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Patient privacy rules frustrate

By William K. Alcorn

Monday, February 23, 2004

HIPAA has provided yet another area in which to sue doctors.
Family members get angry when they can't get medical information from the doctor who is taking care of their elderly relative.
"When I say we can't tell them [without their relative's permission because of new federal rules governing the privacy of medical records] they become irate," said Dr. Dean Economous, president of the Columbiana County Medical Society. Dr. Economous is associated with the Salem Family Practice.
In April 2003, when the new medical records privacy rules that are part of the Health Insurance Portability and Accountability Act of 1996 went into effect, residents at Copeland Oaks-Randall Medical Park Retirement Community were upset when they suddenly found the list of fellow residents hospitalized was no longer posted.
That policy has since been adjusted, and now, if a resident gives permission to post his name, Copeland Oaks considers it allowable under HIPAA, a spokeswoman said.
"There were situations where physicians would not send us protected health information and vice versa, for fear of potential financial penalties associated with HIPAA," said John Schultz, Forum Health's compliance officer and data security administrator.
Changes in offices
Some doctors removed sign-in lists from their offices so patients wouldn't see one another's names. Other physicians asked patients to sign in with their first names only, or used lists with stickers that were immediately removed after patients signed in.
Charts were hung on examining room doors with the patient name and medical information facing inward so it could not be seen by people passing by.
In some cases, there were costs to health care providers for physical changes in their offices.
Dr. Lori Crowl, associated with Family Health Care of Columbiana County, said a door was installed in the office between the waiting area and patient care area to keep unauthorized people out of the patient area and away from any medical information that might be there. Dr. Crowl is 2003 president of the Columbiana Medical Society.
The Visiting Nurse Association of Greater Youngstown walled in an area of its office to keep client medical records, with a locked door, as a reaction to HIPAA, said Suzanne Tucci, VNA director.
"From my standpoint as a surgeon in private practice, HIPAA has created ... more out-of-pocket expense to do exactly what I did before," said Dr. Marc Saunders, president of the Mahoning County Medical Society.
Also, he said, HIPAA has provided yet another area in which to sue doctors, who are already gun-shy because of medical malpractice suits and the resulting huge increases in medical liability insurance.
Using common sense
There was a lot of paranoia in the medical community when HIPAA first came out, Schultz said. But, now the concern, while not totally abated, is starting to calm down, he said.
"I told our people at Forum Health, if you remember nothing else about HIPAA, remember common sense and what's reasonable," he said.
Staff at Humility of Mary Health Partners were told: "If you keep the best interest of the patient first and foremost, you won't err," said Kathy Proper, HMHP's interim corporate responsibility and privacy officer.
"Our instruction to the HMHP staff in handling medical information is to ask: "Are they authorized to know and do they need to know," Proper said.
"For instance, if a person brings somebody to the hospital who is not able to sign an information release form, we can make the assumption it is OK to tell that person that the patient had a heart attack. However, we can't reveal previous medical information ... only about that moment in time," Proper said.
Probably the most difficult thing about implementing HIPAA was changing the overall culture of sharing patient information freely, especially from employee to employee. It takes time to change mind-sets, Schultz said.
Patients' rights
Patients also have to be made aware of HIPAA regulations, and hospitals ask their patients if they want their names listed in the church and religion directory.
"If they do, when churches call, we can confirm if any of their members are here and give their room numbers; but no specific medical information," Schultz said.
At first, pastors were upset because they could not call a hospital and find out if any of their parishioners were patients, as they had before HIPAA. Now, there is a process at local hospitals, where if patients sign off, their names can be placed on a list accessible by church and family and florists.
Still, not all pastors are pleased with the effects of HIPAA.
Hospitals no longer call churches, as they did previously, to let them know when a member is hospitalized, even if the patient requests they do so, said the Rev. Martin Hardy, pastor of the First United Church of Christ in Warren.
"This hinders our efforts as a church to stay in touch with and provide spiritual nurturing for our members when they are hospitalized," said the Rev. Mr. Hardy, secretary of the Warren Area Clergy Association.
Hypothetical scenario
"If someone calls the hospital, be it the police or a family member, and they give a good description of the patient, we'll say yes, maybe we do have somebody, you better come down," Schultz said.
But, if the police say they are looking for a suspect who may have a cut on his arm, but provide no description or other identifying information, the hospital would not give out the names of people treated for an arm cut, Schultz said.
However, Lt. Robin Lees of the Youngstown Police Department said hospitals are required to report all violent crimes to the police. Lees said he knows of no instance when the police department has been unable to get information it needed for an investigation.
Individuals and the press have to ask for patients by name to receive information. But if a patient requests no information be released, the hospital won't give out any information to anyone, including clergy, family or the police, Shultz said.
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