Yes, Susie, you are absolutely correct. And I do that sort of thing all the time, usually to, or so my patient understands that I can on some level relate to what they are going through. I would say something like, "I had another patient once who..., or I have a good friend that had....", or something of the like, and yes, that is perfectly acceptable.
However, if my best friend comes to my house one afternoon for a visit and she tells me about her (bad example, I know, but you will get the point easier with a more disgusting diagnosis than say an infected hang nail. So she tells me she has vaginal herpes).
And say a few months down the road another friend of mine tells me that he has started dating the before mentioned friend, while I wouldn't say anything, someone else without even thinking because it all was said casually between friends, might say something along the line of, "well, you might want to make sure you wrap that thing, just saying". Which would lead him to prompt more questions which might eventually lead the friend with the license, into saying more than she should. So out of trying to protect one friend from contracting a gift that will keep on giving for the rest of his life, she violates HIPAA by outing medical knowledge of the other friend. A mighty hard spot to be in, and one I have been in many a time, way more than I care to remember. And this case almost exactly landed a nurse acquaintance of mine in front of our Ohio Board of Nursing who suspended her license for 3 months while they deliberated the case. From what I gathered from all three parties involved, the OBN conducted interviews from all three of them, all three said basically the same story. The nurse in question admitted exactly what she said and also said that since the conversations happened away from her work place and in her own home, and with friends she didn't think that HIPAA applied.
If I had to guess, her last statement is the one that sealed her fate in the eyes of the OBN. So after having her license already suspended for 3 months while the interviews were conducted, and then they deliberated, they suspended her license for another 9 months, making it a year total. She also has to every year for the next 5 years take 40 hours of CEU's just on HIPAA regulations and nursing law, on top of her other 30 hours of CEU's she's already required to have every 2 years. Then, at the end of that 5 years her case will be reevaluated, and most likely that will be the end of it, but you never know with a medical board. There is a lot of politicking that happens on boards at certain times.
Susie, I don't know how long you have been a nurse, longer than I have been for sure. We are close to the same age, but your medical knowledge outranks mine 100 fold. But our nursing class was given a bit of a "heads up" when we , or prior to us signing our names to our license'. We were told pretty casually, but told none the less that depending on the situation at hand, licensed medical professionals are above the law, meaning that we have laws that protect us that if a non licensed person would do could land them in prison. But on the other hand, more often, that is reversed and as in the military, we are automatically guilty until proved innocent.
It was explained to me shortly after my "event" by our multiple teams of lawyers that the second we signed our medical license's that we basically are signing away at least 50 percent of our basic rights as Americans. And again, a lot of things concerning medical professionals varies state by state, and as I said earlier, my state according to two of the top rehab centers, and by rehab I don't just mean for drugs, or alcohol, or other things of that nature but for all things, no matter what it is, that rehabs a medical professional so that they can transition back into returning to work, but two of the top places that do that sort of thing in the nation have both said that my state is the hardest and most strict on it's medical professionals. Both places have also said that they almost hate even dealing with our boards because seldom will they ever even consider budging or changing a decision they have already made.
Other little oddities in my state that other I know don't have. And this all relates to my earlier statement of by signing my name to my nursing license in my state, that means me signing away a good 50 percent of my basic rights as an American. For example, here in my state, I have to be a registered voter, and actually vote. If I get one DUI my medical board has the right to revoke my license, although to be fair, on your first one if you have not had any other issues with the board they usually just fine you or restrict your ability to distribute narcotics, or I have seen them require you to have one of the breath analyzers installed at your expense for 6 months to a year. Every single time we get pulled over for any reason we have to report it to our board. Any address or phone number change has to be reported within 72 hours, and if not, again we are in trouble. Every single med error we make by law here is also required to be reported to the board, whether it's for giving someone an extra breathing treatment, or even being out of our time frame of an hour prior to an our after to give that breathing treatment, it's still a med error, to a narc error. And I don't know how many you are allowed to have or how that part of it is broken down. I would assume they are looking for patterns of some kind or another, but to many of any of them and you will get that call from the board mandating you to appear before to board to discuss an issue, and they will not tell you what issue "that issue" is, so you have no way of preparing yourself.
