hippa

March 15, 2006

Moreover, I'm even willing to bet that a Google search of HIPAA would supply

lots of information, quite possibly even from the very Federal agencies that

promulgate the regulations for HIPAA.

-Wes Ogilvie

In a message dated 3/15/2006 10:44:59 PM Central Standard Time,

bbledsoe@... writes:

First, it is HIPAA (Health Insurance Portability and Accountability Act of

1996) Your employer should have, by law, provided you training in regard to

HIPAA. W.E. " Gene " Gandy is one of the foremost experts in Texas in this and

he is available through Hill-Gandy Associated. Page, Wolfberg and Wirth is a

national law firm--but you can find the answers with our Texas experts.

BEB

HIPPA

DOES ANYONE KNOW WHERE I CAN FIND OUT INFO ABOUT HIPPA?

MY PROBLEM IS THAT I HAVE A COUPLE OF POLICE OFFICERS REQUESTING

PATIENT REPORTS. THEY STATE THAT THEY CAN HAVE COPIES CAUSE THEY ARE

EXCEMPT FROM THE HIPPA LAW?

I NEVER HEARD OF THAT SO I NEED INFO TO PROVE MY CASE

ALSO WHEN WE DO CALLS IN JAIL THEY ALSO WANT COPIES SO THAT THEY HAVE

PROOF THAT THE INMATES GOT THEIR MEDICAL ATTENTION THAT THEY REQUESTED.

CAN YOU HELP ME?

Yahoo! Groups Links

March 15, 2006

First, it is HIPAA (Health Insurance Portability and Accountability Act of

1996) Your employer should have, by law, provided you training in regard to

HIPAA. W.E. " Gene " Gandy is one of the foremost experts in Texas in this and

he is available through Hill-Gandy Associated. Page, Wolfberg and Wirth is a

national law firm--but you can find the answers with our Texas experts.

BEB

HIPPA

DOES ANYONE KNOW WHERE I CAN FIND OUT INFO ABOUT HIPPA?

MY PROBLEM IS THAT I HAVE A COUPLE OF POLICE OFFICERS REQUESTING

PATIENT REPORTS. THEY STATE THAT THEY CAN HAVE COPIES CAUSE THEY ARE

EXCEMPT FROM THE HIPPA LAW?

I NEVER HEARD OF THAT SO I NEED INFO TO PROVE MY CASE

ALSO WHEN WE DO CALLS IN JAIL THEY ALSO WANT COPIES SO THAT THEY HAVE

PROOF THAT THE INMATES GOT THEIR MEDICAL ATTENTION THAT THEY REQUESTED.

CAN YOU HELP ME?

March 15, 2006

thank you for all the information.

and web links!

Thanks

Rita

March 17, 2006

In a message dated 16-Mar-06 22:57:21 Central Standard Time,

dems614@... writes:

I used to be in law enforcement myself, it is hard not to talk about

patients and their injuries/ illness. Granted when law enforcement is involved,

hippa applies to the sensitive issues of the patients care unless it is in

direct cause of any type of crime. HIPPA is there to protect the patient from

the

families and general public. HIPPA says dont go around talking about your

patients but, if you need to talk with lawenforcement or have information that

may be relevant to an investigation, it is your obligation to advise the

officer of the facts that pertain to the investigation. YOU COULD BE HELD

LIABLE

IF YOU DONT TELL...

And HIPAA has very limited protections referring to statements the patient

makes in front of the police...

S. Krin, DO FAAFP

March 17, 2006

Yes and no. If the patient decides to talk to the police, or he makes

statements that are heard by the police, as long as you have taken reasonable

steps

to minimize leakage of information, the patient's statements are not covered.

On the other hand, if your patient requests confidentiality or otherwise

indicates that he does not want the police to hear, it is your duty to protect

the

patient by asking the police to leave the truck, or putting the patient in

the truck and closing the door, et cetera. You are NOT required to place a

soundproof tent over the patient and prevent all transmission of conversation.

You must only take reasonable steps, under the circumstances, to protect the

patient's privacy as well as can be done while carrying on patient care.

As far as reporting what the patient tells you, the rule is that you must

report what the law requires you to report. No law, no report. Typical

reportable items are child, elder, and spousal abuse, certain infectious

diseases,

certain injuries, and so forth. Otherwise, you cannot disclose what the

patient says, because the patient interview is a part of the medical record.

HIPAA is strictly construed. There is NO paramedic/patient privilege like

the doctor/patient privilege. So, if the patient says to you, " I shot , "

that's not confidential. But is it covered by HIPAA? Since most

jurisdictions require the reporting of felonies, the statement is probably not

protected

by HIPAA. However, if you were a lawyer and you had a lawyer/client

relationship, the statement would be privileged. As a lawyer who is also a

Paramedic, I would report the statement, since I am not representing the

patient, and

I do not have a lawyer/client relationship with him.

What if the patient admits having drunk 12 beers and a quart of Tequila just

prior to the motor vehicle collision? HIPAA covers the statement because

most states do not require the reporting of misdemeanors. If the police

officer

asks you if the driver admitted drinking, you can't tell him. But you can

say, " I expect you'll want to subpoena the records to find out the answer to

that question. " If he or she can't pick up on that, s/he is too dumb to be a

cop.

Police officers can get the records with a grand jury subpoena, a district

attorney's subpoena, or a court subpoena. If they have a subpoena, the

patient's authorization is not required.

Now, keep in mind that the Texas Attorney General has ruled that the

provisions of the Texas Open Records Act trump HIPAA. However, an AG's opinion

is

not law. There is currently in court a case filed by the Austin

American-Statesman challenging HIPAA. The case is just sitting in the Fourth

Court of

Appeals, and the Court doesn't seem to be able to get an opinion out on it.

