Rant: I have a bone to pick with patient privacy laws (HIPPA) and power of decision

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MotionMan

Lifer
Jan 11, 2006
17,312
12
81
My thoughts and prayers to you OP. I would strongly consider a living will once he is out so are aren't in the same predicament again.

Everyone should have one. Once something happens, it is already too late. Also, you should make sure everyone who is in the living will knows your wishes on medical issues.

I hope everything works out, OP.

MotionMan
 

RKS

Diamond Member
Oct 9, 1999
6,824
3
81
Good luck to you and your family OP. I deal with HIPAA daily and it's indeed a pain for all involved. Your sister-in-law has to get a grip on the situation. My wife is very strong willed and at times a PITA but it's these same qualities that help her make good decisions is stressful situations.
 

MotionMan

Lifer
Jan 11, 2006
17,312
12
81
Good luck to you and your family OP. I deal with HIPAA daily and it's indeed a pain for all involved. Your sister-in-law has to get a grip on the situation. My wife is very strong willed and at times a PITA but it's these same qualities that help her make good decisions is stressful situations.

How is it a pain? What do you suggest as an alternative?

MotionMan
 

mattpegher

Platinum Member
Jun 18, 2006
2,207
0
71
My recommendation, seeing as you have multiple family members that are physicians, have her sign a release form for each of you to discuss the case with all caregivers. A copy should be in the chart and each of you should carry a copy.

You can discuss having her sign over Power of Attorney for medical discision making if she feels that she cant make decisions but it sounds like she wants to retain that responsibility. Therefore you will have to meet with her freq to discuss the plan.

From a practical point of view, transfer to another facility can be difficult if the recieving facility does not see a need. You may want to discuss transfer with physicians at the recieving facility first, often if the family can secure an accepting physician, it makes transfer much easier. Most physicians arent so proud as to deny transfer if another physician is willing to take on the case at a tertiary facility.
 

RKS

Diamond Member
Oct 9, 1999
6,824
3
81
How is it a pain? What do you suggest as an alternative?

MotionMan

For example I have a client who went to the ER and surgery. I need the medical bills and records. Now I have send HIPAA releases to:

the ER for records
the ER biller
the treating ER physician for records (if any)
the physician's biller
the radiologist (if any separate report)
the radiologist's biller
the surgeon for surgical notes
the surgery center for bills

I also have to know what facilities have their own specific releases and which ones will accept my generic release. I also have to know if the release can be faxed, emailed, or have to be sent via ordinary mail.

As an alternative it would be nice to have a clearing house where I can send one release and they have all records and bills available for central distribution since most of the time it's third parties like HealthPort or MRO handling a lot of requests.
 

MotionMan

Lifer
Jan 11, 2006
17,312
12
81
For example I have a client who went to the ER and surgery. I need the medical bills and records. Now I have send HIPAA releases to:

the ER for records
the ER biller
the treating ER physician for records (if any)
the physician's biller
the radiologist (if any separate report)
the radiologist's biller
the surgeon for surgical notes
the surgery center for bills

I also have to know what facilities have their own specific releases and which ones will accept my generic release. I also have to know if the release can be faxed, emailed, or have to be sent via ordinary mail.

As an alternative it would be nice to have a clearing house where I can send one release and they have all records and bills available for central distribution since most of the time it's third parties like HealthPort or MRO handling a lot of requests.

Did that exist before HIPAA?
Does HIPAA not allow that?

MotionMan
 

Kaervak

Diamond Member
Jul 18, 2001
8,460
2
81
HIPAA just protects patient treatment/medical history records and only authorizes certain people to have access to it. It has nothing to do with who can make decisions about treatment for a patient. That is a POA issue. In this case, the doctors have to follow what the POA tells them (usually) otherwise they can get sued into oblivion. I deal with both on a routine basis and they're both a pain in the ass. Glad to see that he's getting moved to a more appropriate facility, hopefully things turn around. And you might want to get the POA/living will/medical directives changed/amended so that she isn't the only one that has to make the decisions. Might help her out with tough situations.
 

MotionMan

Lifer
Jan 11, 2006
17,312
12
81
HIPAA just protects patient treatment/medical history records and only authorizes certain people to have access to it. It has nothing to do with who can make decisions about treatment for a patient. That is a POA issue. In this case, the doctors have to follow what the POA tells them (usually) otherwise they can get sued into oblivion. I deal with both on a routine basis and they're both a pain in the ass. Glad to see that he's getting moved to a more appropriate facility, hopefully things turn around. And you might want to get the POA/living will/medical directives changed/amended so that she isn't the only one that has to make the decisions. Might help her out with tough situations.

I think it can get frustrating for people like OP because they cannot be told information about the patient by the Dr. unless allowed by the spouse.

