A Correctional Nurse called the hospital for treatment and discharge information on a patient who was seen in the emergency department after an assault in the rec yard and returned with a wired jaw. The emergency room nurse refused to provide any information, stating it would be a violation of HIPAA. She instructs the Correctional Nurse to obtain the information she needs from the patient himself.
A Correctional Nurse Practitioner is reprimanded for telling a housing officer that one of the inmates is a brittle diabetic and needs his evening snack on time.
Confidentiality of patient health information has always been a concern for nursing. Valuing patient privacy is an ethical imperative, even in the correctional setting. In recent years the Health Insurance Portability and Accountability Act (HIPAA) has moved healthcare information confidentiality to a legal concern for nurses.
HIPAA was legislated to address the maintenance, security, and sharing of private health information. There have been several changes to the original 1996 legislation. In 2003 the Final Rule on Security Standards was issued, and the Privacy Rule included a definition of Protected Health Information (PHI): “any information held by a covered entity which concerns health status, the provision of healthcare, or payment for healthcare that can be linked to an individual.” This information can be written or electronically stored. It also discusses what uses of this information are allowed and when the information can be shared without the patient’s permission.
The Privacy Rule recognizes the need for information sharing within the correctional setting and allows the sharing of information without the patient’s expressed permission between law enforcement and healthcare providers for certain activities, including the provision of health and safety for the staff and other incarcerated individuals; the maintenance of the safety, security, and good order of the correctional institution; the transport of incarcerated persons; and the provision of healthcare to the incarcerated person (45 C.F.R. 164.512 (k) (5) (i)).
Examples of HIPAA Permitted Disclosure
For example, officers may need to know about medical conditions or disabilities that require special equipment or accommodation. Officers transporting patients to off-site consultation may need to know special needs and/or signs to watch for. Officers may need to know that health conditions or potential medication side effects require changes in work assignment. (This does not mean the officer needs to know the condition/ medication). Through their job duties, officers may know that a patient has a certain diagnosis (i.e. diabetes), but they are required to maintain that information with confidentiality.
According to this section of HIPAA regulations, an ER nurse can confidently share health information with the receiving nurse in the prison infirmary and a nurse practitioner can alert an officer to a health need of an inmate in his charge.
Many in corrections are confused about how to implement HIPAA regulations and the boundaries of patient privacy and confidentiality of medical information. Share your experiences in the comments section.
Thomas L. Gilevich says
Two additional important points. HIPAA’s privacy regulations apply to “covered entities” that meet specific requirements and most jails and prison systems do not consider themselves covered by the federal regulations. Regardless, the provisions often can provide valuable guidance in the absence of any contrary local policy or state laws. Secondly, neither the regulation setting out the “correctional exception” in HIPAA’s privacy regulations (allowing disclosure of otherwise protected medical information for safety, security and good order of the institution) nor case law help in dealing with the proverbial questions of patient confidentiality in correctional settings. What if custody asks for a copy of the ER drug test? What if a patient informs the nurse his cellie has just received some fentanyl? Local policies and training should provide staff with guidance on these matters and the quick escalation of issues to senior management.
Lori Roscoe says
Thanks so much Thomas for your comments! I agree that policies and training is most important, especially before a potential situation arises.
Lupe says
Question: in our facility we are bound to HIPPA so much that our safety is at risk. The deputy is not allowed to be in the room while the nurse is asking medical questions upon booking. The door must remain closed with tge nurse and arrestee and law enforcement standing by tge closed door watching through the window. Isn’t this a bit extreme to be in compliance with HIPPA? What about the nurses safety?
Lori Roscoe says
Thank you for sharing this. The practice you describe, that the door is closed and only you and the patient are in the room, is very concerning and would be looked upon at most of the facilities in which I have worked as a significant safety issue and would not be allowed, even with the officer looking through the window. At a minimum, the door should be open and the officer should stand-by outside the door. HIPAA would support the officers hearing medical information, understanding that they are bound by confidentiality laws and (hopefully) policies and procedures. The officers working in any area where they could potentially become aware of medical or mental health information need to have documented confidentiality training, and of course, they need to abide by it. If the concern is that other incarcerated persons are in the area and could potentially hear, then a strategy must be developed to minimize that, like the officer is in the room and the door is closed, (You must also consider that a patient may not disclose important information if someone from custody is in the room…) or the door is open with the officer just outside and you speak at a level that others outside the door cannot hear. Perhaps you need to bring the HIPAA compliance in corrections information to your supervisor and whoever is in charge on the custody side, and share the nursing safety concerns to them. Please keep us updated.
Lori