Probably because they're still trying to figure HIPAA out themselves.

To further complicate matters, the Emergency Medical Services Act, Chapter

773, Texas Health and Safety Code, has extensive confidentiality provisions,

some of which conflict both with the Texas Open Records Law and with HIPAA.

One

can argue that when EMS services are involved, THAT is the law that governs,

because HIPAA provides that state law that is more stringent than HIPAA

prevails over HIPAA.

So this is far from uncomplicated.

Now, back to HIPAA's provisions, where jails and correctional facilities are

concerned, Jeri's comment is correct, is you read it carefully. But there's

far more to the requirements regarding what information you can share with

jails and correctional facilities.

Jeri says that when you return the inmate to the facility, you give a copy of

the records to the facility so that care can be continued. Fine. But what

if there is no further care required? What, for example, if the inmate was

taken in because he had received a laceration to his finger with a kitchen

knife, and the ER simply placed a butterfly on it, wrapped it, and sent him

back.

There's no medication to take, no further visit to the ER required, no

wound care except for the inmate to keep the dressing as clean as possible.

There is nothing there that requires records to be transmitted to the

facility, and they cannot be.

Now, let's modify the scenario. The inmate received 3 stitches in his hand,

and the stitches are to be removed in 5 days. This will be done by the jail

nurse. Further, antibiotics are prescribed and he is given a prescription

for them which will have to be filled. Records go to the jail nurse, but NOT

to the administration.

I posted a chart showing the requirements that apply to jails several days

ago, and I will not repost it now. You can do a google on HIPAA and Jails and

you can find the jail rules.

HIPAA and other patient confidentially laws ARE NOT SIMPLE. Every service

should have the services of a lawyer who is HIPAA savvy. Few city and county

attorneys are, and so are few attorneys in private practice. Consult a

lawyer who has experience in EMS law, not a lawyer who represents hospitals.

Hospitals are notorious for misunderstanding and misapplying HIPAA's provisions.

Let's not forget that every health care provider must have a HIPAA Privacy

Officer. That officer is the person charged with applying the HIPAA

provisions. That is the person who should interact with the HIPAA lawyer.

That is

the person who should be the in-house HIPAA expert and handle all HIPAA matters.

That is what the law requires.

Happy St. Pat's Day,

Gene Gandy, JD, LP

> HIPAA only covers protected health information not

> what the patient said or didn't say. Now you are

> stretching HIPAA. So if a patient of yours tells you

> he/she was molested you aren't going to report it to

> the proper authorities as required byy law/TDH?

> Gene correct me if I am wrong please.

> Salvador Capuchino Jr

> EMT-Paramedic/VOL. FF

>

> --- Jeri sen

> wrote:

>

> > You can go to www.mchd-tx.org and there should be

> > information on the website about HIPPA. If the

> > officer is requesting the reports they need to get

> > the final report from your office with a written

> > request for the report or a court order of the

> > report. And approval from the patient. They are not

> > except from the HIPPA law. That is why when you are

> > on scene and the patient stated that they had some

> > beers to drink you are not allowed to reveal that to

> > the officers.

> >

> > You are to provide the jail with information in

> > regards to the patient if there were treated at the

> > ER and you returned them. They are assuming the

> > inmate and are required to follow up with the

> > treatment.

> >

> > Hope this can help you

> > HIPPA

> >

> > DOES ANYONE KNOW WHERE I CAN FIND OUT INFO ABOUT

> > HIPPA?

> > MY PROBLEM IS THAT I HAVE A COUPLE OF POLICE

> > OFFICERS REQUESTING

> > PATIENT REPORTS. THEY STATE THAT THEY CAN HAVE

> > COPIES CAUSE THEY ARE

> > EXCEMPT FROM THE HIPPA LAW?

> > I NEVER HEARD OF THAT SO I NEED INFO TO PROVE MY

> > CASE

> >

> > ALSO WHEN WE DO CALLS IN JAIL THEY ALSO WANT

> > COPIES SO THAT THEY HAVE

> > PROOF THAT THE INMATES GOT THEIR MEDICAL ATTENTION

> > THAT THEY REQUESTED.

> >

> > CAN YOU HELP ME?

> >

March 17, 2006

Correct, Mr. Mike. In fact, LE ain't covered by HIPAA, and has NO right to

PHI unless it is granted that right in the statute.

As I mentioned in another post just before this one, what EMS people in

Texas need to remember is that Chapter 773 of the Health and Safety Code, The

EMS

Act, has extensive and stringent confidentiality requirements which, in some

cases, exceed the requirements of HIPAA.

HIPAA states that if a state law is more stringent than HIPAA, state law

prevails. So, maybe we ought to be taking a look at 773 and trying to figure

out

how those provisions fit with HIPAA.

Don't get into the trap of violating 773 while trying to comply with HIPAA.

Now, none of us are on the Supreme Court of Texas (are we?) or the 5th

Circuit Court of Appeals (Federal appeals court) or THE SUPREMES (well, you know

them), and none of those courts have made any sort of ruling about the

relationship of HIPAA to 773's provisions, and they may NEVER do it.

So what's a mother to do? May I suggest the use of common sense. Be

conservative in your decisions to release PHI, consult your Privacy Officer, and

if

she doesn't know the answer, she'll contact the HIPAA/Confidentiality

Attorney, and they'll figure it out.

One resource that folks always seem to forget is to just call the CMS people

and ask them point blank what their interpretation is. If you do that, you

add some body armor, and even though they often say, " Hmmmmm......we've never

thought of that before. We'll have to get a staff opinion, but we'll get back

to you on it, " they can be a huge asset. After all, they hear lots of

stories, and they may have already figured your problem out.

