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February 6, 2016

HIPAA, and what it doesn’t cover.

By | Healthcare Policy, Nursing | 2 Comments

HIPAA. ¬†The elephant in the room, or the Hippo, depending on who you talk to ūüôā

I love this Myth and Fact list….¬†It is really concise, and answers a lot of questions.

hipaa-hippoHowever, there are other things that hospitals and physician practices  need to get over about HIPAA.  If they want these rules to be part of their personnel or operations manual, great. However, they are NOT HIPAA Violations:

  • Showing a parent the medical information about their minor child. This is specifically¬†controlled by state law. ¬†Minor Children do not have to sign a release form for their parents to be able to get their medical information. There are a few exceptions to that.
  • Examples of organizations that do not have to follow¬†the Privacy and Security Rules include:
    • Life insurers
    • Employers
    • Workers compensation carriers
    • Most schools and school districts
    • Many state agencies like child protective service agencies
    • Most law enforcement agencies
    • Many municipal offices
  • Completely de identified health information.¬†When you do not give a patient’s age, sex, location, a specific description of an injury, identifying information in the patient’s history (ie, patient has had three stillbirths) name, address, telephone number, email address, family names, etc….you have violated NOTHING. “OMG This patient is KILLING ME” is not a HIPAA violation. ¬†However, your employer has the right to say that you are not allowed to mention work at all on social media.
  • “We are understaffed” NOT A HIPAA VIOLATION. Nice try, healthcare organization. Your employer should not have a right to regulate that, and quite frankly should have to disclose it to all patients depending on care at the facility. IJS.However, at this point they can tell you you are not allowed to post about the facility on social media.
  • The HIPAA Privacy Rule allows physicians and staff to use and disclose PHI without a patient’s written authorization for purposes related to treatment, payment, and health care operations.¬† It further defines “health care operations” to include “to conduct training programs in which students, trainees, or practitioners in areas of health care learn under supervision to practice or improve their skills as health care providers.”¬†So you do not need permission to use a case with de identified health information as a case study. ¬†However, you must use the minimum amount of PHI possible, and it must stay within the organization. Transmitting it elsewhere is different.
  • Treatment, Payment, and Healthcare operations rules can be found here

HIPAA is actually pretty simple. ¬†Don’t tell people about other people’s medical conditions who have no business knowing about them. A ton of the ‘rules’ we follow are myths and ridiculous. ¬†If you make a mistake, document it and don’t do it again.

My story of the ridiculousness of HIPAA.  IMG_0032

My Son, Alexander was killed on February 18, 2011 at the age of 17, two months before his 18th birthday. ¬†I received a bill from the EMS provider and called to ask for an itemized statement in June. ¬†I was told that he had not released his medical information to me in writing. ¬†I said that I was his mother, and that he was dead. ¬†The company stated that he was an adult and had to sign to give me permission to have the statement. ¬†I told the person that he actually died as a minor. ¬†She said, “But he is over 18 now.”

I declined to pay.



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Taking care of our Heroes – The challenges and the love

By | Uncategorized | 14 Comments

I am a proud and grateful VA Nurse. ¬†Don’t laugh. ¬†The VA is literally the hardest job I have ever loved. ¬†I feel as though I am marked as soon as I tell people where I work. The only thing anyone ever hears about are the scandals, the mistakes, and the wait times. The other 99.9% of VA patients are effectively silenced, because stories about good care, lovingly delivered are not exciting.

Except maybe to us….Nurses understand this.

When the Phoenix VA scandal broke, the first thing that was said was how dozens or hundreds of vets died waiting for care.   Naturally, this was not QUITE the case. There was a LOT of truth, and some corrupt people, but there are also a lot of unreasonable expectations that the VA is expected to meet, and the private sector does not have to worry about.  

The world never sees a whole lot about care that our heroes get with the VA.  Can I tell you about some of it?

