Re: question on HIPPA: What can you tell police?

[Guest guest]

It's perfectly OK to give police basic information necessary to identify the

patient. Other information must pass this test: Is there an immediate need

for the information so that the police can solve a crime against the patient,

stop a crime in progress, apprehend an offender who is attempting to flee,

prevent a crime, prevent harm to others, or do any function that requires

immediate information? If the answer is yes, give them the information. If

no,

then they should obtain a subpoena for the information. Also remember that

the " minimum necessary rule " applies. However, you are allowed to rely on the

representations of the police on the scene as to what is the minimum necessary

information they need.

Read the confidentiality provisions of Chapter 773, Texas Health and Safety

Code. Those provisions are, in some ways, more stringent than HIPAA and speak

specifically to what information you can give to police and the procedures you

must go through in providing that information.

You must not only comply with HIPAA and its Texas reincarnation, Chapter 181,

TH & SC, but also with Chapter 773's confidentiality provisions. The most

stringent law governs. Chap 773 trumps HIPAA in some ways.

Basic rule to follow: If the police can reasonably wait to obtain a subpoena

or warrant for the information, they should. If it's not reasonable for them

to wait because it would interfere with the investigation and prevent them

from immediately solving the crime or apprehending a culprit, then you are

authorized to give them the information necessary. Other information, such as

statements of the patient, details of injuries or circumstances that are " case

building " in nature can wait for process.

Best,

Gene

[Guest guest]

Thanks Gene.

JB

Re: question on HIPPA: What can you tell police?

> It's perfectly OK to give police basic information necessary to identify

the

> patient. Other information must pass this test: Is there an immediate

need

> for the information so that the police can solve a crime against the

patient,

> stop a crime in progress, apprehend an offender who is attempting to

flee,

> prevent a crime, prevent harm to others, or do any function that

requires

> immediate information? If the answer is yes, give them the information.

If no,

> then they should obtain a subpoena for the information. Also remember

that

> the " minimum necessary rule " applies. However, you are allowed to rely on

the

> representations of the police on the scene as to what is the minimum

necessary

> information they need.

>

> Read the confidentiality provisions of Chapter 773, Texas Health and

Safety

> Code. Those provisions are, in some ways, more stringent than HIPAA and

speak

> specifically to what information you can give to police and the procedures

you

> must go through in providing that information.

>

> You must not only comply with HIPAA and its Texas reincarnation, Chapter

181,

> TH & SC, but also with Chapter 773's confidentiality provisions. The most

> stringent law governs. Chap 773 trumps HIPAA in some ways.

>

> Basic rule to follow: If the police can reasonably wait to obtain a

subpoena

> or warrant for the information, they should. If it's not reasonable for

them

> to wait because it would interfere with the investigation and prevent them

> from immediately solving the crime or apprehending a culprit, then you are

> authorized to give them the information necessary. Other information,

such as

> statements of the patient, details of injuries or circumstances that are

" case

> building " in nature can wait for process.

>

> Best,

>

> Gene

>

>

>

[Guest guest]

I just tell them where " I " will be in the next half-hour or so. " If you

need anything else, I'll be at XYZ hospital. " Beyond that, if the

transport is arising out of an investigatable crime, then I'll tell them

how the patient is doing (they already know this, typically. " Looks like

he just got beat up pretty bad " ). Otherwise, if it is a chest pain call

(medical) that they happened to come in on, they don't ask and we don't

tell.

Schadone, NREMT-Paramedic

City of Austin

Austin/ County EMS

Medic 12 / Medic 24

@...

Re: question on HIPPA: What can you tell police?

In NJ it is a State law that a LEO must document the destination of any

patient from a MVC. Would this law allow an EMT in NJ to provide that

information

per HIPPA? It's done daily in NJ as a matter of routine, I've even made

a point

to tell the PD on scene we were going to X location and if for some

reason

that changed we'd have dispatch notify them of the change. Hell in the

Alarm

Room we'd tell them if they called a day later but we never had names

only what

ambulance went where.

Louis N. Molino, Sr., CET

FF/NREMT-B/FSI/EMSI

LNMolino@...

(Home Office)

(Fire Field Office)

" A Texan with a Jersey Attitude "

The comments contained in this E-mail are the opinions of the author and

the

author alone. I in no way ever intend to speak for any person or

organization

that I am in any way whatsoever involved or associated with unless I

specifically state that I am doing so. Further this E-mail is intended

only for it's

stated recipient and may contain private and or confidential materials

retransmission is strictly prohibited unless placed in the public

domain by the original author.

[Guest guest]

WRITTEN EARLIER:

For example, you are getting ready to transport a patient to ABC

Hospital to be evaluated for their back pain and the laceration on their

forehead. PD asks you how bad the patient is and where you are taking

them.