You won't be penalized for asking them for help, and they'll remember your

cry in the wilderness in the event that some bozo files a complaint against you.

Happy St. Pat's day, or what's left of it.

Gene Gandy, JD, LP

> Information gathered during the course of patient assessment or treatment

> would fall into HIPPA guidelines. There is a distinct difference between what

> we may divulge under HIPPA and waht we are required to report under state

> guidelines. That's apples to oranges.

>

> If an officer wants a copy of a patient report, it needs to be gotten via a

> subpeona, or the patient can request one from my privacy officer and give it

> to him.

>

> Law enforcement is certainly NOT exempt from HIPPA by any stretch of the

> imagination.

>

> Mike

> ----- HIPPA

> >>

> >> DOES ANYONE KNOW WHERE I CAN FIND OUT INFO ABOUT

> >> HIPPA?

> >> MY PROBLEM IS THAT I HAVE A COUPLE OF POLICE

> >> OFFICERS REQUESTING

> >> PATIENT REPORTS. THEY STATE THAT THEY CAN HAVE

> >> COPIES CAUSE THEY ARE

> >> EXCEMPT FROM THE HIPPA LAW?

> >> I NEVER HEARD OF THAT SO I NEED INFO TO PROVE MY

> >> CASE

> >>

> >> ALSO WHEN WE DO CALLS IN JAIL THEY ALSO WANT

> >> COPIES SO THAT THEY HAVE

> >> PROOF THAT THE INMATES GOT THEIR MEDICAL ATTENTION

> >> THAT THEY REQUESTED.

> >>

> >> CAN YOU HELP ME?

> >>

March 17, 2006

HIPAA only covers protected health information not

what the patient said or didn't say. Now you are

stretching HIPAA. So if a patient of yours tells you

he/she was molested you aren't going to report it to

the proper authorities as required byy law/TDH?

Gene correct me if I am wrong please.

Salvador Capuchino Jr

EMT-Paramedic/VOL. FF

--- Jeri sen

wrote:

> You can go to www.mchd-tx.org and there should be

> information on the website about HIPPA. If the

> officer is requesting the reports they need to get

> the final report from your office with a written

> request for the report or a court order of the

> report. And approval from the patient. They are not

> except from the HIPPA law. That is why when you are

> on scene and the patient stated that they had some

> beers to drink you are not allowed to reveal that to

> the officers.

>

> You are to provide the jail with information in

> regards to the patient if there were treated at the

> ER and you returned them. They are assuming the

> inmate and are required to follow up with the

> treatment.

>

> Hope this can help you

> HIPPA

>

> DOES ANYONE KNOW WHERE I CAN FIND OUT INFO ABOUT

> HIPPA?

> MY PROBLEM IS THAT I HAVE A COUPLE OF POLICE

> OFFICERS REQUESTING

> PATIENT REPORTS. THEY STATE THAT THEY CAN HAVE

> COPIES CAUSE THEY ARE

> EXCEMPT FROM THE HIPPA LAW?

> I NEVER HEARD OF THAT SO I NEED INFO TO PROVE MY

> CASE

>

> ALSO WHEN WE DO CALLS IN JAIL THEY ALSO WANT

> COPIES SO THAT THEY HAVE

> PROOF THAT THE INMATES GOT THEIR MEDICAL ATTENTION

> THAT THEY REQUESTED.

>

> CAN YOU HELP ME?

>

March 17, 2006

Good thoughts and good advice.

Gene Gandy

> My HIPAA advice is no different from the advice that I

> generally gave healthcare providers in any

> medical-legal situation when I was still practicing

> law:

>

> 1) err on the side of caution;

> 2) be familiar with the provisions of the

> statute you are operating under;

> 3) when in doubt don't guess, call the lawyer;

> 4) if it doesn't make sense, don't do it until

> you've completed steps 1 through 3;

> 5) protect your patient; and

> 5) document, document, document.

>

> We've all known these things since completing our

> basic EMT courses. Whether you're dealing with a DNR

> Order, a Durable Power of Attorney for Healthcare, an

> Advanced Directive, a HIPAA situation, or staring at a

> Subpoena Duces Tecum for tomorrow morning, these steps

> will help calm your nerves and help you make a

> well-reasoned, intelligent decision.

>

> Todd, B.S., J.D., EMT-P

>

> --- wegandy1938@... wrote:

>

> > Correct, Mr. Mike. In fact, LE ain't covered by

> > HIPAA, and has NO right to

> > PHI unless it is granted that right in the statute.

> >

> > As I mentioned in another post just before this one,

> > what EMS people in

> > Texas need to remember is that Chapter 773 of the

> > Health and Safety Code, The EMS

> > Act, has extensive and stringent confidentiality

> > requirements which, in some

> > cases, exceed the requirements of HIPAA.

> >

> > HIPAA states that if a state law is more stringent

> > than HIPAA, state law

> > prevails. So, maybe we ought to be taking a look

> > at 773 and trying to figure out

> > how those provisions fit with HIPAA.

> >

> > Don't get into the trap of violating 773 while

> > trying to comply with HIPAA.

> > Now, none of us are on the Supreme Court of Texas

> > (are we?) or the 5th

> > Circuit Court of Appeals (Federal appeals court) or

> > THE SUPREMES (well, you know

> > them), and none of those courts have made any sort

> > of ruling about the

> > relationship of HIPAA to 773's provisions, and they

> > may NEVER do it.

> >

> > So what's a mother to do? May I suggest the use of

> > common sense. Be

> > conservative in your decisions to release PHI,

> > consult your Privacy Officer, and if

> > she doesn't know the answer, she'll contact the

> > HIPAA/Confidentiality

> > Attorney, and they'll figure it out.