Also, when we go before the board, we may bring the best lawyer in the world, but it won't matter, they are their own governing board and are not governed by anyone above them, not even our rights and laws we are entitled to as Americans. And again, we are guilty until proved innocent. If you have read my blogs then you know that in September I was pulled over for expired tags that I didn't know had been expired since April, a mistake on the DMV's part in which they owned up to. However, in a strange series of events, I was pulled over again last month for a headlight being out, in which when my license was ran, was discovered that I was then driving on a suspended drivers license. That last little bit according to my board is enough for them to fine and suspend my nursing license, but coupled with the previous one would be more than enough for them to revoke it. Again, I got lucky because I was able to prove that both were a matter of clerical errors both by the DMV which I was able to get the judge to write a letter accordingly, we got copies of all the paper work, had it all notarized and then sent to my board of nursing. In return I received a letter from the OBN thanking me for my honesty in self reporting prior to them finding out on their own, (which never looks good) because they always find out, and they do. They thanked me for all the work in getting both issues taken care of promptly, (within 24 hours of being cited), then getting all the paper work gathered, neatly compiled, in chronological order and even notarized by the judge with a letter from him as well telling them how diligent I was, prompt, and concerned about getting the information off to the board, in an organized and professional manor. He also put in a little bleb of his own personal note telling them that I presented myself in his courtroom as a professional, dressed professionally, I was respectful, maintained eye contact, and was upfront in explaining to him that as a nurse in this state that not only does my nursing board, but she, meaning me, holds herself to a higher standard than most others, and the judge wrote to them, "in all my years of being a judge, and of all the times I have heard a statement like that, she is probably one of only 5 I have heard that from and actually believe to be a true and accurate statement. Then along with that statement and the other paperwork dating back to September 13 up to the day the letter being sent, he included as the last page his judgment, which in a nutshell basically stated that all charges against me by this court have been dropped, all fines were waved, and no points would be added to my license. Case number XXXXXX has been dropped and settled. So I was happy with this and even sent the judge a thank you note for going out of his way for me and helping me put together and notarizing everything that needed to be so that I could send it off to my board. (Its' the proper thing to do, and to be 100 percent honest, if I should ever find myself in front of him again, he will most likely remember, which should help me and my case and maybe make him go easier on me again???) I just hope I don't find myself there again anytime soon, or ever for that matter.
So I sent the packet off to my board of nursing. About 10 days later I received a letter from my board telling me that they will be meeting again the last week of June where the will be reviewing my case in full, along with any other issues I have had or reports they have received since my license was obtained 10 years ago. So, who knows, they might decide to do nothing, or I might find myself without a job for a while. Depends on their mood, depends on the seriousness of the med errors I have made in the past.
Am I nervous, yes, you bet your first born I am. I made a major HIPAA violation about 4 years ago that I really hope was not reported to the OBN. There was a lady behind the nurses desk with a lanyard that said Ohio Board of Nursing printed on it over and over and over. Hanging off if it was a name badge that had her first name then under it it was again printed Ohio Board of Nursing. She was going through my charts, and was there for quite a while. When I came back to chart she was asking me multiple questions about different residents and I answered her. By the end of the day I was called to the office where the lady from the state was sitting, my administrator, my DON and my immediate supervisor. Long story short, it was a test and I failed. I don't know if that was reported back to the OBN or not, I am guessing not because it was actually meant as a learning tool. But the mistakes I made were that anyone working for the state will have a first and last name printed clearly on their name tags, along with their credentials, when those credentials expire and a photo id, as well as their state ID number. So that if someone comes I can call the OBN with their name, and ID number and a brief description of the person and the OBN will be able to tell me if they have someone like that, and if or not they are scheduled to be at my facility that day. So because I didn't check for a picture ID, nor their state ID number or their credentialing expiration date or even if they had one at all, I was in complete and total breech of most of, if not all of HIPAA's laws and regulations. So a good lesson learned, and to be honest with you, one I have shared with every single nurse I have met since. However, if that one shows up on my record with the OBN along with the few med errors I have made, and yes, I have made some, and I don't care, every nurse who has ever handled medications has made a med error at least once, and now with these two driving issues even though the DMV made it blatantly clear that neither were my fault, but that ignorance is no excuse of the law, it's hard to tell what the OBN might decide to do with me. I highly doubt I get off Scott free, no one who goes before them usually does. So I sit and wait until the end of June to find out my fate. Nerve wracking to say the least.
