Author Beware: HIPAA– It’s No April Fools

April 1, 2019April 1, 2019 / Jordyn Redwood / Leave a comment

One of the biggest errors authors make in regards to writing about something medical is that their character violates HIPAA. HIPAA is a law that outlines a patient’s rights regarding their protected health information (PHI). I’ve blogged extensively on this topic and you can find these posts by following these links:

Author Beware: The Law: HIPAA Part 1/3
Author Beware: The Law: HIPAA Part 2/3
Author Beware: The Law: HIPAA Part 3/3

HIPAA and Law Enforcement
Author Beware: Proof’s Problem with HIPAA
Disasters and HIPAA
Modern Family: S10/E7 Disclosing Pregnancy Results

The simplest way to explain a HIPAA violation is that someone accesses a patient’s information when they are not directly caring for that patient and/or discloses protected health information about a patient publicly.

Two recent stories have highlighted each of these scenarios.

The first involves actor Jussie Smollett and several dozens of hospital employees accused of viewing his medical information at Northwestern Memorial Hospital in Chicago, Illinois. They were all fired, reportedly some didn’t even open the chart, but just “scrolled by” it. The point is, with today’s technology and electronic medical records, it is very easy to determine who has accessed someone’s health information. It’s basically tracked electronically. Unless you are directly involved in caring for a patient, it is illegal for you to look at their information. I can’t even access my own children’s medical charts at the hospital where I work unless I go through the proper channels, which is signing a release for them through medical records.

Image by Mabel Amber, still incognito… from Pixabay

The second, and perhaps more frightening case, is of the nurse who disclosed a toddler was positive for measles in the pediatric ICU where she worked and then posted about it to an anti-vaxxer group she belonged to on social media.

She didn’t give the patient’s name, sex, or exact age so she should be okay, right? Many times, people think this is a way to get around HIPAA and sometimes they can be right— it depends on the volume of such a diagnosis. For instance, if my ER sees 5,000 patients a day (which is insane– I don’t know any ER that can even possibly do this) and I say we saw a patient with a rash (and that’s it) then that doesn’t necessarily signify the one I might be talking about because there were probably dozens of patients seen with a rash that day with that volume of patients. However, I will also say this could still be considered a HIPAA violation, but let me further illustrate my point.

The more unique and rare a medical diagnosis is, the more easily it would be to identify a patient even without disclosing name, sex, or age and that is this nurse’s first problem. There was probably only one patient in the PICU that had a medical diagnosis of measles. It had likely been in the news that there were measles cases in Texas (this is frequently disclosed for the public good to encourage vaccinations), but the nurse’s information narrows down the hospital, the general age group, and just how sick he was. Then neighbors can start thinking, “Hey, we live close to Texas Children’s and I haven’t seen Billy (totally made up name) in a while and he’s a toddler—” and then phone calls go out to Billy’s mom asking if he has measles. See?

The frightening aspect of the scenario, from a purely pediatric standpoint is, that even after seeing how sick this child was, she remained an anti-vaxxer and even mused about taking a swab from the ill child’s mouth and attempting to give wild measles to her own child! For one, I consider this child abuse. I truly cannot fathom in my mind how this nurse believes giving her child the real thing is preferred over a vaccine that can prevent the entire illness.

**The safest thing for ANY healthcare worker is to not discuss their patients at home or on social media no matter how vague they try to make the scenario.**

It is also the safest thing for authors who are writing these scenarios. As I’ve always said, you can have a character that violates HIPAA in your novel, but they must face repercussions for it. The positive side of this is that it increases the conflict in your story automatically. It also shows the reader that you’ve done your research.

Author Question: Nurse Comforting Orphaned Child

July 17, 2017July 6, 2017 / Jordyn Redwood / Leave a comment

Erynn Asks:

First Question: What’s the protocol when a child is brought in after a traumatic event (like being the sole survivor of an accident) while waiting for next of kin if they’re not local? I had originally written a scene where a nurse was comforting him, but I feel like I remember a reader telling me they wouldn’t be allowed to hug or hold a child . . . .even if they’re alone. Is this correct? Are there nurses who wouldn’t care and would do it anyway?

Second Question: Would CPS (child protective services) necessarily be involved? The child in question has an adult sibling and a will exists that will show that he should be the guardian. Would there be any hoops for him to jump through before they let him take him home?

