irishone
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RE: Communications Info Concerning Medical/Mental Subjects
IT SOUNDS LIKE A FEEL GOOD POLICY, WHICH IN TURN JEOPARDIZES OFFICER SAFETY. THIS MEDICAL CONDITION INFORMATION IS USUALLY TRANSMITTED OVER FIRE AND PARAMEDIC RADIOS, SO WHY THE DIFFERENCE. OFFICERS HAVE A NEED TO KNOW IF SOMEONE THEY ARE GOING TO DEAL WITH ON A CALL FOR SERVICE WILL BE A HEALTH OR SAFETY THREAT TO THEM. IT IS THE SAME THING AS A DISPATCHER ADVISING OFFICERS IF A SUSPECT WERE ARMED....
HERE IS AN OLD BATCH OF POSTS ON THE SAME SUBJECT;
09-02-2007, 08:55 PM #1
WISHIN4BEACH
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My agency dispatch tells me that if a caller informs them they have a medical condition (AIDS, hepatitus,whatever), that the dispatcher is FORBIDDEN by the HIPAA law from relaying that information to the officer responding?
The dispatcher tells me she was informed of this in her APCO class.
So tell me what do you know about this ?
And what procedure does your agency follow?
And does anyone have any solid information that HIPAA laws do or do not apply to public safety?
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09-02-2007, 10:43 PM #2
Bing_Oh
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Posts: 2,473 HIPAA specifically restricts medical personnel from releasing medical information about a patient without either the prior consent of the patient or other exigent circumstances. HIPPA does not apply to law enforcement in any way...it's for medical personnel. By relaying that information to a dispatcher, the person is giving up any right to privacy about that information and its dissemination to law enforcement officers.
In my experience, HIPAA is the most confusing and misunderstood law to come out in a very long time. Law enforcement doesn't deal with it enough to know the fine details, and medical personnel minunderstand it as meaning that they cannot release any information at any time for any reason without the written consent of th patient (usually in blood and notorized by God).
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09-03-2007, 12:06 AM #3
willowdared
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Universal Precautions
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09-03-2007, 12:17 AM #4
SRT936
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Originally Posted by Bing_Oh
In my experience, HIPAA is the most confusing and misunderstood law to come out in a very long time. Law enforcement doesn't deal with it enough to know the fine details, and medical personnel minunderstand it as meaning that they cannot release any information at any time for any reason without the written consent of th patient (usually in blood and notorized by God).
We had an extensive legal update specifically about HIPAA and what our (LE) rights are under it. What we learned is that nearly all hospital staff don't have the slightest clue what HIPAA allows for and what it doesn't.
The problem is so bad that there has been talk of actually criminally charging hospital staff that refuse to provide information that falls under the numerous HIPAA exceptions.
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09-03-2007, 02:45 AM #5
willowdared
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Posts: 4,008 You guys are kinda mixing up what medical people can advise us of, and what dispatchers can broadcast, which is what the question is about.
My understanding, as far as dispatch is concerned, is we cannot broadcast that someone has HIV, hepititis, etc.....but we can advise "use universal precautions" if an RP advises us that someone has that sort of condition.
I can find out what exactly informs this position, but I'm guessing it's an FCC issue (public airways) more then HIPAA.
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09-03-2007, 02:54 AM #6
Voirdire
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Posts: 477 When I do missing persons reports and if they are needed to be put into NCIC (due to disability or endangered or whatnot), we cannot put that that person has AIDS. I always get approval from a supervisor when it comes to things like that.
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09-03-2007, 03:27 AM #7
Bing_Oh
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Originally Posted by SRT936
We had an extensive legal update specifically about HIPAA and what our (LE) rights are under it. What we learned is that nearly all hospital staff don't have the slightest clue what HIPAA allows for and what it doesn't.
The problem is so bad that there has been talk of actually criminally charging hospital staff that refuse to provide information that falls under the numerous HIPAA exceptions.