Sorry to rant and rant tonight. It's that "time", I'm hot, crampy, in need of chocolate, which I had here in my desk which was so kindly eaten up by others without my permission which does't quite add to my sense of humor......at all might I add, lol.
But again, this is just the tiniest tip of a huge ice burg of rules, regulations, laws, by-laws, sanctions, guidelines, suggestions, and you name its' that medical professionals have to follow, give up, or pay for to continue serving more often than not unappreciative, condescending patients living off of our hard earned paychecks, expecting to be treated ahead of, and better than our private paying and or insured patients who are usually the ones that are the most respectful, have more patience, and are seldom complainers and are almost always gracious when we provide our services to them that THEY are actually paying for. These are the two types of folks, with very very very few exceptions to the other kind, that I will gladly stay late at the office for, go way out of my way to fit them in when they are very sick and need seen ASAP, call different pharmacy's looking for discount plans, ideas, coupons, professional discounts on everything from medications to any other medical type of things they need. Heck, I have even more than I can remember, depending on the pharmacist and my patient, knowing their real history and what they are and are not able to do and knowing they are doing the best they can, as long as no narcs are involved, will strike a deal with the pharmacist, who will allow a "donation" to be made in that persons name so that they can get the medications that they really need. These are the folks that will get the free samples from the docs as well.
But to round back up to the top of this way to freaking long post, ( really have to learn to stop venting to you poor folks, stop ranting, bitching and stay on topic and get to the damn point already, much faster than I have been lately), Susie is absolutely correct. As long as no "true identifiers" are used in relating a story, then we are free to discuss. Occasionally I get those cute little questions from the student nurses on HIPAA type topics and what is and isn't appropriate to say. I will ask them what they know about that sort of thing and they usually say the same as I just told you, "as long as no identifying information is given, then it's okay to discuss." I usually ask them the same question, and for the life of me most of them get it wrong and I don't know why. I say to them, "okay, you live in a town of a couple thousand people. A guy comes into your ER who had been playing chicken with a train on the tracks that run down the center of town, and he loses, train wins. He was in the car with his girlfriend who was trying to "orally complete" him before the train came. When the train hit, she bit down, parts were severed, both will make a full recovery, but "some things" will never be the same. As a nurse in the ER that night you are in the thick of the incident and are taking care of both guy and girl involved in the incident. Later in the week your friends and family or whomever starting asking you questions about the accident, what happened, how extensive were her injuries, more importantly his injuries. Well, you don't give them names so according to HIPAA, so are you allowed to share or not? They almost always say yes to this. When I ask them why they all say because they never tell them their name and are not giving any identifying information. However I clearly let them know that in the health care field each and every single case presents with a completely different set of HIPAA rules and regulations, along with other variables such as geographic location, population of the area you are in, how close of a community you reside in etc. All of these things are factors into how much or how little information you can give out.
In this case I tell them that because the community is only 2000 members, chances are, everyone a few days on the outside has already heard about what happened especially since it happened in the middle of town, also due to the age of the patients, and due to the nature of some of the wounds acquired from the accident itself. So in this case, sharing any information I feel would be a gross violation of HIPAA, because the identifiers are already there, so anything said would just be a blatant contribution to detailed private medical information. And to be honest with you most of them still don't quite get it, but thank goodness, they eventually do. So in a geographical location that is a close community I have always found starting a story something like, "back when I first started nursling's, way down in hillbillyville I had a patient once with the same sort of things/thing.....that way it completely eliminates the person I am relating the story to to be able to link my current correlation to anyone they might possibly know. My patients trust me 100 percent with not only their medical histories, but their deepest and darkest secrets, and most importantly, their complete trust, which is something I hold very dear, and to me having that trust given to me is something I think is precious, and dear to me, and is probably one of the greatest gifts one human can give to another human, aside from their unconditional love and their heart, all of which I take very seriously, honor, and also deeply respect.
Okay sorry for the rant, thanks for reading if you actually got to the end of my "period" rantinges and comments, an automatic karma, but for anyone who does and leaves a response will also get a free shot in their backside, a rectal temp, or if you are really lucky, I might also include a prostate massage? I have to give you some sort of reward for reading all of my long and usually stupid and meaningless posts right?
Thanks again for all those who read some, half or a all, I greatly appreciate someone out there who is just willing to listen at this point to a cranky old nurse, lol.
Mashie