Jordyn Says:

I’ve worked as a pediatric ER nurse at two different large pediatric medical centers and have never been admonished to not hug or hold a child if that’s what they emotionally required. I actually find that utterly shocking any hospital would tell their nurses not to do this— though obviously understand why.

A pediatric nurse will always provide age appropriate care. Infants and toddlers usually need to be held to be comforted. With a school age child or older we would go based on the child’s cues. We would probably ask, “Do you need a hug?” or “Can I sit with you?” Sometimes, open ended questions are hard for kids who are dealing with traumatic events to answer. Questions like, “What do you need right now?” probably won’t elicit much of a response so the nurse will ask very pointed questions.

Who else could assist the child? An ED tech. A volunteer. A child life specialist.

I think you’d need to place close attention to where this novel is set and the hospital would need to match your setting. Community ER’s (common in rural areas) are more comfortable dealing with the adult patient so they might approach this situation very differently and not have as many resources available.

Child Life specialists are generally not staffed 24/7 so I would keep that in mind. I also haven’t found them outside pediatric hospitals. Same with chaplains– may not be available 24/7. Depends on the type of hospital.

As a pediatric institution, we also would probably not involve Child Protective Services though probably social work consultation would be advisable in this situation. In CO— we generally reserve CPS for concerns for abuse.

If the adult sibling could prove legal guardianship in the case of the death of the parents than the child would be released into their care. Even in the case of lack of paperwork, the child would likely go to next of kin, of which it sounds like would be this sibling.

Happy writing!

Button Batteries: Preventable Cause of Pediatric Death

March 10, 2017March 6, 2017 / Jordyn Redwood / 1 Comment

There is nothing that will raise the ire of a pediatric nurse more than a preventable pediatric death. So, in an effort to educate the public, today I’m focusing on a very real danger in your home that could kill your child if ingested and that is the button battery.

Button batteries are those disc shaped, silver batteries that are found in hearing aids, watches, weight scales, and often toys. I would be surprised if you didn’t have these in your home.

Typically they are swallowed by younger children (age 1-3) who may or may not tell you what has happened. We can tell the difference between a button battery and a coin by a characteristic halo appearance of a button battery on x-ray. If you look at the underside of the battery, you’ll see this gap that will show on film.

If the battery becomes lodged in the upper esophagus, it leaks a highly caustic alkaline solution, even if the battery is spent, that begins to erode through tissue. This process happens quickly. I’ve seen these burns develop in just two hours. These burns can lead to scarring and long term complications— that can be a minor complication.

There is also a deadly complication. Even after the battery is removed, this alkaline solution can remain in place, eroding and burning away tissue. Typically, the cause of death in a button battery ingestion is hemorrhage because this solution eventually erodes through a major blood vessel. Even if the patient is in a hospital when the bleeding starts it is very difficult to repair.

For prevention:

1. Button batteries need to be treated as highly toxic objects. They should be kept out of the reach of children (even locked up) like other dangerous objects in your home.

2. Toys that have button batteries need to have screws that lock them in place. Toys should be checked frequently to be sure this compartment stays locked. Best case is not to have these types of toys in your house at all with younger kids.

3. Be aware of items in other environments that have button batteries. Button batteries are used in hearing aids. So be careful at grandma and grandpa’s house and have a discussion with any caregiver about the dangers of having these unsecured.

4. Give age appropriate education to other children in the home about how dangerous button batteries are. Tell older children to tell you immediately if they see a younger sibling with anything in their mouth that they’re not supposed to have. Have them show you toys when they break to see if the battery has become loose. If it’s not there— find it.

5. If swallowed, proceed immediately to the closest emergency department. I mean, really drive there now. You don’t need to call 911 but you do need to go. Do not delay being seen. Button battery ingestions are a true emergency. Your child should immediately receive and x-ray to determine the location of the battery. Treatment depends on its location.

6. If discharged home after a button battery ingestion, any bleeding needs to be treated as an emergency as well. If bleeding is significant then you should call 911 and be transported. Even minor (or spot) bleeding from the mouth needs to be evaluated emergently.

For additional cases and information you can read here and here.

As one of my physician co-workers said, “Respect the button battery.”

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