HIPAA and Law Enforcement

/ Jordyn Redwood / Leave a comment

I had a phone consultation with an author who wanted to discuss HIPPA.

As you know, HIPAA is a set of laws designed to protect patient privacy.

Here’re links to a previous series I did on HIPAA: Part I, Part II, and Part III.

His question centered around whether or not law enforcement was privy to medical info.

In the pediatric ER– we will readily discuss medical issues with law enforcement because it usually deals with us reporting child abuse. Police also need information so they know the degree of serious bodily injury (or SBI) to determine if charges should be pressed.

However, I didn’t know much about how my adult ER compatriots generally approached the issue. HIPAA is difficult to understand in its entirety and most healthcare professionals are apt to err on the side of providing no information rather than get in trouble for giving out information that they shouldn’t.

Keep in mind that the main crux of this law was also to give you the power to always view your medical information. A hospital or medical provider cannot keep your records from you. Even if you are in the hospital– you should be able to ask to see documents. What the hospital may do is have a representative sit with you to “watch” you so 1. you don’t tamper with the record and 2. they can explain the medical lingo.

Unfortunately, some places make it challenging for patients to get their information. You should absolutely have to sign a medical release form. But after that, I’ve known of hospitals to state it can be up to two weeks or more for records and that they may charge you for the copying of each page. That can be frustrating experiences for families.

Pertaining to this author’s question– come to find out through a little research for said author, that HIPAA does allow for discussions with law enforcement personnel.

Here is the particular section that pertained directly to the authors question from this link:

Law Enforcement Purposes. Covered entities may disclose protected health information to law enforcement officials for law enforcement purposes under the following six circumstances, and subject to specified conditions: (1) as required by law (including court orders, court-ordered warrants, subpoenas) and administrative requests; (2) to identify or locate a suspect, fugitive, material witness, or missing person; (3) in response to a law enforcement official’s request for information about a victim or suspected victim of a crime; (4) to alert law enforcement of a person’s death, if the covered entity suspects that criminal activity caused the death; (5) when a covered entity believes that protected health information is evidence of a crime that occurred on its premises; and (6) by a covered health care provider in a medical emergency not occurring on its premises, when necessary to inform law enforcement about the commission and nature of a crime, the location of the crime or crime victims, and the perpetrator of the crime.34

Just goes to show you what you can learn whilst doing some research!

Are ER Nurses Superstitious?

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Sometimes as an author, you need to get the flavor of a certain profession. What are some of the things they believe or don’t believe? These don’t necessarily have to be based in scientific fact, but are held beliefs none the less.

So– what are some held beliefs among ER nurses that may or may not be true.

1. Full moons (the celestial bodies– not a patient’s backside exposed) do cause people to come to the ER. If the unit is falling apart, there have been moments where all of us have looked at one another and asked, “Is it a full moon tonight? Is it coming in the next few days?” I don’t know what it is but it feels like ER volumes go up and mental health patients increase too.

2. Strange medical diagnosis happen to medical people. Personally, I feel if you work in medicine, you should get a free pass illness wise (yes, Lord, I am talking to you!) You hear stories of Hem/Onc nurses getting cancer. Doctors going into preterm labor– this may be proven as I think I looked it up once on a slow shift that doctors are more apt to go into preterm labor because of the odd sleeping hours and time spent on their feet. But, if you’ve never heard of an illness, a medical person probably has come down with it. You could say– well, perhaps it’s because they’re all hypochondriacs. Maybe a little truth there (as she slowly creeps hand up.)

3. If you mention a particular patient– they will check in. It’s like a batman signal. Sadly, not all patients are warm and fuzzy to deal with. That’s just a fact of life. So, you really don’t want to say the name of a patient you had a tussle with.

4. We NEVER say the following phrases– and if someone does, they will be scorned.

“Wow, it’s really quiet.”
“It is soooo slow!”
“Is it time to run someone over so we can take care of a patient?”
“Come on! Isn’t it flu season?”
“Nothing is going on.”
“We’ll be with you in ONE minute.”

