h2g2 The Hitchhiker's Guide to the Galaxy: Earth Edition

I have asked the moderators to remove all references to two fellow residents, and to change a couple of names. I took this action at Ladera's request because there was the potential to do harm to the institution in which I dwell.

In the US, the Health Insurance Portability and Accountability Act of 1996, widely known as HIPAA, controls how and under what circumstances a person's medical records may be shared. This link goes to a summary of the law in fairly clear English:

http://www.hhs.gov/ocr/privacy/hipaa/understanding/summary/

Basically, HIPAA holds organisations such as hospitals, doctors' clinics, nursing/rehab facilities and insurance companies responsible for keeping patient information confidential. The original intent was to protect people such as those suffering from AIDS from being stigmatized publicly, losing their jobs and so forth. Like so many good intentions that convert to statutes, however, the law has grown tentacles and inserted itself into so many aspects of patient care that patient care is, in my opinion, sometimes hindered.

There was a time when an aide could enter a room, lift the chart at the foot of the bed, and know within minutes the state of the patient's metabolism, progress, state of mind, recent history and prognosis. Instructions on what to do with the patient would be right on top. Now, if the aide wants to know what to do with the patient, they must go to the nurses' station or the medical records office. Even if the information is at the other end of the hall.

Here's what happens, as a consequence of obeying the law and every possible ramification of it that lawyers might have to answer for in a court of law. At the end of shift, aides and nurses "give report" to the incoming shift as well as write out what happened (if anything) with each of the patients under their care, which latter activity is called charting.

In giving report, the outgoing staff walk down the hall with the incoming, stop at each room and describe what's going on. When the aides are both the regular staff for that hall, then of course the patients will be familiar to them, and the report will be quick and painless. If one of them is new, then it will take longer to share the report. If both aides are unfamiliar with the hall, well, that's why I hate the holidays.

If you ask my room mate if she's OK, she'll always tell you she's fine, even if she isn't. The regular staff know this as a matter of course, and check her over. The unfamiliar aide asks and sometimes takes her at her word. The unfamiliar aide, mark you, is operating in a state of apprehension about getting tasks completed and not hurting anybody, about preventing falls, about the screamer three doors down, about answering the call lights, and not forgetting the patient who needs help getting off the toilet and may be confused enough to try and do it themselves. I notoriously insert myself into the scene if I think the aide is misled by my room mate's stoicism. My words are almost always accepted, but a couple of times I have been rebuked because HIPAA.

Would that the aide had handy charts right there in the room with the patient!

But somebody might snoop. And so it is forbidden.

So how come I know so much about what's going on? I don't really. That is, my knowledge of the Ladera medical universe is limited to the parts I have come into contact with. Usually it's easy to tell -- pits and scars of brain surgery, parkinsonian tremor, paralysis of one side of the body, evident mental confusion, or a missing limb and regular trips to dialysis. Very often patients tell each other all about the illness or event that brought them hence. In the case of several room mates, the family simply suck me into their circle, include me in the pizza order, tell me all about my erstwhile room mate. And sometimes I just hear it spoken about.

HIPAA is aware of this and has a section called "Incidental Uses and Disclosures." It absolves the institution of responsibility for cases where word gets out unavoidably because of hall activity, information sharing by relatives and the like. This is where I fall, me and my blogging about life on the hall. The staff can't talk, but a patient has no legal restriction on her volubility.

There exists the possibility that a litigation-minded relative might come across my journals, recognise the person under the pseudonym, and decide to pick a fight. They might be hoping for a cash settlement. They might just be convinced that their relative has been exposed and that Ladera is liable under HIPAA. Even though they would turn out not to have a case, it would be extremely unpleasant for the institution. There would be lawyers, their fees using up the funds that could be used for bacon and repairing the disability bus. The publicity would be bad. If a formal complaint were made to the state, then an inspection would ensue. The administrator would not like me any more.

And so I have voluntarily complied with Ladera's request to remove whatever is easy to identify as a particular patient. But I'll keep writing. Carefully.

Yay! I *love* the law!

I can see where they're coming from though, and I feel sorry for them that they're in that position.

So do I, and I also am stuck under something similar. Technically, if I run into a parent of one of my students, and they ask how their child has been, I'm supposed to refer them to the teacher. Which has pissed some parents off. I'm not even supposed to tell any one that a particular child is in Special Ed. Of course, this being a small town, the last is a pretty moot point, and i very much doubt that my telling kindergartners that no, I'm not [fellow kindergartner that I'm shadowing]'s mom, I'm one of [fellow kindergartner]'s teachers is a problem, especially since they have no clue that I'm one of the aids in the Special Ed class.

Also, yes, mustn't endanger bacon flow!

It's like data protection in the UK - all about not being sued.

Deb

On the other hand, you now know that your writings are reaching an extended audience.