Author Beware

Author Beware: The Law– HIPAA (3/3)

/ Jordyn Redwood / Leave a comment

Today, I’m concluding my three-part series on the HIPAA law. I’m going to focus on how I’ve seen it violated in published works of fiction.

Image by Neven Divkovic from Pixabay

Situation 1: A hard-nosed journalist makes entry into the hospital and begins asking the staff about a current patient. One nurse pulls him aside and gives him the information. This is a clear violation of HIPAA. All media requests will go through the public relations office. For any information to be released, the patient needs to give their permission.

Situation 2: A nurse on duty calls her friend and notifies her that another victim involved in a crime spree, that her sister was a victim of, is an inpatient at her hospital. Again, unless that person has provided direct care to the patient or the patient gives their consent for the information to be released, the nurse is in violation of HIPAA. However, the author of this particular manuscript handled it well. At least she had the character divulge that she could get in “big trouble” if upper management found out what she’d done. Think back to Brittney Spears in Part One of this series.

Situation 3: A small town high school mascot falls ill on the field during a football game and is rushed to the hospital. A paramedic takes him to the ER. When the paramedic’s wife arrives, she inquires about his condition. The paramedic/husband tells her what the doctors found. Again, the wife is not providing direct medical care to the patient. This paramedic has violated the patient’s HIPAA rights by divulging this information to his spouse. Now, I understand, in small towns– this information may “leak out”. A better way for the author to have handled this would have been to have the wife of the fallen mascot tell this woman what his diagnosis was. HIPAA doesn’t apply to family members and they can willingly share information with who they wish. That may not make the patient very happy— ahh . . . another area of conflict!

Have you seen HIPAA violations in works of fiction that you’ve read?

Author Beware: The Law– HIPAA (Part 2/3)

/ Jordyn Redwood / Leave a comment

Situations involving minors can be an easy way to increase conflict in your manuscript. Here is an easy area to use.

Minors presenting to the ED for evaluation of a pregnancy or STD related complaint.

Here’s a set-up. Mother brings her 14 y/o daughter in to “get checked for pregnancy”. Okay, great. Already we have inherent conflict. After all, if the daughter was in agreement about allowing her mother to know this information, they could have done a home pregnancy test and matter solved.

At times, parents will bring their children to the ER thinking that, because they’ve signed them in as a patient and they’re the parent, we’ll have to do as they ask and they’ll learn the information that way.

This isn’t the case. Will we do the pregnancy test? Maybe. The patient has to be willing. Will we relay the pregnancy test results to the parent? If the 14 y/o patient says “no” then we will not.

Most states have laws surrounding minors and issues related to pregnancy or STD’s is protected information and can only be released to the patient. Depending on the state, the cut-off is 13 or 14 years. This is different from us giving information about a follow-up culture for strep throat.

I’ve had parents call back for these types of test results. Nope, can’t give you the information.

Another area is that minor patients can sign themselves into the ER without parental consent for these matters as well. Generally, for all other conditions, we have to make attempts to get the parent on the phone for verbal consent witnessed by two individuals.

What do we do?

As healthcare providers, we really do try and facilitate open dialogue between the parent and child. We’ll sit with the 14 y/o daughter privately and go over why it would be best for her to share this information, regardless of the results, with an adult.

Can you think of other healthcare situations involving minors that could be high areas of conflict?

Author Beware: The Law– HIPAA (Part 1/3)

/ Jordyn Redwood / Leave a comment

Several months ago, I was watching a local TV news station when a nurse manager was being interviewed about the fact that you could look up ER wait times on the Internet before checking in. That’s a whole other can of worms I won’t get into today but the problem with her interview was that the camera shot included her standing next to their patient tracking board in which you could clearly see the last name of the patient, their age, and their medical complaint.

Stock Photo by Sean Locke
http://www.digitalplanetdesign.com

I almost fell out of my chair. This was a clear HIPAA violation and that ER manager should have known better than to be standing anywhere near that board.

Each time you visit the doctor’s office or sign into the urgent care or emergency department for treatment, you should be given a paper that outlines your rights under HIPAA which stands for the Health Insurance Portability and Accountability Act. It basically outlines rules on how to deal with a patient’s “protected health information” or PHI.

What this boils down to for the bedside clinical worker falls into a couple of areas and I’ll give some examples below.

1. I should be providing direct care to a patient or should have provided recent care in order to look up their chart. Some of you may remember the healthcare workers that were fired for accessing Brittney Spears medical information. They were likely fired under this provision.

2. I can’t share any specific information (name–never, age, and complaint) listed together in areas where other’s could become aware of the patient’s visit. This would include areas like social media (a big no-no). When cases are presented at medical conferences, generally all patient information is blacked out (say on x-rays). And the patient is only spoken of in general terms. Such as: 16y/o presented to the ER for evaluation of neck pain. Now, across the USA for one day, probably several patients presented with this complaint so how do you know which one it was?