> >

> > One resource that folks always seem to forget is to

> > just call the CMS people

> > and ask them point blank what their interpretation

> > is. If you do that, you

> > add some body armor, and even though they often say,

> > " Hmmmmm......we've never

> > thought of that before. We'll have to get a staff

> > opinion, but we'll get back

> > to you on it, " they can be a huge asset. After

> > all, they hear lots of

> > stories, and they may have already figured your

> > problem out.

> >

> > You won't be penalized for asking them for help, and

> > they'll remember your

> > cry in the wilderness in the event that some bozo

> > files a complaint against you.

> >

> > Happy St. Pat's day, or what's left of it.

> >

> > Gene Gandy, JD, LP

> > In a message dated 3/17/06 20:57:36,

> > hatfield@... writes:

> >

March 17, 2006

Information gathered during the course of patient assessment or treatment would

fall into HIPPA guidelines. There is a distinct difference between what we may

divulge under HIPPA and waht we are required to report under state guidelines.

That's apples to oranges.

If an officer wants a copy of a patient report, it needs to be gotten via a

subpeona, or the patient can request one from my privacy officer and give it to

him.

Law enforcement is certainly NOT exempt from HIPPA by any stretch of the

imagination.

Mike

----- HIPPA

>>

>> DOES ANYONE KNOW WHERE I CAN FIND OUT INFO ABOUT

>> HIPPA?

>> MY PROBLEM IS THAT I HAVE A COUPLE OF POLICE

>> OFFICERS REQUESTING

>> PATIENT REPORTS. THEY STATE THAT THEY CAN HAVE

>> COPIES CAUSE THEY ARE

>> EXCEMPT FROM THE HIPPA LAW?

>> I NEVER HEARD OF THAT SO I NEED INFO TO PROVE MY

>> CASE

>>

>> ALSO WHEN WE DO CALLS IN JAIL THEY ALSO WANT

>> COPIES SO THAT THEY HAVE

>> PROOF THAT THE INMATES GOT THEIR MEDICAL ATTENTION

>> THAT THEY REQUESTED.

>>

>> CAN YOU HELP ME?

>>

March 17, 2006

My HIPAA advice is no different from the advice that I

generally gave healthcare providers in any

medical-legal situation when I was still practicing

law:

1) err on the side of caution;

2) be familiar with the provisions of the

statute you are operating under;

3) when in doubt don't guess, call the lawyer;

4) if it doesn't make sense, don't do it until

you've completed steps 1 through 3;

5) protect your patient; and

5) document, document, document.

We've all known these things since completing our

basic EMT courses. Whether you're dealing with a DNR

Order, a Durable Power of Attorney for Healthcare, an

Advanced Directive, a HIPAA situation, or staring at a

Subpoena Duces Tecum for tomorrow morning, these steps

will help calm your nerves and help you make a

well-reasoned, intelligent decision.

Todd, B.S., J.D., EMT-P

--- wegandy1938@... wrote:

> Correct, Mr. Mike. In fact, LE ain't covered by

> HIPAA, and has NO right to

> PHI unless it is granted that right in the statute.

>

> As I mentioned in another post just before this one,

> what EMS people in

> Texas need to remember is that Chapter 773 of the

> Health and Safety Code, The EMS

> Act, has extensive and stringent confidentiality

> requirements which, in some

> cases, exceed the requirements of HIPAA.

>

> HIPAA states that if a state law is more stringent

> than HIPAA, state law

> prevails. So, maybe we ought to be taking a look

> at 773 and trying to figure out

> how those provisions fit with HIPAA.

>

> Don't get into the trap of violating 773 while

> trying to comply with HIPAA.

> Now, none of us are on the Supreme Court of Texas

> (are we?) or the 5th

> Circuit Court of Appeals (Federal appeals court) or

> THE SUPREMES (well, you know

> them), and none of those courts have made any sort

> of ruling about the

> relationship of HIPAA to 773's provisions, and they

> may NEVER do it.

>

> So what's a mother to do? May I suggest the use of

> common sense. Be

> conservative in your decisions to release PHI,

> consult your Privacy Officer, and if

> she doesn't know the answer, she'll contact the

> HIPAA/Confidentiality

> Attorney, and they'll figure it out.

>

> One resource that folks always seem to forget is to

> just call the CMS people

> and ask them point blank what their interpretation

> is. If you do that, you

> add some body armor, and even though they often say,

> " Hmmmmm......we've never

> thought of that before. We'll have to get a staff

> opinion, but we'll get back

> to you on it, " they can be a huge asset. After

> all, they hear lots of

> stories, and they may have already figured your

> problem out.

>

> You won't be penalized for asking them for help, and

> they'll remember your

> cry in the wilderness in the event that some bozo

> files a complaint against you.

>

> Happy St. Pat's day, or what's left of it.

>

> Gene Gandy, JD, LP

> In a message dated 3/17/06 20:57:36,

> hatfield@... writes:

>

> > Information gathered during the course of patient

> assessment or treatment

> > would fall into HIPPA guidelines. There is a

> distinct difference between what

> > we may divulge under HIPPA and waht we are

> required to report under state

> > guidelines. That's apples to oranges.

> >

> > If an officer wants a copy of a patient report, it

> needs to be gotten via a

> > subpeona, or the patient can request one from my

> privacy officer and give it

> > to him.

> >

> > Law enforcement is certainly NOT exempt from HIPPA

> by any stretch of the

> > imagination.

> >

> > Mike

> > ----- HIPPA

> > >>

> > >> DOES ANYONE KNOW WHERE I CAN FIND OUT INFO

> ABOUT

> > >> HIPPA?