You have just invited hoards of people to check into the ER in the next 30 seconds. It’s worse than saying a patient’s name you may not want to see. It’s one million bat signals sent into the universe. These phrases are strictly forbidden to be uttered. Period.

5. Yes, some providers do have black clouds over them– like Pig Pen’s dust trail. Not in the weather sense but in the Angel of Death/Sickness sense. When some people work, it just hits the fan. Patients are sicker and there will likely be a code. It’s probably akin to the cat who would visit the nursing home patients and sit with them when they died. The Grim Cat.

Did you know about these ER superstitions?

Sweating Bullets: A Story of Anne Boleyn 1/4

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I am so honored to have JoAnn Spears back at Redwood’s Medical Edge. Her posts about the ailments of long lost monarchs are hugely popular and entertaining as well.

This four part Monday series focuses on Ann Boleyn and the mysterious sweating sickness that had a 70% mortality rate!

Welcome back, JoAnn!

Part I:  Working up a sweat, bugs indeterminate, and a man named Butts.

The courtship of Anne Boleyn and Henry VIII is the stuff of legend.  Tudor history buffs and Anne Boleyn fans alike will already know that Anne Boleyn was the first and foremost proponent of ‘if you like it… put a ring around it’.  By 1528, after about two years of courtship, Henry had yet to do so.  Anne parried with a retreat from Henry’s court to her family’s country home at Hever.  Romantically enough, she was suffering from, or at risk of contracting, a catching ailment.  There was a real chance she could die from it.  More romantically still, she hastened away to protect Henry from the contagion. 
Dr. William Butts

On a less romantic note, Henry himself did not follow Anne to Hever.  His devotion only stretched to his sending, in his stead, his second-best physician.  Less romantically still, that physician was called Butts, and the disease he was to treat Anne Boleyn for was known as ‘The Sweat’.

Life-threatening plagues and infectious diseases were a feature of life in Europe during the Middle Ages and the Renaissance.  Some of these illnesses are fairly well understood retrospectively.  For example, a good deal is known today about the causation, mode of transmission, treatment, and natural course of Yersinia pestis, or Plague.  The Sweat, however, remains, like its star sufferer, something of an enigma.

The Sweat debuted in England around the same time that the Tudor dynasty did, in 1485.  It recurred in 1508, 1517, 1528 and 1551; as far as we know, it did not recur thereafter. Each of these outbreaks began in England, and four of them had little or no spread outside of the British Isles.  The fourth, the outbreak of 1528, made its way across much of northern and eastern Europe. 

Two Tudor physicians, Thomas Forestier and John Caius, are the sources of much of the extant medical information about The Sweat.  The accounts these two physicians give of the condition are like bookends to its history.  Forestier speaks from the perspective of the first outbreak of The Sweat, in 1485.  He isolates The Sweat from other pestilences and poxes of the time by identifying the primary way in which it was unlike them; the absence of rash, pustule, buboe, or other manifestation on the skin.   “The exterior is calm in this fever”, Forestier explained, “and the interior excited.” 

John Caius authored “A boke or counseill against the disease commonly called the sweate or sweatyng sicknesse” in 1552, after the last outbreak of The Sweat.  He felt confident enough in his experience and findings to subtitle the work “uery (very) necessary for everye personne and much requisite to be had in the hands of al (all) sortes, for their better instruction, preparation and defence, against the soubdein (sudden) comyng, and fearful assaultyng of the same disease”.

Prominent as Forestier and Caius were as practitioners, they do not have the same Tudor cache as the man who was on the job when Anne Boleyn commenced The Sweat:  Dr. William Butts.  Other than his Sweating-Sickness association with Boleyn, little is known about the man.  Just what would the second-best Butts encounter when he arrived at Hever to tend his King’s lady love?  It’s difficult to tell the exact point in Anne Boleyn’s Sweat trajectory at which Butts came into the picture.

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JoAnn Spears is a registered nurse with Master’s Degrees in Nursing and Public Administration. Her first novel, Six of One, JoAnn brings a nurse’s gallows sense of humor to an unlikely place: the story of the six wives of Henry VIII. Six of One was begun in JoAnn’s native New Jersey. It was wrapped up in the Smoky Mountains of Northeast Tennessee, where she is pursuing a second career as a writer. She has, however, obtained a Tennessee nursing license because a) you never stop being a nurse and b) her son Bill says “don’t quit your day job”.