I worked for a department that came very close to arresting a woman who was in charge of the records department of a local hospital because she refused to release required records to us for an investigation.
She refused to release records to the investigating officer on a drug seeker case. Our chief made contact with both her and the hospital administrator...and she still refused to release the records. The prosecutor issued a subpeona for the records...and she still refused to release them. All because she claimed that they were protected under HIPAA. She finally backed down when the judge told her that she could either release the records or she could bring them personally to court so that she could explain why she was refusing to comply with the subpeona...and face jail time for contempt in the process.
The screwed up part of the whole thing was that it was the hospital...specifically the ER doctor...who had called and made the drug seeker complaint to us initially! The hospital complained and then refused to release information so that we could investigate the complaint!
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09-03-2007, 04:52 AM #8
madchiken
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Posts: 754 I dont know what law would prevent a dispatcher from putting that info out, Im sure its state/local.
Unless I am mistaken, HIPAA only binds medical professionals (1st responders to Dr's) from disclosing specific info with anyone not involved in that patients care.
However, diseases such as HIV, Hep, TB, etc are not covered by HIPAA because under law they must be declared to the health dept.
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09-03-2007, 08:09 AM #9
MrJim911
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Posts: 184 To answer the question, HIPAA does not have any effect on Dispatch centers and what info goes out over the radio. Policies stating dispatchers cannot give out that info are very common.
Giving out any kind of contagious disease info or using any kind of code system (universal precautions) is opening up you (the dispatcher) and your agency to some serious liability. First responders are supposed to be using universal precautions regardless of whether dispatch tells them to or not. I've been to 911 legal update classes and have spoken to an attorney who specializes in laws regarding 911 centers and he said giving out that info in any form is bad. (meaning don't give it out via radio, mdc, phone, etc...)
The only exception is when the person who has the disease tells you over the phone that it is ok to tell the responders what they have. You then have recorded verbal consent. And even then you should do it discreetly such as having the officer call up or send it down to their MDC.
So when I get a caller like that, I will ask him or her if it is ok to relay that info, if they have told me, they are usually ok with me passing it on.
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09-03-2007, 08:09 AM #10
SgtCHP
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Law Enforcement has the right under HIPAA to conduct investigations and is entitled to certain data from the hospital or emergent care facility where the patient is being treated. They may obtain that information without a warrant or order of the court as long as the information is for the investigation at hand.
Here are two sites to help you. The first ist the State of CA information and the second is for an individual.
http://www.ohi.ca.gov/state/calohi/o...ry.jsp?alpha=L
LAW ENFORCEMENT OFFICIAL
A law enforcement official is an official of any agency or authority of the United States or a political subdivision (i.e., State, County, etc.) thereof, who is empowered to:
Investigate or conduct an inquiry into a potential violation of law, or
Prosecute or otherwise conduct a criminal, civil, or administrative proceeding arising from an alleged violation of law.
[45 C.F.R. § 164.501 (definition of law enforcement official) & for more information see 45 C.F.R. § 164.512(f)]
LAW ENFORCEMENT PURPOSES
Law enforcement purposes are those activities where covered entities (See covered entity)may disclose (See disclosure) Protected Health Information (PHI) to law enforcement officials in the following six situations, and subject to specified conditions:
As required by law (including court orders, court-ordered warrants, subpoenas, etc.) and administrative requests;
To identify or locate a suspect, fugitive, material witness, or missing person;
In response to a law enforcement official's request for information about a victim or suspected victim of a crime;
To alert law enforcement of a person's death, if the covered entity suspect's that criminal activity caused the death;
When a covered entity believes that PHI is evidence of a crime that occurred on its premises; and
By a covered health care provider in a medical emergency not occurring on its premises, when necessary to inform law enforcement about the commission and nature of a crime, the location of the crime or crime victims, and the perpetrator of the crime.
