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?

They get it right! ICD-10 Code W5609XS Other contact with dolphin, sequela

The ongoing saga of the new International Classification of Diseases, 10^th revision [ICD-10] continues. ICD-10 is what every physician and hospital must use when submitting bills to various third parties. The list of codes has been expanded from 18,000 to 140,000 and some of them defy description. See other posts about getting sucked into a jet engine and drowning having fallen off burning water-skis.

In today’s episode, we investigate W5609XS Other contact with dolphin, sequela. Since this is listed as “other contact,” you may be wondering what the specific codes might be. They are as follows

W5601XA Bitten by dolphin, initial encounter

W5601XD Bitten by dolphin, subsequent encounter

W5601XS Bitten by dolphin, sequela

W5602XA Struck by dolphin, initial encounter

W5602XD Struck by dolphin, subsequent encounter

W5602XS Struck by dolphin, sequela

Having eliminated bitten or struck, I thought I was left with only my imagination to envision what “other contact with dolphin” might be. What other contact with dolphin could there be? Why would the folks at ICD-10 headquarters have put in such a code? Well, apparently they did their homework on this one.

In 2002, CNN reported that a dolphin was attempting to sexually assault female bathers on the south coast of England. A noted dolphin wrangler was unsuccessful in to trying to lure the dolphin to France. [It's unclear why France was the destination. It be related to the fact that's it's also the home of Dominique Strauss-Kahn, another alleged sexual predator.]

But the other side of the story is the recent news that a man named Malcolm Brenner has written a book about his 9-month long sexual relationship with a dolphin. The book, entitled Wet Goddess: Recollections of a dolphin lover, tells the story of his affair with “Dolly,” who interestingly is portrayed as the aggressor in the relationship. There is also a website devoted to this story. T-shirts and posters are available should you be so inclined.

Somewhat off point, but nonetheless amusing, is the unfortunate juxtaposition of an ad on Amazon.com’s page describing Wet Goddess. Just above the details about how to purchase the book is information on how you can buy a case of Chicken of the Sea Tuna, new or used [sic] for only $39.84.

You may recall that dolphins are known to swim with tuna and are often caught by commercial fishermen. There is controversy about the fate of dolphins ensnared in this way. Ironically, Amazon purchasers of both the book and the bargain tuna might be reading about Dolly and eating her at the same time.

You cannot make this stuff up.

Major Ethical Breach at Bronx Trauma Center

Not to diminish the magnitude of the tragic bus accident that occurred in New York yesterday, but as a surgeon, I am compelled to mention the almost astonishing ethical and privacy violation committed by an unnamed surgeon at a Bronx trauma center.

According to a New York Times article published on March 13, 2011, the following took place:

“The wife of a Jacobi Medical Center surgeon said her husband called her from work and described a passenger with a crushed skull and others with hand and arm amputations. She showed an iPhone photo, texted from Jacobi, of a hand and forearm, severed just below the elbow, lying on an operating table.”

I have many concerns here.

One, why would you call your wife to discuss a victim’s injuries?
Two, why would you text a photo of a severed extremity to you wife?
Three, did the victim sign consent for photographs and did he agree to let the surgeon disseminate information about his condition to the wife or the New York Times?
Four, why would the wife discuss this case with a New York Times reporter and show him the picture?

In the next few days, I expect that heads will roll on this, and rightfully so.

Medicolegal Musings: Physician Posting on Social Media & the Internet

You are in the middle of a deposition. Plaintiff’s lawyer asks, “Do you blog or tweet?” Before you answer, consider this. If you blog or tweet and respond in the affirmative, I believe anything you have ever posted would be subject to discovery by the plaintiff. Oh, you post anonymously? Would you then lie under oath and say you do not blog or tweet? For many physicians, admitting that you blog or tweet might not be a problem. But in my short career as a blogger/tweeter, I have read some things that frankly would not enhance a malpractice defense if projected on a large screen in front of a jury.

I will allow that I am skeptical and sarcastic, but I do not think I have posted anything that is derogatory to a patient, either generally or specifically. There are some very popular anonymous doctor-tweeters who post some scathingly negative comments about patients. Even if a patient could not be identified, the tone of some of these posts implies a deep-seated resentment of patients and their problems, not to mention many are vulgar, sophomoric or both. OK, some of them are funny as well, but the humor would be lost in a courtroom. Some of these tweeters disseminate prodigious numbers of posts per day perhaps suggesting that they are not always focused on their work.

I have followed several medical bloggers who post clinical anecdotes, which are essentially case reports. Despite disclaimers stating they are not about real patients, it seems obvious that they are. If the subject of one of these case report blogs decides to sue, it might be difficult to convince a jury that the blog was about a fictitious case. And this type of publication might be considered a HIPAA violation especially because it is unlikely that a blogger would have obtained institutional review board permission to publish the case report.

By the way, if you blog or tweet anonymously and answer falsely that you don’t, you better never have told anyone that you do. A lie under oath that is discovered tends to undermine your credibility quite a bit. [Defense lawyer, “Your honor, may we have a short recess while I talk to my client.”]

As far as I know from an attempt to search for medicolegal references to Twitter and blogging, this perspective has not been brought up before. What do you think?