Up and Coming

/ Jordyn Redwood / Leave a comment

Hello Redwood’s Fans!

How has your week been?

Mine… one word. EDITING! Ugghhh.

What one word would describe your week?

For you coming up:

Monday: JoAnn Spears returns!! I love, love, love her posts where she takes a current medical eye to long lost monarchs and their illnesses. This Monday starts a four part series on Ann Boleyn (our favorite Tudor bad girl) and the mysterious Sweating Sickness.

Wednesday: Are ER nurses superstitious? What might some of those beliefs be?

Friday: HIPAA and law enforcement. Can medical professionals disclose patient information to the police?

Hope you guys are doing well. Anyone Christmas shopping yet?

Jordyn

Author Question: Treatment of Minor Injuries

/ Jordyn Redwood / Leave a comment

Maisie Asks:

I’m writing today with a medical question, I really appreciated the flow of your medical expertise in Proof, with it being a part of the story, and not a distraction from the story. I want to accomplish that same steady flow with my current work in progress.

My 16-year-old female main character is going to jump down from something (akin to jumping from a tree branch), the ground below is pitted and sloped though, and I need her to get injured. In my mind, it would be her ankle or her wrist (from catching herself) with some minor lacerations to her face. I’ve never broken anything to know how it feels.

I want the medical scene that follows to be realistic. Her Mom will meet her at the hospital, it’s late at night. What would be the steps, the healing process, pain management, any specialists, and healing time. I want her to be injured, but I don’t want her to be crippled for the entire summer (length of the novel). I want to know how the hospital scene and future doctor appointments will go, what they’ll look for, and how this is going to encumber her in her regular life.

Jordyn Says:

Thanks so much for sending me your question.
The thing to know about ankles is that they rarely fracture– 95% of the time they are sprained. For a sprained ankle, an air splint (crutches if the patient can’t bear weight) for 7-10 days and then the patient should work themselves out of the splint at that point. If still painful– they should follow-up with their regular doctor or orthopedic doctor at that time.
 
It’s more likely, with your scenario of falling down a hill, for a simple break to the lower forearm. Treatment in the ER would be x-ray to evaluate for fracture, and pain medication (usually Ibuprofen suffices). These would be the same initial treatments for an ankle injury as well. If fractured, the patient is placed in a splint and NOT a cast. Patient will follow-up with ortho in 7-10 days for cast placement. Cast is on for 4-6 weeks. There shouldn’t be any permanent damage.
 
Lacerations: generally a topical numbing agent is applied. This sets in place for 20-30 minutes. Or, the patient is directly injected with Lidocaine. Wound is irrigated with normal saline. Stitched up. Antibiotic ointment over the stitches. Wound should be cleansed twice daily with mild soap and water then Neosporin or equivalent over top. Stitches to the face are usually removed in 5-7 days. Tetanus shot if the patient hasn’t had one in the last five years.
 

Author Question: Major vs. Minor Organs

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When I first got this author question, I thought, okay– this should be really simple. A major versus minor organ– easy right?

Until I started to think about it.

What I would consider the major organs would be the brain, heart and lungs. Then I began to think about some of the minor organs (liver, stomach, etc…) that become very problematic if they aren’t functioning correctly causing major problems for the patient.

 
Then I thought– this isn’t really a distinction I make in medicine. For instance, it’s not a term used on a daily basis. So, then I wondered if someone did use that type of terminology.
 
On with Dee’s question.

Dee Asks:

I’m wondering if/hoping you could answer a quick question for me…

Is a spleen considered a major organ? Or not so much because it’s not vital to the body?

