical conundrum at all, IMHO, to report illegal activities and all necessary information to local authorities.

Todd J. Scarbrough, M.D. said...

Put it this way, Patient A says "I just saw an albino with a yellow hat and a red sweater murder someone in the parking lot and then flee the scene." If I had just met with my red-sweatered, yellow-hatted, albino patient in my office moments prior--I would call the police immediately, and I can promise you that's not a HIPAA violation.

Anonymous said...

It's a violation if you give them patient B's identity without consent. But I, for one would happily give written consent if it meant my car was going to be fixed.

Skeptical Scalpel said...

Good suggestions. Todd, I agree that murder would supersede HIPAA. I'm not so sure about a fender bender.

Anonymous said...

If Patient B files a police report, they can subpoena information, which would avoid violating HIPPA.

You could also ask your malpractice carrier for advice. They have legal counsel and policies in place for this type of question, since they'd be defending you in the HIPPA lawsuit.

Anonymous said...

I don't think just giving the name of a patient violates HIPPA. No health info is being exchanged. In a waiting room, names are called out for all to hear and that is not considered a violation.
DD

Skeptical Scalpel said...

Thanks for commenting. I could be wrong, but the way I understand HIPAA is that you cannot call out full names of patients in a doctor's office. I don't believe in going to the doctor, but people who do tell me that most clerical personnel call out first names only. Hospitals had to redesign registration areas for more privacy too.

ADS2015 said...

If you reported it to the police without disclosing the name of patient X to the other patients, then I'd let them take care of it. I'm sure Patient B would find out the name of Patient X in court or something, but I don't think that is a HIPAA violation either. Don't your rights end where my rights begin or something to that effect? For me, this wouldn't be a difficult decision at all. Tell the cops everything, let them figure out the rest.

Skeptical Scalpel said...

ADS2015, sorry I am late responding to your comment. I was off the grid for parts of the last few days.

I'm not sure about where one's rights begin and end as far as HIPAA is concerned.

I was hoping a lawyer would chime in here but Since I routinely trash them, I don't think many lawyers follow my blog.

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