Nursing Voices

Wednesday, May 23, 2007

HIPAA and Mister X

This nursing pulp fiction book is a classic. It was published in 1961.

“Her first impression was a huge head with silver-white hair, and fierce eyes. It was like seeing the Eiffel Tower or the Colosseum for the first time after having looked at it hundreds of times in magazines or on post cards. Lily’s professional smile was frozen on her lips.

Usually she would approach a patient briskly, her hand outstretched, and introduce herself. She had been taught how to do it in nursing school—with just the right amount of cheerfulness. But this was a man who simply didn’t lend himself to this kind of approach. This was a man who had terrorized the White House, a man even the President was said to be afraid of……".

Who was Mister X?

If this were a current book, I’d guess that Mister X is Dick Chaney. He has a huge head, white hair, fierce eyes, and he shoots his friends when he goes quail hunting. I don’t blame President Bush if he is wary of Dick. Look out, George, Dick is watching you. Mister X didn’t want anyone to know that he was in the hospital. Today his secret would be safe thanks to HIPAA.

HIPPA is a great idea on paper, but it can be a pain in the posterior when you’re trying to talk to a patient’s family member over the phone.

Me: Hello, Mother Jones, RN, may I help you?

Family: I brought my wife/husband/child to the hospital last night and they were admitted to your unit. How is my family member doing today?

Me using HIPPA-speak: I’m sorry, but I can’t confirm or deny the presence of anyone on the unit due to confidentiality laws. If that person is here, I can give them a message and ask them to call you back.

Family: HUH? What are you talking about? I was there last night. I know the person is there. WTF?

These phone calls often end badly, and things get more fun when the family member, who now thinks I’m a jerk, comes to the unit for a visit. I humbly apologize for the frustration that I caused them by following the law, and explain, once again, why I can’t give out any information about their family member. I’ve had people ask me why I won’t give out information over the phone even if their family member has signed a release of information form. I tell them that I am protecting the patient’s confidentiality. After all, anyone can claim to be anybody over the phone, and how can I tell whom I’m really speaking to over the phone? I generally am able to make peace with the family, but only after spending copious amounts of time soothing their ruffled feathers.

As a side note, there’s been a lot of chatter in the blogosphere about medical bloggers and HIPPA regulations. Let me make this very clear. I write composite stories about many different people that I’ve cared for over the years. Names, dates, and other identifying factors about patients and their family members have been changed to protect the innocent AND the guilty. You are having ideas of reference if you recognize yourself in any other these stories. These stories are not about you.

Let's hear it for HIPAA. Where would we be without those glorious regulations?


Blogger Doc's Girl said...

Everyone's disappearing...and it's even caused resident boyfriend to seriously consider deleting his blog. :( (And he just started it!!)

I can't count how many times family members have lashed out to me over the phone at the hospital when I explain HIPAA. It's only there to protect...

10:48 AM  
Blogger The Curmudgeon said...

When someone says, "I'm from the Federal government and I'm here to help" -- RUN, do not walk, away as fast as possible.

HIPAA illustrates this principle marvelously. At home recuperating from surgery, the surgeon's office calls for a wellness check. Well, I'm just fine sitting in my recliner, thank you, but when you can't talk to my wife and you make me get up and come to the phone... I'm no longer nearly so good. And why is this required? Ask Ted Kennedy: HIPAA. (He was a principal sponsor.)

HIPAA even screwed up prayers in the Catholic Church: G*d forbid the congregation says a prayer for the recovery of Parishioner X, recovering down the street in the hospital for a fortnight: It would violate his privacy. Fortunately for me, my wife was able to get me on the prayer list at church when I was hospitalized recently without my express written consent... but don't tell the Feds. They might shut the place down.

HIPAA has screwed up the practice of law too, you know. We used to be able to subpoena medical records in PI cases. Suing someone for the injuries you received in a car crash was a pretty good clue that you'd authorized discovery of the injuries you were claiming. But no! Now we need HIPAA releases... and the regulations say we have to return/destroy medical records at the conclusion of an engagement.... OK... but what about the copies we had to file with the court to comply with discovery? We can't remove those -- we may not have to file these papers in court... but we have to be able to prove that they were produced. Trust me when I tell you a judge is more persuaded when s/he's holding a file stamped copy of the disputed records that has been extracted from the court file....

HIPAA -- by name -- started out as a means of requiring group health insurers to offer continued coverage, for a time, to departing group members (employees leaving, etc.)

Oh -- I'm sorry -- I seem to have run on a bit here -- someone has pushed another of my many buttons....

12:11 PM  
Blogger greensunflower said...

It is a double edged sword. As a patient I appriciate it. As a daughter I hate it. As a nurse I can both appriciate it and dislike it.

I am in peds now and with that we are able to tell parents just about anything, except of course sensitive services, and that is so nice. Loved ones are often relieved to hear things are going ok.

4:18 PM  
Blogger poody said...

I am still thinking about the book on Fiestaware!

5:10 PM  
Blogger Kim said...

It can't be Dick Cheney. Mister X has hair! : D

3:39 PM  
Blogger Rose said...

Hey Nurse R,
Just a short note to say how much I love your blog.I have been a psych nurse for 20 years!! and can really relate. Thanks for the humor that we all need to keep sane in our jobs. Keep up the good work and you Go Girl!!!!!!!!!!!

9:48 AM  
Blogger Cyndy said...

We have a similar system here in Australia.... to protect the innocent.....very frustrating at times.....We recently held a morning tea to raise funds for the cancer council, and I have some pictures that I want to publish in the local newspapers, but I will have to track down everyone in them and have them sign a release first.....this could take weeks, so what will be the point by then? It won't exactly be topical local news will it???

10:12 AM  
Blogger Curt Purcell said...

I really like that book cover!

7:47 PM  
Anonymous Anonymous said...

HIPPA has increased the cost of doing business for the insurance companies.

8:59 AM  
Blogger Alyson said...

When my mom was in the hospital they gave me a code that let them know I was authorized to have information released to me over the phone.

As a doula, I too, have to have a signed HIPAA form because I become privy to their personal medical information. And my clients are always wondering exactly why I have to have HIPAA coverd too.

It so makes me look forward to finishing nursing school ;)

7:31 PM  
Anonymous Dena Jackson said...

Hello Mother Jones,
I found your blog and I can't see how to get in touch with you personally.
I work for a company that can help you with your HIPAA woes. We have a system, FamilyLine, that we can set up for you at your hospital. It allows for the patients family to call in to our system, provided they have the password given to them by the patient. They will then hear a recorded update from the nurse twice a day.
I know that others have a password system in place, however, that still requires that the nurse get interrupted from his/her duties to take the call. With our system, the families learn to stay in touch via FamilyLine. They even can leave messages for one another or leave their own update about the patient within FamilyLine. Doctors also can leave information for the families as well as case managers. If Ms. Thomas has a pending discharge for Thursday, then the case manager can leave a message on FamilyLine for that family to please be available at lunchtime on Thursday.
We have a whole host of other modules that may be of consideration to you. Our system has been around for 20 years and it is completely built by nurses. Let me know if I can help! Thanks,
Dena Jackson,, 800-442-4874

11:04 AM  
Anonymous Sandie Marsden said...

So when family members call on the phone, you're not allowed to release any information.

But does HIPPA require that you decline to provide this for someone claiming to be working for the hospital (say accounting?)

Or for someone claiming to be from law enforcement?

8:42 PM  

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