New Amsterdam and The Law: Real or Not Real?

In Episode Two of the new NBC show New Amsterdam, there are some pretty amazing claims about two specific laws. Keep in mind, I’m not a lawyer, and this blog is for fiction writers so you might be interested in doing your own research, but these are my thoughts on these “two laws”.

Law #1: In one scene, a man is standing outside his room complaining that he must choose between his wife’s care and a car— eluding to how expensive the medical care will be and that the hospital won’t tell him how much it is. Dr. Goodwin says in passing, “Congress actually made it illegal for hospitals to disclose prices to you.”

Having worked in health care for twenty-five years, I understand how frustrating this can be and there definitely needs to be reform in this area. However, let me give some insight into why it is hard for hospitals to give you an exact price up front. Simply, humans are not machines and often do not medically act the same in every situation.

Let’s say your child comes in for stitches and we tell you it costs “X” amount. This assumes your child only needs a topical numbing agent for the procedure. However, your child is not on board with the medical plan and won’t hold still for his stiches so a decision is made to give them some sedation— and the topical medication isn’t enough to numb the site so we then have to inject a medication. Since the child received sedation, now there’s increased monitoring time to make sure the child is okay to be discharged home. Things like this happen every day in healthcare.

The problem is when you quote someone a price, they want to (rightly so) hold you to it. When you can’t, then it creates dissatisfaction for both the patient/family and the hospital.

Despite this, I could not find any such law that congress has passed that prohibits a hospital from disclosing prices. I think the reluctance is on the side of the hospital for the reasons I mentioned above. In fact, there seems to be movement legislative wise, in the other direction for more transparency. You can read the American Hospital Associations thoughts on it here.

Law #2: A young boy is brought in for psychiatric treatment and the psychologist on staff believes he’s being overmedicated and wants to wean him off all his meds. Quick note on that— not sure why a neurologist would be involved in this process. A psychiatrist, yes.

There’s a statement made regarding the Prohibition of Mandatory Medication Amendment of 2004. As from the link, this law does exist. Put very simply, a school cannot force a child to take medication to receive educational services. However, in the show, it’s stated that the school can force a child to take meds for educations purposes if the mother has signed an IEP otherwise known as an individualized education plan.

I could not find any source to support this statement. This blog post written by a mom who seems familiar with this issue would be a good one to read. Do I believe that schools try to “strongly suggest” that kids are medicated. Yes, I do. However, I don’t think it’s supported by law.

Author Beware: The Law– HIPAA (3/3)

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 1/3)

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.