> > >> MY PROBLEM IS THAT I HAVE A COUPLE OF POLICE

> > >> OFFICERS REQUESTING

> > >> PATIENT REPORTS. THEY STATE THAT THEY CAN

> HAVE

> > >> COPIES CAUSE THEY ARE

> > >> EXCEMPT FROM THE HIPPA LAW?

> > >> I NEVER HEARD OF THAT SO I NEED INFO TO PROVE

> MY

> > >> CASE

> > >>

> > >> ALSO WHEN WE DO CALLS IN JAIL THEY ALSO WANT

> > >> COPIES SO THAT THEY HAVE

> > >> PROOF THAT THE INMATES GOT THEIR MEDICAL

> ATTENTION

> > >> THAT THEY REQUESTED.

> > >>

> > >> CAN YOU HELP ME?

> > >>

March 18, 2006

I have a question, Gene, regarding inmates. Isn't the prison or county or city

the temporary " legal guardian " of an inmate? What if an inmate wants an

ambulance ride to the ED but their particular complaint is not justifying

emergency transport to the hospital meaning that the jail has to decide how and

when the patient will be evaluated? Doesn't the jail have the right and the

responsibility to refuse transport and then take care of the patient by other

means REGARDLESS of what the patient wants when it is not an emergency? (This

is the typical scenario where the patient is trying to get out of jail cause

they know many jails would rather release them and let them go in the ambulance

and worry about arresting them another time than paying for the ambulance bill.)

Since the jail can legally refuse for the patient (can't they in this scenario?)

rather than letting the patient be transported for a non-emergency situation and

getting stuck paying for unnecessary services, doesn'

t that establish the precedent that the county, city, whatever is the temporary

legal guardian of a prisoner? Is there a law that defines this? And if so,

does that extend as it does to a regular patient's legal guardian as far as

release of records, etc.?

Jane Hill

--------- HIPPA

> >

> > DOES ANYONE KNOW WHERE I CAN FIND OUT INFO ABOUT

> > HIPPA?

> > MY PROBLEM IS THAT I HAVE A COUPLE OF POLICE

> > OFFICERS REQUESTING

> > PATIENT REPORTS. THEY STATE THAT THEY CAN HAVE

> > COPIES CAUSE THEY ARE

> > EXCEMPT FROM THE HIPPA LAW?

> > I NEVER HEARD OF THAT SO I NEED INFO TO PROVE MY

> > CASE

> >

> > ALSO WHEN WE DO CALLS IN JAIL THEY ALSO WANT

> > COPIES SO THAT THEY HAVE

> > PROOF THAT THE INMATES GOT THEIR MEDICAL ATTENTION

> > THAT THEY REQUESTED.

> >

> > CAN YOU HELP ME?

> >

March 18, 2006

Gene says:

" As far as reporting what the patient tells you, the rule is that you must

report what the law requires you to report. No law, no report. Typical

reportable items are child, elder, and spousal abuse, certain infectious

diseases,

certain injuries, and so forth. Otherwise, you cannot disclose what the

patient says, because the patient interview is a part of the medical

record. "

I am aware of the reporting issuse with all of the above EXCEPT " spousal

abuse. " Could you reference that for us? Are you saying that an adult, who

is not physically handicapped or otherwise especially " at risk " who has been

assaulted domestically is reportable? My understanding is that a typical

wife beating scenario (not involving gun/knife assault use whch is

reportable) can NOT be disclosed to the authorities without the patient's

permission.

Thanks for the update.

Kirk D. Mahon, MD, ABEM

6106 Keller Springs Rd

Dallas, TX 75248

March 18, 2006

There is a new form out that TDSHS says must be on

every vehicle and is to be used in the case of

domestic violence.

Salvador Capuchino Jr

EMT-P/Vol. FF

--- Kirk Mahon wrote:

> Gene says:

>

> " As far as reporting what the patient tells you, the

> rule is that you must

> report what the law requires you to report. No

> law, no report. Typical

> reportable items are child, elder, and spousal

> abuse, certain infectious

> diseases,

> certain injuries, and so forth. Otherwise, you

> cannot disclose what the

> patient says, because the patient interview is a

> part of the medical

> record. "

>

> I am aware of the reporting issuse with all of the

> above EXCEPT " spousal

> abuse. " Could you reference that for us? Are you

> saying that an adult, who

> is not physically handicapped or otherwise

> especially " at risk " who has been

> assaulted domestically is reportable? My

> understanding is that a typical

> wife beating scenario (not involving gun/knife

> assault use whch is

> reportable) can NOT be disclosed to the authorities

> without the patient's

> permission.

>

> Thanks for the update.

>

> Kirk D. Mahon, MD, ABEM

>

> 6106 Keller Springs Rd

> Dallas, TX 75248

>

March 18, 2006

Gene,

Please clarify as I was under the impression that domestic violence is a

required reportable offense..... and quiet honestly, at this particular moment,

I don't feel like searching for the answer on the internet.....

Mike

Hatfield FF/EMT-P

---------- Original Message ----------------------------------

Reply-To: texasems-l

Date: Sat, 18 Mar 2006 10:40:19 -0600

>Gene says:

>

> " As far as reporting what the patient tells you, the rule is that you must

>report what the law requires you to report. No law, no report. Typical

>reportable items are child, elder, and spousal abuse, certain infectious

>diseases,

>certain injuries, and so forth. Otherwise, you cannot disclose what the

>patient says, because the patient interview is a part of the medical

>record. "

>

>I am aware of the reporting issuse with all of the above EXCEPT " spousal

>abuse. " Could you reference that for us? Are you saying that an adult, who

>is not physically handicapped or otherwise especially " at risk " who has been

>assaulted domestically is reportable? My understanding is that a typical

>wife beating scenario (not involving gun/knife assault use whch is

>reportable) can NOT be disclosed to the authorities without the patient's

>permission.

