patient privacy breach

[Amber]

I've a friend who received an interesting e-mail from her cousin today. Seems my friend's cousin and mother both go to the same Dr., which makes sense, as it's a small town with only one Dr.

Anyways, the e-mail stated that the cousin had discussed my friend's mother's medical conditions and pain-medication usage with the Dr. Isn't this a breach of patient confidentiality, and what can be done to prevent it from happening again, other than speaking to the Dr. directly and asking him to keep this information confidential?

[Miss X]

You shouldn't have to ASK any healthcare professional to keep something confidential. I don't know what the code of conduct is like in the US, but in the UK there are very specific rules about when we can break confidentiality. A professional can be struck off for breaking those rules. I'd look into it, there's no way a Dr should be discussing another patients pain medication with a relative.

[Gan]

I've a friend who received an interesting e-mail from her cousin today. Seems my friend's cousin and mother both go to the same Dr., which makes sense, as it's a small town with only one Dr.

Anyways, the e-mail stated that the cousin had discussed my friend's mother's medical conditions and pain-medication usage with the Dr. Isn't this a breach of patient confidentiality, and what can be done to prevent it from happening again, other than speaking to the Dr. directly and asking him to keep this information confidential?

When you say discussed you mean the conversation was where information was freely given from the cousin and from the doctor, or at least thats my interpretation of it.

You have several remedies to pursue, depending on how serious the breech of security is considered by your mom.

1. First and foremost, your mom needs to notify the physician, in writing (so its official) that under no circumstances is the physician to discuss her medical condition with anyone, including family members without her explicit consent. Cease and Desist.

2. Familiarize yourself with HIPPA (http://www.hhs.gov/ocr/hipaa/)(Health Insurance Portability and Accountability Act). This is the governing guidelines for the confidentiality of patient information that all healthcare professionals and facilities must abide by.

3. Here is information on filing a complaint (http://www.hhs.gov/ocr/hipaahowto.pdf) used to file violations of the HIPPA act. This is what you need after you have determined the actual violation and wish to pursue beyond a letter of cease and desist to the physician.

4. And lastly, your mom should consider the option of switching healthcare providers.


For those interested in the legal application of how this rule is established:

Bottom of pp.12/middle column - the section starting with Consent: Current law and practice.
http://www.hhs.gov/ocr/part1.pdf

[Kyra231]

The only exception to the 'privacy' or hippa rules is if the daughter is the mothers poa or the mother had signed a paper giving consent for information to be given to the daughter.

If none of those are true, she can hang that office out to dry.

~K.

[Gan]

Yea, I didnt go the 'designated caregiver route' since I didnt read that into the OP.

I would hope it was all for good intentions; regardless, the doctor should have known better.

[Ilvane]

I would say it's a huge HIPPA violation if she didn't give permission. Basically that is all I have to add, since Gan pretty much covered what I would have said.

Angela

[kgolfer]

If the cousin initiated the discussion, and the doctor didn't give out personal medical information....then there probably wasn't anything "breached".

If at any point said doctor gave out personal information to someone not in the "need to know" or as delineated by the mother, then it is a HIPPA violation.

The "mother" would have to file the complain, and there is monetary compensation for said damages, although could be small; depends on the extend and damages.

[Stanley Burrell]

Anyways, the e-mail stated that the cousin had discussed my friend's mother's medical conditions and pain-medication usage with the Dr. Isn't this a breach of patient confidentiality, and what can be done to prevent it from happening again, other than speaking to the Dr. directly and asking him to keep this information confidential?

If it's a small enough town, they would probably had to have begun legal action with the confidentiality breaches by not having signed more than a handful of HIPAs, I'm imagining.

How tight-lipped can an MD be? If you're a wealthy private practitioner, you're pretty much obliged to give casuals an update on things.

[Jorddyn]

We recently went through an issue with my grandfather overmedicating on Vicodin. When we sent him into rehab, I personally went and discussed his usage and our family's concerns with three of his doctors and all of the pharmacists in town (small town - only 4 of them).

Did they breach confidentiality? I don't think so. I spoke, they listened.

In your situation, I would think it depends on who broached the subject, and how much if any information was provided.

Jorddyn

[kgolfer]

This is exactly what I was getting at.....if the physician answered general questions in regard to the mother, and didn't offer personal information on her, then there is NO violation.