[For more information, see 45 C.F.R. § 164.512(f)]
LIMITED DATA SET
A limited data set is Protected Health Information (PHI) from which certain specified direct identifiers of individuals and their relatives, household members, and employers have been removed. This information may be used and disclosed (See disclosure) for research, health care operations, and public policy purposes, provided that the recipient enters into a data use agreement agreeing to specified safeguards of the PHI within the limited data set.
[For more information, see 45 C.F.R. § 164.514(e)]
LOCAL CODES
Local Codes are proprietary codes used by a state or other political subdivision, or by a payer to identify a specific product. This term is most commonly used to describe Healthcare Common Procedure Coding System (HCPCS) Level III Codes, but also applies to state-assigned Institutional Review Codes, Condition Codes, Occurrence Codes, Value Codes, etc. HIPAA does not allow use of these codes.
For more information: Center for Medicare and Medicaid Services Glossary or www.cms.hhs.gov/glossary.
LOGICAL OBSERVATION IDENTIFIERS, NAMES AND CODES (LOINC)
Logical Observation Identifiers, Names and Codes (LOINC) are a set of universal names and identifier codes that identify lab and clinical observations. LOINC codes are maintained by the Regenstrief Institute (U.S.) and are expected to be used in the HIPAA claims attachments standard.
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http://www.privacyrights.org/fs/fs8a-hipaa.htm
Law enforcement access to protected health information under HIPAA is a significant concern of privacy and civil liberties advocates. Some disclosures may be made to law enforcement without a warrant or court order.
Further .
Law enforcement access is authorized in a number of ways under HIPAA. In some cases information may be disclosed without a warrant or court order.
Obviously, many of the disclosures listed above are made for the public good. Some disclosures are required by law. Who could argue, for example, with the need to alert public health officials to an outbreak of a deadly disease. And, there is without a doubt a strong public interest in mandatory reporting of suspected child abuse.
Each one of the disclosures listed above that can be made without the authorization of the subject carries with it a set of conditions. For a complete list of those conditions, you may want to look at §164.512 the Privacy Rule itself, www.hhs.gov/ocr/regtext.html. If you still have a question, you can visit the HHS web site and submit a question, www.hhs.gov/ocr/hipaa/finalreg.html. But, be aware, there are many questions that remain unanswered about HIPAA.
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09-03-2007, 01:19 PM #11
willowdared
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Originally Posted by MrJim911
Giving out any kind of contagious disease info or using any kind of code system (universal precautions) is opening up you (the dispatcher) and your agency to some serious liability.
If the "precaution" is general, and not specific to any individual, there should be no liability issues.
And I'm still presuming this is specific to what can be broadcast over the air...you can document in the text, and advise the officer there is "info needed" in the call.
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09-03-2007, 01:46 PM #12
sam I am
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Posts: 1,032 I work in the medical field and agree HIPPA is a pain in the booty at the best of times. It makes it really hard for us to do our jobs at times.
For instance I cannot tell Mr. Smith if his wife is in our care or not. So I say for patient privacy "I cannot inform you if Mrs. Smith is or was here today sorry". hang up..
Then I go find Mrs. Smith and let her know that Mr. Smith called and was looking for her, and I have a phone if she needs it to call him back. Who knows if Mr. Smith is the person that sent her here with a black eye, a stranger or her caring hubby wanting to know when to pick her up?
As for the AIDS thing, I have to either inject this person with something, or more often draw their blood. On my first time I was a bit freaked out by it, but after that I reaslized that it should not matter if this person has AIDS or Hep - C or whatever. I should treat EVERY person with the same care and attention to safety. Whether that means me looking like a dork wearing my glasses, gloves and white lab coat then so be it. But I really have to take responsibility for protecting myself.
Much like LEO's, has to choose if they wear their body armor as it s hot or they are on some other duty, that they deem as les dangerous.
Then as we stay in the same field we get a little more relaxed and think we can pick and choose who to be extra careful with and who we think is a lesser risk. MISTAKE!!