Jordyn Says:

Not sure how I would answer. Why is it important to make the distinction?
This isn’t a distinction we make in medicine.
Maybe this explains my difficulty: http://www.anatomy.org/content/how-many-organs-no-matter-how-minor-it-does-human-being-have-and-what-are-they

****************************************************************************

Dee J. Adams is the author of the Adrenaline Highs series published by Carina Press. Her first book, Dangerous Race, was a finalist in the 2012 Golden Quill Contest. Adams also has the distinction of being hired by Audible.com to narrate Danger Zone and Dangerously Close. Living Dangerously will be a May 2013 release. New York Times bestselling author Suzanne Brockmann says: “Dee J. Adams delivers it all in Danger Zone: romance, intrigue, and a cast of characters to fall in love with, authentically set in the gritty and entertaining world of movie-making. This one’s on my keeper shelf!” You can connect with Dee J. via her website: http://www.deejadams.com/

Author Interview: Eddie Jones

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As a nurse, I do think it’s important to consider the spiritual aspects of patient’s lives and all that entails. What is their spiritual belief and does it have elements that are becoming more mainstream? When a patient is in crisis– we need to consider these aspects.

As a pediatric nurse, I want there to be a love of books among children. But, how do we capture a culture that is obsessed with instant gratification? I don’t want to lose the next generation of readers, particularly boys, to movies and video games.

Eddie has some interesting thoughts on these aspects and he’s released an inspirational novel geared toward boys that deals with spiritual issues. He even offers advice to aspiring authors at the end of the interview.

Welcome, Eddie!

Tell us about your upcoming release, Dead Man’s Hand, with Zondervan.
First, it’s a fun, fast read aimed for middle school boys, but we’re also getting nice reviews on Goodreads from teachers and mothers. But my aim is to give boys a book they can enjoy, one taps into today’s fascination with the occult. This is the first book in the Caden Chronicles series and each story involves one element of the supernatural. Book one explores the concept of ghosts, spirits and what happens to our souls when we die.

Zonderkids is a Christian publisher, so the paranormal aspect is surprising.

I added the paranormal aspect because I want parents and youth to struggle with eternal questions. We’ve created such a culture of blood-letting through books and movies involving vampires, zombies and survival contests, that the reality of death doesn’t carry the sting it once did.

In high school my youngest son lost several friends to driving accidents. When another friend recently died, we asked how he felt and he replied, “I’m numb to it.” I fear that’s what we’re doing with our youth: desensitizing them to the horrors of death. In Dead Man’s Hand,Nick and his family discuss spirits and ghosts and the afterlife because I think it’s important for teens to wrestle with these questions before they’re tossed from a car and found dead on a slab of wet pavement.