>

>Thanks for the update.

>

>Kirk D. Mahon, MD, ABEM

>

>6106 Keller Springs Rd

>Dallas, TX 75248

>

March 18, 2006

In a message dated 18-Mar-06 10:41:09 Central Standard Time,

kirkmahon@... writes:

I am aware of the reporting issuse with all of the above EXCEPT " spousal

abuse. " Could you reference that for us? Are you saying that an adult, who

is not physically handicapped or otherwise especially " at risk " who has been

assaulted domestically is reportable? My understanding is that a typical

wife beating scenario (not involving gun/knife assault use whch is

reportable) can NOT be disclosed to the authorities without the patient's

permission.

Several states, including at least Louisiana and Tennessee have had 'spouse

abuse' and 'elder abuse' laws on the books for some time modeled after the

various well tested child abuse laws.

with the same type of reporting requirements and protections in general for

reports made in good faith.

One of the differences is that an adult 'victim' of abuse can refuse to

press charges after the report is made *in some cases*...in others, where there

is evidence of serious bodily harm, no complaint is needed and the apparent

perp is hauled off for booking. If there is the elevated potential for serious

bodily harm, the two parties may be required to at least cool down in

separate domiciles for a period of time

S. Krin, DO FAAFP

March 18, 2006

For anyone who wants to read th rule in full... Chpater 91 of Texas Statutes

Family Code can be accessed at the following link:

Entire Family Code:

http://www.capitol.state.tx.us/statutes/fatoc.html

Direct to Chapter 91

as PDF:

http://www.capitol.state.tx.us/statutes/docs/FA/content/pdf/fa.004.00.000091.00.\

pdf

as DOC:

http://www.capitol.state.tx.us/statutes/docs/FA/content/word/fa.004.00.000091.00\

..doc

I hope this is helpfull all,

Tom Snead

Woodlands, Texas

Re: HIPPA

Gene,

Please clarify as I was under the impression that domestic violence is a

required reportable offense..... and quiet honestly, at this particular

moment, I don't feel like searching for the answer on the

internet.....

Mike

Hatfield FF/EMT-P

---------- Original Message ----------------------------------

Reply-To: texasems-l

Date: Sat, 18 Mar 2006 10:40:19 -0600

>Gene says:

>

> " As far as reporting what the patient tells you, the rule is that you

must

>report what the law requires you to report. No law, no report.

Typical

>reportable items are child, elder, and spousal abuse, certain

infectious

>diseases,

>certain injuries, and so forth. Otherwise, you cannot disclose what

the

>patient says, because the patient interview is a part of the medical

>record. "

>

>I am aware of the reporting issuse with all of the above EXCEPT

" spousal

>abuse. " Could you reference that for us? Are you saying that an

adult, who

>is not physically handicapped or otherwise especially " at risk " who has

been

>assaulted domestically is reportable? My understanding is that a

typical

>wife beating scenario (not involving gun/knife assault use whch is

>reportable) can NOT be disclosed to the authorities without the

patient's

>permission.

>

>Thanks for the update.

>

>Kirk D. Mahon, MD, ABEM

>

>6106 Keller Springs Rd

>Dallas, TX 75248

>

March 18, 2006

Never mind, found it, Chapter 91. Doesn't require is to report it to

authorities, however, it requires us to provide the victim (or alleged

victim) with information regarding family violence shelters, and it must

be provided in English and Spanish.

Salvador, the form you are talking about has been out for some time, I

can remember making the typing them up at least 7 years ago for a

service that I worked for.

Mike

Re: HIPPA

Gene,

Please clarify as I was under the impression that domestic violence is a

required reportable offense..... and quiet honestly, at this particular

moment, I don't feel like searching for the answer on the

internet.....

Mike

Hatfield FF/EMT-P

---------- Original Message ----------------------------------

Reply-To: texasems-l

Date: Sat, 18 Mar 2006 10:40:19 -0600

>Gene says:

>

> " As far as reporting what the patient tells you, the rule is that you

must

>report what the law requires you to report. No law, no report.

Typical

>reportable items are child, elder, and spousal abuse, certain

infectious

>diseases,

>certain injuries, and so forth. Otherwise, you cannot disclose what

the

>patient says, because the patient interview is a part of the medical

>record. "

>

>I am aware of the reporting issuse with all of the above EXCEPT

" spousal

>abuse. " Could you reference that for us? Are you saying that an

adult, who

>is not physically handicapped or otherwise especially " at risk " who has

been

>assaulted domestically is reportable? My understanding is that a

typical

>wife beating scenario (not involving gun/knife assault use whch is

>reportable) can NOT be disclosed to the authorities without the

patient's

>permission.

>

>Thanks for the update.

>

>Kirk D. Mahon, MD, ABEM

>

>6106 Keller Springs Rd

>Dallas, TX 75248

>

March 18, 2006

Jane,

Once again, yes and no.

First, let's define the issues. It is true that the facility has physical

possession of the prisoner, and that gives them some control over the prisoner.

The correctional facility has the DUTY to provide medical care to the

prisoner. However, it does not have the RIGHT to force unwanted treatment on

the

prisoner. Nor can it legally prevent the prisoner from receiving needed

treatment.

For example, If the prisoner is injured, the facility has the duty to

provide treatment. But, the facility could not force the prisoner to

participate

in medical research against his will. This was done in some instances in the

past that have become famous. Such activities have been declared to be

unconstitutional.