I realize your question is how do you inform officers in the field that the person is HIV +, but the truth is, if you tell the officer that blood is involved,( I don't know what you guys say in that respect)?
They should ALWAYS assume the person has HIV !
I know it sucks and all that, but it will kill you just as a bullet will. It should be taken just as serious.
Its like anything if you get lax and think you don't have to take every step, sure enough one day it will bite you in the butt.
I don't know if what I said make sense or you can use in anyway, I just hope in general that officers always use U/P and don't ever think that because someone looks clean or healthy, that they don't have some funky virus! Even if they do not have active bleeding, they should assume U/P.
Cheers,
oh and wash your hands.
Sam
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09-03-2007, 02:46 PM #13
deputy x 2
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Posts: 2,868 What willow said:
Universal precautions
or double glove
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09-03-2007, 06:07 PM #14
MrJim911
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Posts: 184 Sam I am is correct, their is no need in saying anything like that over the air. Unless the caller is the infected party and gives you permission to relay that info, you don't.
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09-03-2007, 07:25 PM #15
Jellybean400
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Originally Posted by MrJim911
Sam I am is correct, their is no need in saying anything like that over the air. Unless the caller is the infected party and gives you permission to relay that info, you don't.
Exactly.
For one thing, many, MANY people dont KNOW that they're HIV-infected. So hopefully youre using precautions every time.
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09-03-2007, 07:43 PM #16
texaschickeee
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Originally Posted by deputy x 2
What willow said:
Universal precautions
or double glove
word.,.....
IF they are telling DP that they are infected, they will be telling you that info, I am betting. IF the infected person is calling, who's to say that hours after this "crisis" in their life (for what ever reason the EMT'S are going out) that they will *remember* that they gave approval. There would be some very serious legal issues that they would want compensation for and to think they might actually tell the truth and back you up, might be a little out there.
I have had clients that I knew where infected, and at the final stage of AIDS, and I told EMT's as they walked in, for their safety. My boss told me thers no problem doing it that way.
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09-03-2007, 07:52 PM #17
nobody33
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Posts: 571 In my dispatch center (where I work part time) we are not allowed to say the condition straight out. This argument is a lot similar to another one I heard a lot when I worked dispatch regarding weapons involved in a call- 'officer's should always treat each call like there are weapons involved, blah blah. like they should always use universal precautions'
that's really not how it works. Some diseases require more than universal precautions (which to me just means glove up).
Since going to the field a couple years ago I've noticed that some dispatchers have this picture in their head of a perfect little world where people have the ability to do exactly the right thing under each circumstance. That's obviously not the case, though it's hard to seen when you are just staring at a computer screen. I always found away to let my officers-- off the official record-- know they need to take extra precautions. If someone sends me into a house knowing the person has TB or this nasty flesh eating disease I've been seeing around here, and I don't get a heads up- I'm ****ed. Officer safety is number one. Forget liability, my stuff is worthless if I'm in a hospital puking up my lungs or my foot is rotting off.
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09-03-2007, 09:43 PM #18
SRT936
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Originally Posted by nobody33
In my dispatch center (where I work part time) we are not allowed to say the condition straight out. This argument is a lot similar to another one I heard a lot when I worked dispatch regarding weapons involved in a call- 'officer's should always treat each call like there are weapons involved, blah blah. like they should always use universal precautions'
If weapons are involved in a call, the dispatcher HAD BETTER tell me about it. If they had that information and didn't put it out, there would be incredible hell to pay.
Quote:
that's really not how it works. Some diseases require more than universal precautions (which to me just means glove up).
Exactly. If you have information that I might be walking in on a TB patient, you'd best tell me. If I have that info ahead of time, I can take precautions against it. Those precautions are not part of "universal precautions" especially at the LE level.
Another example is an HIV or Hepatitis patient that is actively spurting blood. Just gloving up isn't going to do it. Admittedly, all you have to tell me is that blood is actively spurting and I'll do what needs done. Just make sure you let me know that.