This definately falls into the " can't release " category...but the

suggested (and this is so simple it is scary)... " Ask the patient if they

would mind if you told the police officer where you were taking them and

that they are not that seriously injured " .

Comment/question - While this does seem like such a reasonable idea to

ask the pt. if they mind - isn't it true that the police officer (and

anyone else) can simply call a hospital and find out if the patient is

there, what their room number is, and what general condition they are in

(supposedly considered okay by HIPAA regs). How can this be in the

" can't release category " ?

Don Elbert, Tyler

**********************************************************************

This message is confidential, intended only for the named recipient(s)

and may contain information that is privileged or exempt from disclosure

under applicable law. If you are not the intended recipient(s), you are

notified that the dissemination, distribution or copying of this message

is strictly prohibited. If you received this message in error, or are not

the named recipient(s), please notify the sender and delete this e-mail

from your computer. Thank you.

<<<<GWIASIG 0.07>>>>

[Guest guest]

Don,

You are correct that the police can simply call the hospital, ask if the

person is a patient there, what room they are in, and what their condition is.

However, many hospitals are taking the position that unless the patient has

signed a consent to release of that information they won't release it.

The patient must be given the opportunity to decline release of that

information, and some hospitals are taking the position that if the patient is

unable

to consent or decline due to condition, they will presume that the patient has

declined.

I don't see a problem with telling PD where you're taking the patient. Most

of the time they'll know simply through the process of elimination. They can

always get the information from their dispatch if it knows. Most services are

not like ETMC where dispatch is in house EMS. Most are run by public safety

organizations that are not covered by HIPAA.

Going back to the question of why this information might be in the " can't

disclose " category, it is necessary to look at what the law says CAN be released

since that's the way the law is written. Information can be disclosed without

patient consent or authorization only for TPO, treatment, payment, and

healthcare operations. Also information can be disclosed to state or federal

agencies when required by law, as in infectious disease reporting.

Law enforcement is not a part of treatment, payment, or healthcare

operations. So there is no ability to disclose to LE unless the disclosure

falls under

one of the exigent circumstances described in the rules and guidelines issued

by the Office of Civil Rights (OCR) and the Centers for Medicare and Medicaid

Services (CMS) or if the patient authorizes it. And authorization must be in

writing. Those regs and guidelines describe clearly emergency situations in

which information is immediately needed by LE in order to identify an

assailant that might be escaping or dangerous, prevent further crime, protect

the

public safety, and so forth. I think you can justify disclosing hospital

destination but not much more without patient authorization, and then you'd

better

have ironclad documentation of the patient's present mental status to make such

a decision.

Most people working in EMS today don't have a single clue as to how to

determine or document present mental capacity in legally sufficient fashion.

(See

my recent articles in Texas EMS on the subject). So a presumed consent is

worthless unless the patient is possessive of the requisite mental capacity to

consent.

Also go back and read the confidentiality portions of Chapter 773, Texas

Health and Safety Code, the EMS Law. You'll see that when information is sought

by LE for the purpose of charging a patient, the barriers for release are

higher. Couple that with the broad net of inclusion under Chapter 181, TH & SC,

which expands HIPAA coverage in Texas to all health care providers regardless of

whether or not they use electronic billing, then disclosure of PHI is something

that must be taken very, very seriously.

Just to be sure that I'm not misunderstood, I'm not saying that the EMS

provider has the duty to protect the patient from disclosing information to LE

themselves. If a LE officer approaches the patient and says, " What hospital

are

you going to, what's wrong with you, how much of what have you had to drink,

and by the way did you kill Jimmy Hoffa? " and the patient answers, we're not

required to jump in and read the patient his HIPAA rights and stop him from

talking. HIPAA, 181, and 773 only prescribe what WE can disclose to 3rd

parties.

Until we have better evidence of how OCR is going to interpret some of these

HIPAA provisions, we should be quite conservative in what we disclose to LE at

call scenes.

What LE can ask and what we can disclose to them are two entirely different

matters. The fact that they can pick up the phone and try to get the

information out of the hospital doesn't authorize us to disclose without patient

authorization except in clear emergencies.

Hope this helps. This stuff is clear as the coffee I make sometimes, but

it's beginning to fall into place.

Gene G.

In a message dated 7/21/2003 1:23:18 PM Central Daylight Time,

delbert@... writes:

> WRITTEN EARLIER:

> For example, you are getting ready to transport a patient to ABC

> Hospital to be evaluated for their back pain and the laceration on their

> forehead. PD asks you how bad the patient is and where you are taking

> them.

>

> This definately falls into the " can't release " category...but the

> suggested (and this is so simple it is scary)... " Ask the patient if they

> would mind if you told the police officer where you were taking them and

> that they are not that seriously injured " .