MotionMan
 

mattpegher

Platinum Member
Jun 18, 2006
2,207
0
71
I think it can get frustrating for people like OP because they cannot be told information about the patient by the Dr. unless allowed by the spouse.

MotionMan
Yes very frustrating, and with heavy fines that can be levied, many caregivers are overly cautious. Trying to make a law that covers all possible circumstances just isnt possible.

For example if a minor comes in to the ER and appears to be under the influence and I test for drugs, if the minor is over 14 (in NJ) I cant release the results to the parents.
And It is debatable if a parent can force a minor over 14 to have drug testing. (the law is unclear)
 
Oct 9, 1999
15,218
3
81
Update:

He is much better. For now he eating, drinking and sleeping. He is cognitive and alert. 72 hours ago it was dicey. 96 hours there was beyond dicey.

The wife understands the concerns and she is in agreement now. What it took was a screwup by the doctors. It wasn't a major screwup but we caught it. Our family doctors are now talking everyday with the doctors treating him to get the updates. And more importantly the doctors are talking to each other. There was miss communication between the doctors.

He will be in ICU for another 2 weeks at least.
 

disappoint

Lifer
Dec 7, 2009
10,137
382
126
HIPAA just protects patient treatment/medical history records and only authorizes certain people to have access to it. It has nothing to do with who can make decisions about treatment for a patient. That is a POA issue. In this case, the doctors have to follow what the POA tells them (usually) otherwise they can get sued into oblivion. I deal with both on a routine basis and they're both a pain in the ass. Glad to see that he's getting moved to a more appropriate facility, hopefully things turn around. And you might want to get the POA/living will/medical directives changed/amended so that she isn't the only one that has to make the decisions. Might help her out with tough situations.

Is it true 2 doctors can override a family member's decision regarding patient care?
 

alkemyst

No Lifer
Feb 13, 2001
83,967
19
81
Is it true 2 doctors can override a family member's decision regarding patient care?

That is a slippery slope. In the end ANY doctor can make an override, fuck even a nurse or any staff member.

I have a ton of medical practitioners in my family and 'overrides' are sort of why I am not an open organ donor.
 

Pliablemoose

Lifer
Oct 11, 1999
25,195
0
56
That is a slippery slope. In the end ANY doctor can make an override, fuck even a nurse or any staff member.

I have a ton of medical practitioners in my family and 'overrides' are sort of why I am not an open organ donor.

That's wrong, and illegal, you need to stop posting.
 

Kaervak

Diamond Member
Jul 18, 2001
8,460
2
81
I think it can get frustrating for people like OP because they cannot be told information about the patient by the Dr. unless allowed by the spouse.

MotionMan

All family members can be told any information regarding their relatives. HIPAA just restricts who outside of the family can have access to the patient info. With that said, I make sure the person I'm talking to is actually family by either asking my patient or hospital staff. Last thing I want to do is get myself hit with HIPAA violation lawsuit.
 

MotionMan

Lifer
Jan 11, 2006
17,312
12
81
All family members can be told any information regarding their relatives. HIPAA just restricts who outside of the family can have access to the patient info. With that said, I make sure the person I'm talking to is actually family by either asking my patient or hospital staff. Last thing I want to do is get myself hit with HIPAA violation lawsuit.

I am not so sure that an uncle has the right to hear private medical information.

Many doctors I have dealt with won't talk to anyone unless the spouse authorizes it.

MotionMan
 

Kaervak

Diamond Member
Jul 18, 2001
8,460
2
81
I am not so sure that an uncle has the right to hear private medical information.

Many doctors I have dealt with won't talk to anyone unless the spouse authorizes it.

MotionMan

That's odd, if you're family (and obviously can prove it) I'll tell you anything you want to know. Oh well, guess it depends on the person.
 

MotionMan

Lifer
Jan 11, 2006
17,312
12
81

Pliablemoose

Lifer
Oct 11, 1999
25,195
0
56

skyking

Lifer
Nov 21, 2001
22,215
5,075
146
Update:

He is much better. For now he eating, drinking and sleeping. He is cognitive and alert. 72 hours ago it was dicey. 96 hours there was beyond dicey.

The wife understands the concerns and she is in agreement now. What it took was a screwup by the doctors. It wasn't a major screwup but we caught it. Our family doctors are now talking everyday with the doctors treating him to get the updates. And more importantly the doctors are talking to each other. There was miss communication between the doctors.

He will be in ICU for another 2 weeks at least.

Great news, I am really happy for your family. Our family had a similar scare not long ago so I do know that feeling.
Brother in law had a stroke with a pretty bad bleed, that somehow did not cause much damage. It looked really bad though. Bad enough that they airlifted him to Harborview from Yakima, because the ambulance ride was going to take too long. The docs in Yakima wanted him elsewhere
 
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