Quote:
Since going to the field a couple years ago I've noticed that some dispatchers have this picture in their head of a perfect little world where people have the ability to do exactly the right thing under each circumstance. That's obviously not the case, though it's hard to seen when you are just staring at a computer screen. I always found away to let my officers-- off the official record-- know they need to take extra precautions. If someone sends me into a house knowing the person has TB or this nasty flesh eating disease I've been seeing around here, and I don't get a heads up- I'm ****ed. Officer safety is number one. Forget liability, my stuff is worthless if I'm in a hospital puking up my lungs or my foot is rotting off.
BINGO! Exactly my point.
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09-03-2007, 10:03 PM #19
willowdared
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Originally Posted by nobody33
I always found away to let my officers-- off the official record-- know they need to take extra precautions.
Tricky, since the phone line is recorded, and CAD messages are considered part of the official record too.
But yeah, I try to give my guys the best heads-up possible.
The laws really need to be changed, so the balance is towards protecting the health of any first responder.
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09-03-2007, 11:52 PM #20
Bing_Oh
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Originally Posted by MrJim911
Sam I am is correct, their is no need in saying anything like that over the air. Unless the caller is the infected party and gives you permission to relay that info, you don't.
I whole-heartedly disagree! Information received by the dispatcher should definitely be forwarded to the responding officer, especially if it's information regarding a potentially life threatening issue. Whether that life threatening issue is a weapon or a subject with a deadly communicable disease, that's information that the officer needs to know to better protect his or her life. I agree that officers should treat people they deal with with due caution, whether that caution be regarding weapons or communicable disease, but that does not mean that pertinant information should be withheld because officers should automatically be dealing with people in such a way. I deal with a person I know to have a weapon differently than a person who might have a weapon. The same goes for communicable diseases. I go out of my way to avoid bodily fluids, for example, but I'm going to be just that much more cautious when I know that the person they came from is a carrier of whatever disease.
Any dispatcher who knows such information and doesn't relay it to the officer is doing a grave disservice to those guys on the street and is doing nothing but putting them at even further risk by not doing exactly what your primary job function is...to give them necessary information.
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09-04-2007, 02:22 AM #21
mdrdep
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Posts: 510 saying a dispatcher can't inform a responding officer of a medical condition is like saying a triage nurse can't tell the doctor what the medical problem is. Sorry but if a dispatcher beccomes aware of a medical problem, he/she is obligated to tell the responding officers. As first responders the officer is the first step of medical care and therefore has a right to know the medical condition. If it's not a medical call then HIPPA does not apply....
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09-04-2007, 08:15 AM #22
MrJim911
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Posts: 184 Well, comparing weapons to contagious diseases just doesn't make any sense, so I'm not even going to touch on that. But I was just passing on what I heard the attorney say, relaying contagious disease info is bad.
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09-04-2007, 10:31 AM #23
Jellybean400
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Posts: 3,279 Here's what i could find. I was curious on the HIV aspect of it...thinking that most HIV+ people wouldnt want it broadcasted over open radio, where anyone with a scanner could hear it. (all i could find was something EMS-related)
"Q. If we learn that a caller is HIV positive or has AIDS, we then radio that information to responding medical units. Is this a violation of federal medical privacy laws? updated 8-30-2006
A. Basically, it is not a violation of federal medical privacy laws, which are contained within the Health Insurance Portability and Accountability Act (HIPAA) of 1996. Both a reading of the law inself and our EMS legal contacts point out that dispatch agencies are not agencies covered by the regulations. In general, the law regulates health care providers who conduct certain electronic business transactions that contain medical information--that doesn't include public safety comm centers. (Note, however, that law enforcement officers and firefighters are covered if they provide medical services.)