>

> Comment/question - While this does seem like such a reasonable idea to

> ask the pt. if they mind - isn't it true that the police officer (and

> anyone else) can simply call a hospital and find out if the patient is

> there, what their room number is, and what general condition they are in

> (supposedly considered okay by HIPAA regs). How can this be in the

> " can't release category " ?

>

> Don Elbert, Tyler

>

>

[Guest guest]

The extreme of this is when you send in a Jane Doe 2 years old in by air

service with all the family dead and follow to the hospital in a ground unit

and try to give the hospital pt information the are rude and don't want to

even admit they have your patient this is creating a problem they have

really created a monster I had the data and was trying to make sure the

hospital knew who little Jane Do was so they could contact next of kin the

were actual not interested . The hospitals not hippiaa is going to be a big

problem.

D.

EMTP

Silsbee EMS

806 Lee Rd.

Silsbee, Texas 77656 U S A

wetseal@... silsbeeems@...

Add this card to your address book

Re: question on HIPPA: What can you tell police?

> Don,

>

> You are correct that the police can simply call the hospital, ask if the

> person is a patient there, what room they are in, and what their condition

is.

> However, many hospitals are taking the position that unless the patient

has

> signed a consent to release of that information they won't release it.

>

> The patient must be given the opportunity to decline release of that

> information, and some hospitals are taking the position that if the

patient is unable

> to consent or decline due to condition, they will presume that the patient

has

> declined.

>

> I don't see a problem with telling PD where you're taking the patient.

Most

> of the time they'll know simply through the process of elimination. They

can

> always get the information from their dispatch if it knows. Most services

are

> not like ETMC where dispatch is in house EMS. Most are run by public

safety

> organizations that are not covered by HIPAA.

>

> Going back to the question of why this information might be in the " can't

> disclose " category, it is necessary to look at what the law says CAN be

released

> since that's the way the law is written. Information can be disclosed

without

> patient consent or authorization only for TPO, treatment, payment, and

> healthcare operations. Also information can be disclosed to state or

federal

> agencies when required by law, as in infectious disease reporting.

>

> Law enforcement is not a part of treatment, payment, or healthcare

> operations. So there is no ability to disclose to LE unless the

disclosure falls under

> one of the exigent circumstances described in the rules and guidelines

issued

> by the Office of Civil Rights (OCR) and the Centers for Medicare and

Medicaid

> Services (CMS) or if the patient authorizes it. And authorization must be

in

> writing. Those regs and guidelines describe clearly emergency situations

in

> which information is immediately needed by LE in order to identify an

> assailant that might be escaping or dangerous, prevent further crime,

protect the

> public safety, and so forth. I think you can justify disclosing hospital

> destination but not much more without patient authorization, and then

you'd better

> have ironclad documentation of the patient's present mental status to make

such

> a decision.

>

> Most people working in EMS today don't have a single clue as to how to

> determine or document present mental capacity in legally sufficient

fashion. (See

> my recent articles in Texas EMS on the subject). So a presumed consent is

> worthless unless the patient is possessive of the requisite mental

capacity to

> consent.

>

> Also go back and read the confidentiality portions of Chapter 773, Texas

> Health and Safety Code, the EMS Law. You'll see that when information is

sought

> by LE for the purpose of charging a patient, the barriers for release are

> higher. Couple that with the broad net of inclusion under Chapter 181,

TH & SC,

> which expands HIPAA coverage in Texas to all health care providers

regardless of

> whether or not they use electronic billing, then disclosure of PHI is

something

> that must be taken very, very seriously.

>

> Just to be sure that I'm not misunderstood, I'm not saying that the EMS

> provider has the duty to protect the patient from disclosing information

to LE

> themselves. If a LE officer approaches the patient and says, " What

hospital are

> you going to, what's wrong with you, how much of what have you had to

drink,

> and by the way did you kill Jimmy Hoffa? " and the patient answers, we're

not

> required to jump in and read the patient his HIPAA rights and stop him

from

> talking. HIPAA, 181, and 773 only prescribe what WE can disclose to 3rd

parties.

>

>

> Until we have better evidence of how OCR is going to interpret some of

these

> HIPAA provisions, we should be quite conservative in what we disclose to

LE at

> call scenes.

>

> What LE can ask and what we can disclose to them are two entirely

different

> matters. The fact that they can pick up the phone and try to get the

> information out of the hospital doesn't authorize us to disclose without

patient

> authorization except in clear emergencies.

>

> Hope this helps. This stuff is clear as the coffee I make sometimes, but

> it's beginning to fall into place.

>

> Gene G.

>

>

>

>

>

> In a message dated 7/21/2003 1:23:18 PM Central Daylight Time,

> delbert@... writes:

>

> > WRITTEN EARLIER:

> > For example, you are getting ready to transport a patient to ABC

> > Hospital to be evaluated for their back pain and the laceration on their

> > forehead. PD asks you how bad the patient is and where you are taking

> > them.