  • When you repeatedly no-show or cancel your own extremely necessary medical appointments with the VA, we keep calling and begging that you show up. ¬†The private sector would simply cross you off the list.
  • We arrange transportation, overnight hotel stays, and intervention from your primary care or mental health team to talk you into doing what¬†will keep you healthy. We even pay you to drive yourself to appointments if you are travel-eligible.¬†The sheer numbers of noncompliant patients in the VA system are astonishing. Part of this is because some of these poor guys have psychiatric and/or TBI issues.¬† This delays their care.
  • The Veteran’s Choice program is a great option for those who wish to seek care outside of the VA system. ¬†There is just one problem with that. ¬†Most of these guys want to come to the VA. ¬†We understand them. ¬†We love them. ¬†We have their medical history dating back to the flood. ¬†When we get the opportunity, we spoil them. ¬†All is not what it might seem like on Fox News.
  • The wait times are not as bad as it might seem. (Phoenix is a huge exception here) Have you ever tried to get into a new primary care physician? It can take 3-4 months if you are trying to get into a specific practice. ¬†We now have an average of 42 days, which we are trying to get under 30 days.
  • Many of our patients are transient and do not have working phone numbers or permanent addresses. ¬†We call many times, and send many letters before we give up on anyone. ¬†And the time spent counts toward our wait times. It is not chalked up to patient noncompliance, or the patient failing to update their address or phone numbers with us.
  • It can take three hours to schedule a patient for a procedure¬†in the environment where I work. ¬†It depends on how complex the patient is, what pre-op testing and teaching is required, and a ton of other factors. ¬†And with some frequency, these patients cancel their procedures multiple times at the last minute. ¬†This wastes valuable lab time, and leaves specialized physicians sitting idle when they want to be taking care of vets. ¬†Make no mistake. ¬†VA Doctors do NOT make a ton of money. ¬†They care, which is part of their compensation.

Before I was a VA Nurse, I was a VA Patient’s family member. ¬†My Father-in-Law was a decorated Vietnam Vet. ¬†Purple Heart, Bronze Star, etc.

He was also a non-compliant drug and alcohol addict with horrible PTSD.  He refused treatment for all of these things for literally decades.  When we finally got him to be (somewhat) compliant with his medications and treatment, it was because a VA counselor spent literally hours on several days talking to him about why he felt the way he did.

He was sent to a specialized inpatient PTSD program for a couple of months. He went to ‘group’ (therapy) every week with the most compassionate physician I have ever met. ¬†He was at Dad’s funeral when he died of cancer in 2012. ¬†He was sent¬†to arguably the best hospital in our region for his lobectomy when his lung cancer was diagnosed. ¬†It didn’t cost him a single dime. ¬†His hospice care was wonderful, also paid for by the VA. ¬†He died with dignity.

His care was way more comprehensive than any I have ever received or witnessed. He asked me to go to work at the VA multiple times, because he knew I would love it and take good care of the vets. So I did, after he died. I would like to think he is proud of me.

A common theme with my patients is a sentiment of bewilderment when they hear about how terrible the VA is on the TV news. ¬†They usually tell me they have never had anything but terrific care at the VA. ¬†I always say the same thing. ¬†“Happy customers do not call news channels.” We laugh about it a bit. ūüôā

There is something I hear over the loudspeaker at work at varying intervals…. I will get some of the words wrong, but you will get the idea.

“At the VA Medical Center in St Louis we honor our veterans in death and in life. A hero is making his final journey, draped in the flag of our nation. We ask that all present and former military members render a salute when he passes, and that civilians place their hand over their heart”

I am humbled to be with these guys when they come in for care, when I am giving them directions to a clinic, when I start their IV, and hold their hand when they are scared. I can rarely see the Veteran passing on the flag-draped stretcher because of the tears stinging my eyes and clouding my vision.

But my vision for our Mission is never clouded.

To fulfill President Lincoln’s promise “To care for him who shall have borne the battle, and for his widow, and his orphan” by serving and honoring the men and women who are America’s veterans

You bet, guys.  I will be here.  










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