3. I shouldn’t be sharing patient information with my spouse unless he has provided direct care to the patient as well. Therefore, since my husband is an accountant, I can’t say— “Oh, by the way our neighbor’s daughter was seen for a broken arm today in the ER.” Unless I’ve asked the mother specifically if it’s all right that I mention this to my husband, I have violated that patient’s rights by sharing that information with my spouse. Working in pediatrics, I’ve been in the situation often and don’t mention the visit at all when home.

4. Requests for information about a patient from the media generally go through the public relation’s office. This tends to happen more off hours, a reporter will get through to the ER desk and begin to ask questions. Most, if not all hospitals, are very firm that all media inquiries go through public relations. This allows them to control the message.

5. Patient information cannot be given over the phone unless specified by permission. This is why, when you fill out those HIPAA forms at your doctor’s office, they generally ask who they can talk to and what kind of information they can share. Perhaps you don’t want your husband to know why you were at the OB’s office. A caveat to this is giving information to your personal physician who is following up on your ER complaint. We will generally give specifics for this because they are providing your follow-up care.

Next post I’ll talk specifically about HIPAA and minors.

Author Beware: Seasonal Illnesses

/ Jordyn Redwood / Leave a comment

One thing to keep in mind when you’re writing a novel is that some illnesses are seasonal. So if your book covers an obvious time of year– say the summer. It may behoove you as an author to be aware of the illnesses that are and aren’t around.

Croup: AKA laryngitis. Used to be seasonal but we typically see it year round. No time restrictions needed here.



fyi.utah.edu

RSV: The leading viral cause of bronchiolitis typically starts in late fall, early winter and lasts approximately 20 weeks. This is what healthcare professionals happily (maybe?) term “respiratory season”. It means gowns, gloves and masks need to be worn for patient’s that present with cough and fever. Another fact to keep in mind.

Influenza: Influenza is truly a respiratory illness and not a gastrointestional (GI) one. You know an author has thoroughly checked their facts when they have a summer illness with vomiting and diarrhea and don’t call it influenza. This is why flu shots are given Sept-Nov… to help prevent the transmission of this illness.

Keep seasonal illnesses in mind when you’re writing a novel that occurs during a specific time of year. It may behoove you to ask if that contagious illness you’re killing off your characters with would actually occur during your time frame.

Have you used a contagion, known or “created” in your novel?

Author Beware: Implausible Killing Methods

/ Jordyn Redwood / Leave a comment

I know the difficulty writers face at having to come up with unique and unusual methods of killing off their fictional characters. Hence, the constant hunt for lethal, undetectable poisons.

One popular author came up with the following scenario for his serial killer. I read this detailed scene with great interest but in the end, the implausibility of the scenario kept me up that night. I continually analyzed the scene in my mind and wondered if the author might have posed the question to a medically sound person as to its plausibility.

In short, essentially the killer drilled holes into the victims ankles to drain her blood. This would be death by exsanguination. But then, plugged up the holes with glue. Proceeded to string the victim up. Then pulled off the glue plugs so the victim would hemorrhage to death.

Inventive… yes, absolutely. Haven’t read anything quite like it. Plausible… not really. Here’s why.

In order to bleed to death quickly, a major vessel needs to be disrupted. Preferably an artery. Your heels are not very vascular meaning they are not rich in blood supply. Imagine a cut on your heel and the same cut on your head. Which will bleed more swiftly? There are arteries in your feet. They are located on the top of your feet and near the inner malleolus which is the knobby bone on the inside of your foot. Drilling through the ankle into the heel likely will not catch either of these major arteries.

The other issue. Plugging up the holes. Any time bleeding is stemmed, the blood has a chance to clot. Now, in this novel, the killer was very busy for quite some time hoisting the victim. I think enough time for the victim’s blood to clot. Therefore, when the plugs were removed, I think very little bleeding would have actually occurred.

What scenarios have you found in novels that are implausible? Were they enough to draw you out of the story? Please, keep the author’s name and book title off any comments, otherwise they will be deleted.

Author Beware: Use of Medical Equipment

/ Jordyn Redwood / Leave a comment

I’m an avid reader. Don’t you have to be as a writer? I have to admit, there are a few authors I lean toward. Generally, I’ll read most of what they publish.

I also have an issue. I know that it can be very hard to get medical details right in a manuscript. I faced this challenge when I wrote an OB scene and had an OB nurse review it. To put it mildly, she was displeased with what I wrote. I was actually relieved to find that out during the editing phase rather than have a whole lot of obstetrical nurses throwing my novel into the trash because they were offended at something I’d written.

Usually, I’ll give a little leeway to those I read… a little. For instance, using EKG instead of ECG is okay… not great but I generally peruse by without much thought.

I was reading one mega-bestselling novelist when he began to write a hospital scene. The character had been beaten up fairly well and there was a description of the medical equipment that was attached to his body. It read something to the effect that, “He had nasal cannulas in his nose.”