> >

> > This definately falls into the " can't release " category...but the

> > suggested (and this is so simple it is scary)... " Ask the patient if they

> > would mind if you told the police officer where you were taking them and

> > that they are not that seriously injured " .

> >

> > Comment/question - While this does seem like such a reasonable idea to

> > ask the pt. if they mind - isn't it true that the police officer (and

> > anyone else) can simply call a hospital and find out if the patient is

> > there, what their room number is, and what general condition they are in

> > (supposedly considered okay by HIPAA regs). How can this be in the

> > " can't release category " ?

> >

> > Don Elbert, Tyler

> >

> >

>

>

[Guest guest]

So what's new about hospitals treating EMS folk like SARS carriers? This

didn't start with HIPAA and it won't end there. It won't end until we spend the

time and effort to educate them about ourselves and lay the groundwork for the

respect we deserve.

This means getting to know the opinion makers in the hospital and reaching

out to them to bring them into our camp. It CAN be done, but it takes some

concentrated and regular efforts on our part.

People are generally not rude to their friends. So we need to make them our

friends. A little bribery can do wonders, in the form of some chocolate chip

cookie deliveries, some invitations to attend our picnics, and just asking

one of them to help us with a problem.

Team building is the answer in solving problems between EMS and hospitals.

Team building takes practice and coaching.

Start by making ONE friend in the ER. That friendship could metastasize to

the whole place. Imagine the consternation among our enemies that would cause.

Commit random acts of friendship.

Gene G.

[Guest guest]

Good Idea Gene....

Here's what I did. I took my paramedic wife, sent her to nursing school,

then she left EMS and went to work full-time in the ED. Now I have my own

live-in Spy Works like a charm...

Re: question on HIPPA: What can you tell police?

> So what's new about hospitals treating EMS folk like SARS carriers? This

> didn't start with HIPAA and it won't end there. It won't end until we

spend the

> time and effort to educate them about ourselves and lay the groundwork for

the

> respect we deserve.

>

> This means getting to know the opinion makers in the hospital and reaching

> out to them to bring them into our camp. It CAN be done, but it takes

some

> concentrated and regular efforts on our part.

>

> People are generally not rude to their friends. So we need to make them

our

> friends. A little bribery can do wonders, in the form of some chocolate

chip

> cookie deliveries, some invitations to attend our picnics, and just

asking

> one of them to help us with a problem.

>

> Team building is the answer in solving problems between EMS and hospitals.

> Team building takes practice and coaching.

>

> Start by making ONE friend in the ER. That friendship could metastasize

to

> the whole place. Imagine the consternation among our enemies that would

cause.

>

> Commit random acts of friendship.

>

> Gene G.

>

>

>

[Guest guest]

We have simply built a form for local police and district attorney's, that

unless it is a subpoena, you have to fill out a form, requesting release of

medical info and it must be signed and notarized by the person with whom they

are

requesting info.

Andy Foote

City of Beaumont

EMS Manager

[Guest guest]

, I did the same thing with my EMT wife, except she went into long-term

care. Worked wonders since she worked at the home in our response area.

Other nurses suddenly realized the BVM and airways on the crash cart weren't

there for decorations and that we wanted to work with them to improve

emergency care and not just around them. Of course, doing their life-safety

inspections, offering CPR classes (where we showed them their crash cart)

and working with their administration on preplans for fires and major

medical emergencies didn't hurt either once we got our foot in the door.

What was that saying Buzz Lighyear always said, " I come in peace. "

Barry

Re: question on HIPPA: What can you tell police?

Good Idea Gene....

Here's what I did. I took my paramedic wife, sent her to nursing school,

then she left EMS and went to work full-time in the ED. Now I have my own

live-in Spy Works like a charm...

Re: question on HIPPA: What can you tell police?

> So what's new about hospitals treating EMS folk like SARS carriers? This

> didn't start with HIPAA and it won't end there. It won't end until we

spend the

> time and effort to educate them about ourselves and lay the groundwork for

the

> respect we deserve.

>

> This means getting to know the opinion makers in the hospital and reaching

> out to them to bring them into our camp. It CAN be done, but it takes

some

> concentrated and regular efforts on our part.

>

> People are generally not rude to their friends. So we need to make them

our

> friends. A little bribery can do wonders, in the form of some chocolate

chip

> cookie deliveries, some invitations to attend our picnics, and just

asking

> one of them to help us with a problem.

>

> Team building is the answer in solving problems between EMS and hospitals.

> Team building takes practice and coaching.

>

> Start by making ONE friend in the ER. That friendship could metastasize

to

> the whole place. Imagine the consternation among our enemies that would

cause.

>

> Commit random acts of friendship.

>

> Gene G.

>

>

>

[Guest guest]

Only if you start showering regularly, Phil! LOL

Wes. (Who no one comes near, due to my even more repugnant profession....)