HIPAA

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  • 1.  Seeking Out Collateral Information

    Posted 3 days ago

    I really need some help with this scenario!  I appreciate any input you can provide!

     ·         Licensed social worker (LSW) is requested by Emergency Department physician to assess the mental health status of patient in crisis (no previous mental health issues)

    ·         During the assessment, LSW has a gut feeling that the patient isn't being forthcoming and cannot make determination whether or not to "pink slip" the patient (transfer to psychiatric facility for further evaluation).

    ·         LSW then seeks "collateral" information (information from a relative, spouse, family friend) to help her.

    ·         LSW contacts the patient's mother, however does not give the patient an opportunity to allow or object to the contact.

    ·         Patient's mother is tearful, begging the LSW to pink slip her son – she is certain that he will commit suicide if he isn't pink slipped.

    ·         LSW pink slips the patient and the patient is transferred to a psychiatric facility for further evaluation.

     Did the LSW commit a HIPAA violation?  My thoughts:

     ·         HIPAA doesn't prevent health care providers from listening to family members or other caregivers who may have concerns about the health and well-being of the patient, but contacting that family member and letting them know the patient is in the emergency department does go against HIPAA, unless certain criteria are present:

     #1 – patient is incapacitated or doesn't have the mental capacity to make a decision
    #2 – patient gives permission
    #3 – patient poses a serious, imminent threat to himself or others

     

    ·         If a provider truly believes that the patient poses a serious, imminent threat to himself or others, they can seek out collateral information from someone who is able to lessen that threat.  However, it is my belief that It shouldn't be standard operating procedure to collect collateral information on every patient a LSW assesses.  Also, reasons for seeking out collateral information should be thoroughly documented.

    ·         There are HIPAA provisions about mental health but the patient hasn't been diagnosed yet as having any mental health issues.   But if patients are in crisis, then can you say the patient does have mental health issues?

     From: https://www.hhs.gov/hipaa/for-professionals/faq/2089/health-care-provider-permitted-discuss-adult-patients-mental-health-information-patients.html

     Is a health care provider permitted to discuss an adult patient's mental health information with the patient's parents or other family members?

     In situations where the patient is given the opportunity and does not object, HIPAA allows the provider to share or discuss the patient's mental health information with family members or other persons involved in the patient's care or payment for care. For example, if the patient does not object:

     • A psychiatrist may discuss the drugs a patient needs to take with the patient's sister who is present with the patient at a mental health care appointment.

    • A therapist may give information to a patient's spouse about warning signs that may signal a developing emergency.

     BUT:

     • A nurse may not discuss a patient's mental health condition with the patient's brother after the patient has stated she does not want her family to know about her condition.

     In all cases, the health care provider may share or discuss only the information that the person involved needs to know about the patient's care or payment for care. See 45 CFR 164.510(b). Finally, it is important to remember that other applicable law (e.g., State confidentiality statutes) or professional ethics may impose stricter limitations on sharing personal health information, particularly where the information relates to a patient's mental health.



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    Cinda
    Corporate Compliance & Privacy Officer
    Ohio
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  • 2.  RE: Seeking Out Collateral Information

    Posted 3 days ago

    Hi,

     

    It sounds to me like the LSW had reason to believe there was a strong possibility the patient was a serious, imminent threat to themselves and therefore sought out more information. Not a HIPAA violation from my perspective.

     


    Michael Scudillo, OTR, CHC, CBIS 
    Chief Compliance Officer/Privacy Officer


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  • 3.  RE: Seeking Out Collateral Information

    Posted 3 days ago

    Thank you Michael!

     

    Cinda

     

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  • 4.  RE: Seeking Out Collateral Information

    Posted 3 days ago
    I don't think the LSW will get into trouble reaching out to the mother if they really felt the patient would be considered to be an imminent threat to themselves.
    I would be curious to know a few more details though.  Did the patient ever talk about suicide?  How hard did the LSW try to convince the patient to allow us to contact the mother or other family member to get more info?  Did the patient seem alert and oriented?

    Whatever details that surrounded this situation should be documented in the chart.  Like "after a great deal of conversation the patient would not agree to contacting a family member but the LSW felt the situation warranted it.", also document what signs or symptoms let the LSW to believe he was an imminent danger to himself.

    Just my two cents.

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    Ann Dunham
    MBA, SPHR, CHC, CHRC
    Compliance Officer
    Hannibal Regional Healthcare System
    Hannibal, MO
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  • 5.  RE: Seeking Out Collateral Information

    Posted 3 days ago

    Great points!  Thanks Ann!

    Cinda

     

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  • 6.  RE: Seeking Out Collateral Information

    Posted 2 days ago
    I'm wondering, why the LSW reached out to the mom? (versus dad, a significant other, someone else) I'd start with that question.

    Is there something in the record to indicate that mom is involved in the patient's care? (i.e, did she attend appointments previously? any previous mention? is the emergency contact)


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    Brenda Manning JD, CHC, CHPC
    Privacy Counsel
    Maximus, Inc.

    The views expressed herein are my own and do not represent those of my employer. They are not meant to constitute legal advice or create an attorney-client relationship.
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  • 7.  RE: Seeking Out Collateral Information

    Posted 2 days ago

    Brenda – good questions to ask – thank you!!

    Cinda

     

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  • 8.  RE: Seeking Out Collateral Information

    Posted 2 days ago
    I agree with Michael and everyone's comments.
    Assuming the mother (or parents) is involved in the patient care and payment for care.
    Assuming that the LSW also was clear documenting that she had reason to believe the patient was imminent threat to him/herself and wanted to signal the involved mother (family members) about it.
    Assuming state limitations were considered.

    Love these scenarios and the sharing of thoughts/perspectives! :)


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    Ximena Restrepo
    Compliance Audit Specialist
    Billings Clinic
    Billings,MT
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