A nasal cannula (nasal prongs) is an oxygen delivery device. It’s very common. The correct way to note the use of this piece of equipment would have been to say, “He had a nasal cannula in his nose.”

The way the writer phrased it immediately brought an image to my mind of two of these stuck up his nose. Now, my story bubble has burst and I’m re-reading this sentence to be sure that’s what he really said.

If you’re unfamiliar with medical equipment, run the scene by someone familiar with its use to avoid simple mistakes like this one.

Author Beware: Wrong Medical Procedure

/ Jordyn Redwood / Leave a comment

Recently, I was reading a novel by a well-known published author. I’m enjoying the story line a lot which is preventing me from putting the book down and reading another one.

This was the written sentence. “We took him to the OR and drilled a hole in his head just in case there was a subdural hematoma.”

WOW! There’s a lot going on in this single sentence. A lot that is medically inaccurate and I’ll tell you why.

First, a subdural hematoma is a “collection of blood on the surface of the brain”– between the brain and the skull.  The volumes of this blood collection vary and do not always need intervention. However, if the volume of the blood collection is large enough, it can actually push on the brain and cause its contents to shift. This is termed herniation. In that case, surgical evacuation of the blood clot by a neurosurgeon is the preferred treatment.

Drilling a hole in a patient’s head is generally done for two reasons. The first is to drain cerebrospinal fluid and the second is to monitor intracranial pressure or ICP. So, even if the patient did have a subdural hematoma, this likely would not be therapeutic treatment.

The next issue is the just in case part. With CT scanning readily available (even at most smaller hospitals), there should be no reason to wonder whether or not the patient has a subdural. This particular patient took a severe beating to his head and has neurological deficits. Standard treatment would be to do a CT of his head. Then the medical staff would know for sure what they were dealing with.

Which leads us to the last issue. The doctor performing the surgery was an orthopedic surgeon. This is not in their realm of specialty. Drilling a hole in someone’s head goes to the neurosurgeon. I can’t think of many ortho types who want to be mucking around near the brain. And if they are, they’ve likely consulted a neurosurgeon.

Scope of practice issues come up commonly in manuscripts. Either the act done is outside that character’s scope of practice. For example, an EMT performing a C-section is outside their scope of practice. Or, a specialist is doing something they usually don’t do as in this case.

To be clear, I do think it is okay that a fictional character does something they’re not supposed to do like operating outside of their scope of practice. This can add great tension and conflict to a scene. Imagine an EMT attempting to do a C-section to save a baby’s life when the mother has died. What I would be sure to do is make it clear that the character knows this is outside their scope and is troubled by doing it or maybe cavalier about doing it but that they know where the line is.

You can also take the other bend, the character doesn’t know and does it anyway. In this instance, there should be discussion from other characters that this person is known for operating outside their scope and presents a danger to patients. Then, your reader will know that your medical knowledge is good but it is the character running amok.

What do you think? How would you have a character do something outside their norm that won’t turn off your reader?

Author Beware: Arterial Bleeding vs. Venous Bleeding

/ Jordyn Redwood / Leave a comment

I’m going to start doing these “Author Beware” posts every now and then. When you see that heading, it signals I’m doing a post on something a published author has written that medically is questionable. Now, I won’t name the author or book, just the situation. So, if you know the book and/or author, please keep it close to the vest. This is merely for learning purposes.


geology.com

In two novels recently, I’ve come across inaccurate descriptions of venous versus arterial bleeding. One novel in which a character had slit his wrists clearly described arterial bleeding but called in venous bleeding. Another novel described a puncture wound to the neck and a “geyser” of blood from the wound yet the character made it to the hospital with a dressing around his neck.

First, what is the difference between arterial and venous bleeding? A short anatomy lesson first. Arteries are on the forward side meaning this is blood that has just left the heart. In order for your heart to get blood through the body, it has to pump. The heart’s pumping is something you can feel… it’s called your pulse. Whereever you feel your pulse is an artery.

Venous blood is on the return side. This is blood that has off loaded its oxygen and is on its way back to the lungs. There’s not as much pressure, per se, in those vessels.

When you puncture an artery, it spurts, pretty dramatically, with each heartbeat. I saw a demonstration once of how long it would take someone to “bleed out” from an untreated arterial bleed to the knee which houses the popliteal artery. Now compared to some, this would be a smaller sized artery compared to your aorta. Any guesses?

About three minutes.

Venous bleeding doesn’t have the characteristic spurting with each heartbeat. It generally oozes though it can ooze quite a bit. Venous bleeding can also be deadly if there is enough of it left untreated.

Arterial bleeding is generally harder to control than venous bleeding. You have to apply a lot of pressure to get it to stop. Hence, my dismay at how a character who sustained an injury to his neck, likely the carotid artery, could have made it to the hospital with a simple dressing in place.

What do you think?