You’re passionate about getting boys interested in books. Why do you feel it’s so important to get boys reading fiction at an early age?
I fear we’re on the verge of losing the male reader. I don’t mean men and boys won’t learn to read: they will. But the percentage male who read for leisure continues to shrink and this could be devastating for our country. We can’t lose half our population and expect America to compete on a global level. Reading forces the mind to create.
With video the scene and characters are received passively by the brain. There is very little interaction; it’s all virtual stimulation, which is different from creation. When you read, you add your furniture to the scene, dress the characters, add elements not mentioned by the author. This is why readers so often complain, “the movie was nothing like the book.” It’s not, because the book is your book. The author crafted the outline of the set but each reader brings their emotions and expectations to that book, changing it forever.
In general, boys would rather get their information and entertainment visually. This is one reason books have such a tough time competing for male readers. It can take weeks to read a book, even one as short as DeadMan’s Hand. Meantime, that same story can be shown as a movie in under two hours. So in one sense the allure of visual gratification is robbing future generations of our ability to solve problems.
I believe Americans only posses one true gift, creativity, and it’s a gift from God. Other nations build things cheaper and with fewer flaws. They work longer hours for less pay. But the thing that has always set America apart is our Yankee ingenuity. We have always been able to solve our way out of problems. That comes directly from our ability to create solutions to problems we didn’t anticipate. If we lose male readers and fail to develop creative connections necessary for the brain to conceive of alternatives, then we will lose our position as the world’s leader. 
What advice would you offer to parents to get their children interested in reading at a young age?
Watch for clues. If your child shows any interest in reading, reward the activity with trips to book fairs. I remember in grade school how excited I got when we were allowed to order books. All we had to do was check a box, (or so I thought), and wham! A few weeks later boxes of books showed up and the teacher began dealing them to the students. I didn’t learn until later my parents had mailed the school money for those books. I still have most of them.
But not all children like reading and you can create an anti-reading environment if you push too hard. An alternative for boys are comic books, graphic novels, or simply cartoon books. I read a lot of Charlie Brown cartoon books and still remember the plot: Lucy has the football. Charlie wants to kick the ball. Lucy promises she will hold the ball in place but at the last moment… We know this story because it’s repeated, not in a novel, but in a cartoon.
Do you have any advice for aspiring authors?
Write devotions, don’t focus on the praise, book sales and reviews. Forget about trying to find an agent and editor. Once you’re successful, they’ll find you. Explore the wounds in your life and minister to others through your writing. If God allowed you to be hurt, you can speak to that with authority. The rest of us, cannot. Ask yourself where your passions lie. I love surfing. If I could do anything, be anywhere, I’d be in a hut on a beach surfing a point break alone. I love playing and hate work. This is reflected in the types of books I write. I love pulling for the underdog, this comes out in the ministry God gave me. Only you can write the stories God dropped in your lap and if you do not, they will die.
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Eddie Jones is the author of eleven books and over 100 articles. He also serves as Acquisition Editor for Lighthouse Publishing of the Carolinas. He is a three-time winner of the Delaware Christian Writers’ Conference, and his YA novel, The Curse of Captain LaFoote, won the 2012 Moonbeam Children’s Book Award and 2011 Selah Award in Young Adult Fiction. He is also a writing instructor and cofounder of Christian Devotions Ministries. His He Said, She Said devotional column appears on ChristianDevotions.US. His humorous romantic suspense, Bahama Breeze, remains a “blessed seller.” When he’s not writing or teaching at writers’ conferences, Eddie can be found surfing in Costa Rica or some other tropical locale. You can connect with Eddie at www.Eddiejones.org

Drug Screens

/ Jordyn Redwood / Leave a comment

I think there is a general misconception in the public that all drugs can be detected by a basic blood or urine drug screen. This is not true.

First, when is a drug screen done?

There are several instances where we would likely run a drug screen. Here are a few.

1. You are having suicidal ideation. Suicidal ideation means you are having thoughts/feelings of hurting yourself and either you have presented or someone has brought you to the ED. This is fairly standard to see what might be in your system. What also will be added will be an acetaminophen (Tylenol) and salicylate (Aspirin) level. These are blood levels.

2. You are acting crazy. Meaning– you’re hearing and seeing things that aren’t there. There are gait disturbances, a decreased level of consciousness. Perhaps even seizure activity. A common set-up for this scenario is a child or teen that begins to act funny at school. Here, there is a concern for ingestion and it will be best to sort out what we might be working with.

3. An actual ingestion in any age group. The history will be looked at very closely but if it is— toddler got into grandma’s medicine cabinet (this happens more often than you would think) and the youngster just flat out began to go through boxes/bottles swallowing everything in sight– he will get a urine drug screen.

A urine drug screen can be an effective screening tool. But it definitely does not rule out all substances. That is the most important thing to know.

So– the following drugs are on a basic drug screen. It may also be called a “drugs of abuse” of panel. Something along those lines.

1. Amphetamines— interesting thing about this is some ADHD drugs contain amphetamines so kiddos on these will show positive. If they are on an ADHD med in this drug class– it doesn’t mean that they are not also abusing other types of amphetamines.

2. Barbiturates: The Truth Serum Drugs (Amytal Sodium, Phenobarbital and Luminal). But, do these drugs really act as truth serum? Interesting article here: http://www.damninteresting.com/the-truth-about-truth-serum/

3. Benzodiazepines: Drugs like Valium, Versed and Ativan are in this drug class.

4. THC: Tetrahydrocannabinol. Cannabis. The active ingredient in marijuana.

5. Cocaine

6. Opiates: Stuff of the opium poppy seed plant. Morphine, Fentanyl, Vicodin, Lortab, Codeine

7. PCP

Notice what is not on the basic drug screen? Alcohol… we would have to test separately for this.