However, your state's medical privacy law may or may not apply to this type of situation. We do not know of any state that specifically mentions dispatch-related communications in its privacy regulations. Many states with medical privacy laws have exceptions to the regulations for emergency situations, for which a 911-generated ambulance response would qualify.
However, again...broadcasting a specific "Victim is HIV positive" or something similar on the open radio channels could be considered a general invasion of privacy, regardless of your state's medical privacy statutes, and could be grounds for a civil lawsuit--just like everything else that you or your agency does. There is also the more general societal position that this information should not be broadcast on the radio, and you may run into political or community objections to the practice.
Lastly, it's pretty common for EMS crews to use "universal precautions" for all incidents. One must ponder the usefulness of broadcasting specific, personally-identifiable infectious disease information, the precautions that EMS crews routinely take, and the legal and social privacy protections that we all deserve. This includes the practice of gathering and storing medical information within a CAD premise database--legally, this is a very dangerous practice, and has lots of privacy concerns that generally make the effort (however well-intentioned) not worth the potential liability.
NENA researched a legal opinion on HIPAA, and concluded it doesn't really affect the basic operations of a public safety comm center.
As well, attorneys Douglas Wolfberg, Stephen Wirth and Cindy Staffelbach wrote an article in the Summer-2003 issue of "The National Journal of Emergency Dispatch" explaining that, "In most cases, dispatch agencies are free to do their jobs with minimal worries imposed by HIPAA. HIPAA permits all communications necessary to treat a patient--from call intake to initial dispatch to on-scene coordination to the communication of medical information to the hospital. However, some dispatch entities may themselves be "covered entities" under the HIPAA Private Rule, which means they have a host of administrative policies and procedures they must implement." The article notes that radio traffic does not need to be restricted, encrypted, etc., and unless your comm center operation is part of a health care plan, provider or clearinghouse, the law isn't applicable. Their law firm also issued a very recent clarification that points up specific dispatching issues that may arise (finding a victim's address, etc.), and how HIPAA does not restrict the flow of information.
You can also download (pdf) a position paper by th law firm of Page, Wolfberg & Wirth LLC.
Finally, you should also read this article from "EMS Magazine" (another one here) (another here) which some legal angles on dispatching and privacy. The author discusses two situations: the first involves an officer revealing medical information to a third-party citizen (which isn't as relevant), while the second involves a law enforcement agency collecting, storing and broadcasting communicable disease information. The author admits, "There is no easy answer to this question," and that, "There is potential for litigation in this area." The author's conclusions pretty much mirror our conclusions."
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Last edited by Jellybean400 : 09-04-2007 at 10:33 AM.
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09-04-2007, 11:05 AM #24
willowdared
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Join Date: Oct 2005
Location: SoCal
Posts: 4,008 Quote:
Originally Posted by mdrdep
saying a dispatcher can't inform a responding officer of a medical condition is like saying a triage nurse can't tell the doctor what the medical problem is. Sorry but if a dispatcher beccomes aware of a medical problem, he/she is obligated to tell the responding officers. As first responders the officer is the first step of medical care and therefore has a right to know the medical condition. If it's not a medical call then HIPPA does not apply....
I think you need to talk to the head of your Comm Center and find out what their P&P states.
Whatever you may think a dispatcher is obligated to tell you, they are required to follow the P&P established by your agency.
Per California POST training.....info is not for broadcast.
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09-05-2007, 12:04 AM #25
Bing_Oh
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Join Date: Nov 2005
Location: Midwest Ohio
Posts: 2,473 You can be sued for anything, by anyone, at any time. We're in law enforcement...we should all already know this. I don't know about the rest of you, but the risk or threat of being sued doesn't even faze me on the job anymore. If vital information regarding contagious diesases isn't being forwarded to the officer in the field because of the mere possibility of being civilly sued for "invasion of privacy," then it sounds like there are departments out there that should take a serious look at their policies and why their officers are being put at risk for political correctness. Because, in the end, that's exactly what we're talking about...another rule based simply on the almighty PC.
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