The other end of this is.....even if the physician breached/violated HIPPA, if this is a small town with limited physician coverage; would you want to put this physician "out of business" and take away all of the town's medical resources?

Some small towns are so close-knit that everyone knows each other's business; good or bad. I spent the majority of my childhood in such a small town, luckily I "escaped".

[Whimsi]

Post a copy of the email with personal info deleted so it's easier to judge intent?

[Tolwynn]

The other end of this is.....even if the physician breached/violated HIPPA, if this is a small town with limited physician coverage; would you want to put this physician "out of business" and take away all of the town's medical resources?

It's pretty much the new American dream to do so, hit a fat lawsuit jackpot, get your lawyer a new Lexus, and fuck all to whatever happens to everyone else.

The doctor in question probably shouldn't have disclosed the information, but is that really an excuse to just go right for the jugular and "hang his office out to dry?"

Maybe some of you greedy bastards wouldn't be so eager to sue if diminishing medical coverage had affected you or yours, but hey, until then, who cares, right?

[Daniel]

Exactly.

[Amber]

Thanks for the info, I'll pass it along. I don't think anyone involved wants a lawsuit, they just want confidential information kept confidential. I can't post a copy of the e-mail as I'd probably be banned from the forum forever. It's honestly the most nasty, vile, horrible, out and out evil, hurtful e-mail I've ever seen.

Gist of the situation....friend's mom is terminally ill and is using fentanyl pain patches with the odd vicodin to control break-through pain. She had been taking oxycontin at one point, but was switched to the fentanyl due to her concerns about becoming dependant upon it.

Friend's mom and cousin had an altercation which had nothing to do with pain medications. Cousin has subsequently been telling everyone she knows that friend's mom is a hypochondriac drug-addict. She wrote in the e-mail that she'd been to see their Dr. and told him that she'd witnessed friend's mom getting stoned on her pain meds. Dr. then told her that it wasn't possible for someone to get stoned on the fentanyl pain patches, what meds was she talking about? Then answered his own question by stating it must be the vicodin. In the course of their conversation, he revealed, and actually gave cousin a listing, of all the medications and dosages friend's mother was taking. Cousin then e-mailed a copy of this list to everyone in the family, along with a horrible e-mail and is now saying that the list the Dr. gave her is proof friend's mom is an addict as cousin has a friend with a bad back who's only taking 25mg of fentanyl daily while cousin's mom is taking 50.

Sorry this is kind of rambling, but I hope it makes sense.

[kgolfer]

Small towns usually have pretty well established, older physician's....HIPPA is a relatively new law.

I agree though, make a mistake as a medical provider, and you are going to be buying someone a new car, etc.......and you may not even "mess up" and risk being sued. Happens all the time in the emergency department I work in.

[thefarmer]

Yeah, that's a violation.

I've had this happen with my ex, who is NOT authorized for any type of information.

[Jolena]

Thanks for the info, I'll pass it along. I don't think anyone involved wants a lawsuit, they just want confidential information kept confidential. I can't post a copy of the e-mail as I'd probably be banned from the forum forever. It's honestly the most nasty, vile, horrible, out and out evil, hurtful e-mail I've ever seen.

Gist of the situation....friend's mom is terminally ill and is using fentanyl pain patches with the odd vicodin to control break-through pain. She had been taking oxycontin at one point, but was switched to the fentanyl due to her concerns about becoming dependant upon it.

Friend's mom and cousin had an altercation which had nothing to do with pain medications. Cousin has subsequently been telling everyone she knows that friend's mom is a hypochondriac drug-addict. She wrote in the e-mail that she'd been to see their Dr. and told him that she'd witnessed friend's mom getting stoned on her pain meds. Dr. then told her that it wasn't possible for someone to get stoned on the fentanyl pain patches, what meds was she talking about? Then answered his own question by stating it must be the vicodin. In the course of their conversation, he revealed, and actually gave cousin a listing, of all the medications and dosages friend's mother was taking. Cousin then e-mailed a copy of this list to everyone in the family, along with a horrible e-mail and is now saying that the list the Dr. gave her is proof friend's mom is an addict as cousin has a friend with a bad back who's only taking 25mg of fentanyl daily while cousin's mom is taking 50.

Sorry this is kind of rambling, but I hope it makes sense.