The facility may choose appropriate means of transport for the prisoner,

within narrow bounds. A prisoner who has been stabbed could not legally be

transported in a sheriff's car if an ambulance is available. This would

violate

the prisoner's rights. But if ambulance transport is not needed, such as when

the prisoner has only a sore throat, transport by car would be appropriate.

The custodian makes these determinations at its peril, however. It had

better be right.

Now, none of this has a single thing to do with the prisoner's HIPAA rights

or the application of HIPAA to a custodial facility. I posted a summary of

situations where the patient's PHI can be shared with a custodial facility the

other day. If you didn't see that, let me know and I'll post it again.

As far as allowing an individual to go to the hospital rather than being

arrested, the key is the term arrest. What constitutes an arrest? Basically,

if the person is not allowed to leave, he's under arrest. Therefore, when th

e patient is given the choice of going to jail or being arrested, he is not

at that moment under arrest. If he decides to refuse medical treatment during

transport and demands that the truck be stopped so that he can leave, he gets

his way. Or if he walks away from the hospital as soon as you deliver him

to the ER, he can do that. On the other hand, if he is under arrest during

the transport, a cop should be along for the ride, but under those

circumstances the city or the county or the state owes the bill.

As far as " precedent " let's remember that social custom does not equal legal

precedent. Legal precedent comes from the courts, interpreting statutes and

common law. The most familiar inmate precedents come from Ruiz v. The State

of Texas, the case that basically defined prisoner rights in Texas.

The custodial facility is NOT the legal guardian of a prisoner. A legal

guardian is established by the courts, and it requires a court order. Legal

guardians have tons of powers that a custodial facility does not have. For

example, a legal guardian can, in some instances, execute a DNR order for the

ward. A custodial facility cannot do that. A legal guardian can buy and sell

property in the ward's name. A custodial facility cannot do that. So the

relationship created between inmate and custodian is a very special sort of

relationship, very narrow in scope in one sense, broad in another. (How's that

for a lawyer's weasel words?)

Inmate law is extremely complex and no short summary can possibly describe

it.

The person that knows the most about inmate medical rights is Tattoo.

He posted a rather comprehensive description of inmate medical rights

recently. You might ask him if he still has that email and if he would forward

it

to you.

I'm not an expert on inmate law by any means. If I have misstated anything,

somebody slap me.

Gene

> I have a question, Gene, regarding inmates. Isn't the prison or county or

> city the temporary " legal guardian " of an inmate? What if an inmate wants an

> ambulance ride to the ED but their particular complaint is not justifying

> emergency transport to the hospital meaning that the jail has to decide how

and

> when the patient will be evaluated? Doesn't the jail have the right and the

> responsibility to refuse transport and then take care of the patient by

> other means REGARDLESS of what the patient wants when it is not an

emergency?

> (This is the typical scenario where the patient is trying to get out of jail

> cause they know many jails would rather release them and let them go in the

> ambulance and worry about arresting them another time than paying for the

> ambulance bill.) Since the jail can legally refuse for the patient (can't

they in

> this scenario?) rather than letting the patient be transported for a

> non-emergency situation and getting stuck paying for unnecessary services,

doesn'

> t that establish the precedent that the county, city, whatever is the

> temporary legal guardian of a prisoner? Is there a law that defines this?

And if

> so, does that extend as it does to a regular patient's legal guardian as far

> as release of records, etc.?

>

> Jane Hill

>

> --------- HIPPA

> > >

> > > DOES ANYONE KNOW WHERE I CAN FIND OUT INFO ABOUT

> > > HIPPA?

> > > MY PROBLEM IS THAT I HAVE A COUPLE OF POLICE

> > > OFFICERS REQUESTING

> > > PATIENT REPORTS. THEY STATE THAT THEY CAN HAVE

> > > COPIES CAUSE THEY ARE

> > > EXCEMPT FROM THE HIPPA LAW?

> > > I NEVER HEARD OF THAT SO I NEED INFO TO PROVE MY

> > > CASE

> > >

> > > ALSO WHEN WE DO CALLS IN JAIL THEY ALSO WANT

> > > COPIES SO THAT THEY HAVE

> > > PROOF THAT THE INMATES GOT THEIR MEDICAL ATTENTION

> > > THAT THEY REQUESTED.

> > >

> > > CAN YOU HELP ME?

> > >

March 18, 2006

Kirk,

Thanks for bringing that up. Sometimes I forget what list I'm writing on.

A number of states do require that spousal abuse be reported.

Texas " suggests " that it be done, but it also requires medical professionals

to hand to the victim a statutory statement advising them of their rights and

document this in the patient's medical records. This applies to all medical

professionals, from EMT first responders, EMT ambulance personnel, to

physicians.

Here's the pertinent article from the Texas Family Code:

FAMILY CODE

SUBTITLE C. REPORTING FAMILY VIOLENCE

CHAPTER 91. REPORTING FAMILY VIOLENCE

Sec.A91.001. DEFINITIONS.AAIn this subtitle:

(1)AA " Family violence " has the meaning assigned by

Section 71.004.

(2)AA " Medical professional " means a licensed doctor,

nurse, physician assistant, or emergency medical technician.

Added by Acts 1997, 75th Leg., ch. 34, Sec. 1, eff. May 5, 1997.

Sec.A91.002. REPORTING BY WITNESSES ENCOURAGED.AAA person

who witnesses family violence is encouraged to report the family

violence to a local law enforcement agency.

Added by Acts 1997, 75th Leg., ch. 34, Sec. 1, eff. May 5, 1997.