Is this what you thought was on a drug screen?

Real Life Zombies?!?

/ Jordyn Redwood / Leave a comment

Writer Dale Eldon often poses medical questions to me but one question that seemed pertinent for his writing vice was whether or not zombies are a real-life medical possibility. The truth, even for the fiction writer, has to be grounded in realism for the reader to buy in. You either have to work from reality or create a believable story world from scratch.
Here’s a post I did for him on The Walking Dead.

So, are there real life examples of something dead coming back to life? In fact, there are. There are three aspects to consider.

One: Let’s examine the compliant aspect of being a zombie. Is it possible to create a wholly compliant individual? Someone without individual will power?
The answer seems to be yes.



Image: Wikipedia
Let’s consider TTX, the neurotoxin found in the blue-ringed Octopus. If this toxin is absorbed through the skin, it’s akin to having a frontal lobotomy and may lead to a compliant individual. Your personal zombie minion. You can find out more about TTX at the Writer’s Forensic Blog hosted by D.P. Lyle: http://writersforensicsblog.wordpress.com/2011/08/17/q-and-a-what-are-the-toxic-effects-of-a-poisonous-octopus-bite/.

Two: Someone that is alive is actually declared dead.

One truly frightening aspect is that sometimes lay people and even medical professionals aren’t all that great at determining whether or not a person has a pulse. This influenced changes to how the American Heart Association teaches CPR. Now, it’s encouraged to not spend more than 10 seconds trying to figure out whether or not a person has a pulse. If they’re not responding to you and you can’t find one—just start CPR. If they are conscious, they’ll let you know. If not, they likely need CPR anyway.

We’ve all heard the legends of corpses being found with nail marks in the lid. Well, how about the story from 2011 of a South African man who was presumed dead and brought to the morgue by his family and placed in the freezer– only to wake up about a day later amongst the truly dead and decomposing. You can find that story here: http://abcnews.go.com/International/south-african-dead-man-wakes-screaming-day-morgue/story?id=14154534.

Three: Are there real-life examples of things that are truly dead—no pulse, no breathing, no brain activity—yet, come back to life.

Let’s take the case of the wolf spider. A French researcher, Julien Petillon, decided to find out and submerged them in water for several hours—like 16. Now dead, they did come back to life. Check out more on this story and what he says about the 16 hour time frame and its significance at: http://www.msnbc.msn.com/id/30348224/ns/technology_and_science-science/t/drowned-spiders-come-back-dead/.

Image: Wikipedia
So yes, I would say there are examples of zombie behavior in our world. The compliant individual, those presumed dead but still alive, and those that have died yet are reanimated.

What zombie-like plot can you come up with based on these real-life examples?

Author Question: Can Chloroform be Sprayed?

/ Jordyn Redwood / Leave a comment

Sarah Asks:

Would chloroform, if shot out from a spray toward the victim, be effective for making a person pass out right away?

Jordyn Says:

Chloroform Mask 1865

Depends. Are you inside or outside?
I’m not sure that method of delivery will work for Chloroform. I found this paragraph that explains why. It is from this link: http://www.wisegeek.com/what-is-chloroform.htm

“Chloroform can easily be carried in water, and when it is exposed to oxygen and sunlight, a chemical reaction forms phosgene, a toxic gas. If chloroform is exposed outdoors, the phosgene will break down and ultimately become harmless, but in enclosed spaces, it can be highly dangerous: in addition to use in modern manufacturing processes, phosgene had a historical use as a deadly chemical weapon in both World War I. In groundwater, chloroform will build up and take a long time to break down, because it is not readily water-soluble. For this reason, most environmental agencies set safety levels for chloroform content, so that water can be routinely evaluated to see whether or not it poses a threat to consumers.”

Must the substance be sprayed? I’m not aware of any substance that could be sprayed that would just knock a person out, leaving them relatively unharmed with their breathing intact. After all, the police would probably readily use it in their work as it wouldn’t be as irritating as pepper spray, the taser, or as lethal as a bullet.

Any thoughts for Sarah?