Just a random comment, but my father was terminally ill and on the 80mg fentanyl pain patch, as well as vicodin for break-through pain. Yes, it can cause you to be loopy from it, but its regulated by the Doctor prescribing it, and if it weren't something the Doctor felt the patient needed to control pain, it wouldn't have been prescribed. That's the thing with terminal illness - its terminal. There's not much else you can do aside from control the pain and attempt to make them as comfortable as possible when its time.

The cousin sounds like she needs some education from the Doctor as well as her family members regarding what terminal illness means, and how much pain it can cause the person who has it without the use of pain meds like the fentanyl patch.

[Latrinsorm]

The cousin sounds like she needs some education from the Doctor as well as her family members regarding what terminal illness means, and how much pain it can cause the person who has it without the use of pain meds like the fentanyl patch.Or at least some education regarding not being a douchebag.

[Gan]

Or at least some education regarding not being a douchebag.

Thats got my vote.

[kgolfer]

If I was terminally ill I would hope a physician would prescribe me TONS of narcs to make life a little easier and tolerable.

[Gan]

There's a guy in my wife's unit who's on a Dilaudid PCA at a dose that would put down a horse.

He's end stage renal, not expected to be around much longer.

Its sick what levels of meds are perscribed to terminal patients and they just shrug it off like it was Tylenol.

[Kyra231]

A good hospice would be a thought also, yes? Having worked for one for more than a year I'm constantly amazed that doctors and the general public have such insane misconceptions about hospice.

At any rate they surely could help with the pain control & with education of the family(which it sounds like they need).

~k.

[TheEschaton]

Tell your friend or whoever might have PoA over your friend's mom, or your friend's mom, to sue the fucking shit out of that doctor.

I don't care if it's a small town doc who everyone counts on, that's egregious and someone should make an example of him to make sure that kind of stuff doesn't continue to go on.

-TheE-

[Tsa`ah]

Tell your friend or whoever might have PoA over your friend's mom, or your friend's mom, to sue the fucking shit out of that doctor.

I don't care if it's a small town doc who everyone counts on, that's egregious and someone should make an example of him to make sure that kind of stuff doesn't continue to go on.

-TheE-

That's a bit extreme don't you think? To me it sounds like someone pretended to have serious concern over a patient and the doc was duped to an extent.

There comes a time when some people in the medical community need to have their ass' litigated into poverty. Usually over gross incompetence/negligence, not addressing what appeared to be a legitimate concern.

[TheEschaton]

Duped to an extent? Supposedly the doc gave the person a list of all the medications the other person was on, and in what amounts.

And, if I can tell correctly, these people aren't related? Amber refers to them as "friend's mom" and "my cousin"? If that's so, there should have been an immediate "You know I can't discuss so-and-so's treatment with you."

This is not a legitimate concern to address. A patient's health, and how to address it, is between a patient, the patient's doctor, and possibly a caregiver/authorized PoA.

-TheE-

[Amber]

And, if I can tell correctly, these people aren't related? Amber refers to them as "friend's mom" and "my cousin"? If that's so, there should have been an immediate "You know I can't discuss so-and-so's treatment with you."

-TheE-

Sorry for not being clearer. Friend's mom and friend's cousin. I'm not related to anyone involved.

We think the Dr. actually had good intentions here. We think he was trying to point out to the cousin that the mother's not addicted because she takes this medicine for this condition, this medicine for this condition, this medication for this condition, etc. etc.

That said, even with the best of intentions, that information should not have been revealed to anyone but my friend's mother or father, who has been authorized to obtain any needed medical information about his wife.

Also, thanks for the info Jolena. What really gets me about this whole situation is that the cousin is using this time that should be so precious and treasured to be an absolute ass. I read the e-mail last night and still haven't been able to get over all the venom in it. My mom's terminally ill also, and I just can't imagine doing anything to hurt her, or anyone, like this woman is trying to hurt my friend's mother. People can be so flipping horribly disgusting.

[Shifted]

There comes a time when some people in the medical community need to have their ass' litigated into poverty. Usually over gross incompetence/negligence, not addressing what appeared to be a legitimate concern.


Such as not hooking you up to the machines in the ER when they give you your pain meds and your blood pressure bottoms out?

[Gan]

A letter of cease and desist to the doctor, then dumping his ass for another practitioner is what I recommend.

Then bitch slapping the cousin into next month.

[Beguiler]

And another succinct and spot-on recommendation from Gan.