Sec.A91.003. INFORMATION PROVIDED BY MEDICAL

PROFESSIONALS.AAA medical professional who treats a person for

injuries that the medical professional has reason to believe were

caused by family violence shall:

(1)AAimmediately provide the person with information

regarding the nearest family violence shelter center;

(2)AAdocument in the personâ€™s medical file:

(A)AAthe fact that the person has received the

information provided under Subdivision (1); and

(B)AAthe reasons for the medical professionalâ€™s

belief that the personâ€™s injuries were caused by family violence;

and

(3)AAgive the person a written notice in substantially

the following form, completed with the required information, in

both English and Spanish:

" It is a crime for any person to cause you any physical

injury or harm even if that person is a member or

former member of your family or household.

" NOTICE TO ADULT VICTIMS OF FAMILY VIOLENCE

" You may report family violence to a law enforcement

officer by calling the following telephone numbers:

___________________________________________________.

" If you, your child, or any other household resident

has been injured or if you feel you are going to be in

danger after a law enforcement officer investigating

family violence leaves your residence or at a later

time, you have the right to:

" Ask the local prosecutor to file a criminal

complaint against the person committing family

violence; and

" Apply to a court for an order to protect you.

You may want to consult with a legal aid office, a

prosecuting attorney, or a private attorney. A court

can enter an order that:

" (1) prohibits the abuser from committing

further acts of violence;

" (2) prohibits the abuser from threatening,

harassing, or contacting you at home;

" (3) directs the abuser to leave your

household; and

" (4) establishes temporary custody of the

children or any property.

" A VIOLATION OF CERTAIN PROVISIONS OF COURT-ORDERED

PROTECTION MAY BE A FELONY.

" CALL THE FOLLOWING VIOLENCE SHELTERS OR SOCIAL

ORGANIZATIONS IF YOU NEED PROTECTION:

_________________________________. "

Added by Acts 1997, 75th Leg., ch. 34, Sec. 1, eff. May 5, 1997.

Sec.A91.004. APPLICATION OF SUBTITLE.AAThis subtitle does

not affect a duty to report child abuse under Chapter 261.

Added by Acts 1997, 75th Leg., ch. 34, Sec. 1, eff. May 5, 1997.

1

Does 91.002 trump HIPAA? Who knows. It is advisory rather than mandatory.

I doubt that there will be a case on this issue anytime soon. I suppose

if I witnessed serious spousal abuse, I'd risk the $100 fine and report it, but

to each his own decision.

Gene

> Gene says:

>

> " As far as reporting what the patient tells you, the rule is that you must

> report what the law requires you to report.Â Â No law, no report.Â Â Typical

> reportable items are child, elder, and spousal abuse, certain infectious

> diseases,

> certain injuries, and so forth.Â Â Otherwise, you cannot disclose what the

> patient says, because the patient interview is a part of the medical

> record. "

>

> I am aware of the reporting issuse with all of the above EXCEPT " spousal

> abuse. " Â Could you reference that for us?Â Are you saying that an adult, who

> is not physically handicapped or otherwise especially " at risk " who has been

> assaulted domestically is reportable?Â My understanding is that a typical

> wife beating scenario (not involving gun/knife assault use whch is

> reportable) can NOT be disclosed to the authorities without the patient's

> permission.

>

> Thanks for the update.

>

> Kirk D. Mahon, MD, ABEM

>

> 6106 Keller Springs Rd

> Dallas, TX 75248

>

March 18, 2006

Mike, I've addressed this in another post. Reporting in Texas is

" encouraged " but not mandatory. Other states do have mandatory reporting

requirements.

GG

E.(Gene) Gandy

POB 1651

Albany, TX 76430

wegandy1938@...

March 18, 2006

Probably, but the company I was last a D.O. for was

required by TDSHS to carry on the unit itself this

last time in 2005 that they recieved their renewal.

--- Hatfield wrote:

> Never mind, found it, Chapter 91. Doesn't require is

> to report it to

> authorities, however, it requires us to provide the

> victim (or alleged

> victim) with information regarding family violence

> shelters, and it must

> be provided in English and Spanish.

>

> Salvador, the form you are talking about has been

> out for some time, I

> can remember making the typing them up at least 7

> years ago for a

> service that I worked for.

>

> Mike

>

> Re: HIPPA

>

> Gene,

>

> Please clarify as I was under the impression that

> domestic violence is a

> required reportable offense..... and quiet honestly,

> at this particular

> moment, I don't feel like searching for the answer

> on the

> internet.....

>

> Mike

>

> Hatfield FF/EMT-P

>

> ---------- Original Message

> ----------------------------------

>

> Reply-To: texasems-l

> Date: Sat, 18 Mar 2006 10:40:19 -0600

>

> >Gene says:

> >

> > " As far as reporting what the patient tells you,

> the rule is that you

> must

> >report what the law requires you to report. No

> law, no report.

> Typical

> >reportable items are child, elder, and spousal

> abuse, certain

> infectious

> >diseases,

> >certain injuries, and so forth. Otherwise, you

> cannot disclose what

> the

> >patient says, because the patient interview is a

> part of the medical

> >record. "

> >

> >I am aware of the reporting issuse with all of the

> above EXCEPT

> " spousal

> >abuse. " Could you reference that for us? Are you

> saying that an

> adult, who

> >is not physically handicapped or otherwise

> especially " at risk " who has

> been

> >assaulted domestically is reportable? My

> understanding is that a

> typical

> >wife beating scenario (not involving gun/knife

> assault use whch is

> >reportable) can NOT be disclosed to the authorities

> without the

> patient's

> >permission.

> >

> >Thanks for the update.

> >

> >Kirk D. Mahon, MD, ABEM

> >

> >6106 Keller Springs Rd

> >Dallas, TX 75248

> >

March 20, 2006

Tattoo... who dat?

wegandy1938@... wrote: