What should I say?

September 25, 2013 4:59 PM

I'm a nurse. Recently, a police officer approached me at work to ask me some questions about a patient. I discussed the issue with my supervisor who clarified my hospital policy on talking to the police, but how do I figure out my personal legal and moral obligations around this?

As a political lefty/radical type, my long-ingraned instinct is to never answer police questions without a lawyer. I don't feel that answering questions about a patient requires me to have my own lawyer, but on the other hand, I still feel discomfort being involved in a police investigation when my role is as an advocate for my patients. I don't feel my job is to support (or obstruct) police investigations and my instinct is to avoid involvement.

I'm wondering if there are online resources, an advocacy organization or non-profit, or a smart legal advocate type public person or organization I could query via the internet to help me think through what I personally want to say to the police in these circumstances.

The answer "talk to a lawyer" will not be helpful to me. However, as I say in my question, if you have a specific legal organization or person you think would help me think this through, I would love to hear that.

posted by latkes to Religion & Philosophy (21 answers total)

Your hospital has a lawyer, and very likely a spokesperson/public affairs officer. Tell police officers to talk to one of those people.
posted by Etrigan at 5:06 PM on September 25, 2013 [16 favorites]

Per the legal department at my hospital, you can't even acknowledge to a third party that you've ever even heard of a patient; if you've provided medical services to them.

My response to the police officer would be 'subpoena or GTFO,' or if I was feeling particularly snippy, 'I am unable to confirm or deny the particular details of your inquiry at this time pursuant to the Health Insurance Portability and Accountability Act,' because as far as I know, even confirming the existence of a patient at any point in time is technically a federal offense as well as being against every hospital's own legal policy.
posted by hobo gitano de queretaro at 5:07 PM on September 25, 2013 [22 favorites]

What did the supervisor say? Does the supervisor understand that you are still uncomfortable?

That would be helpful information. However, I think the hospital, not you, should do any talking.
posted by Lesser Shrew at 5:10 PM on September 25, 2013 [3 favorites]

I don't feel my job is to support (or obstruct) police investigations and my instinct is to avoid involvement.

That's irrelevant - your job is to do what your employers tell you to do, provided it is both legal and ethical.

What do your employers tell you to do? Is your employers' instruction legal and ethical?
posted by saeculorum at 5:11 PM on September 25, 2013 [8 favorites]

You need to speak with the legal counsel at your hospital, who will inform you of what your obligations are.
posted by NotMyselfRightNow at 5:11 PM on September 25, 2013 [1 favorite]

Are you a member of the ANA or a similar nursing organization? The ANA has web resources on nursing ethics, including patient confidentiality, and an email address for ethics issues. So, I'd start by contacting them.

But as a human being in whom other human beings have put an absolute trust that you will safeguard their privacy, you have, I think, an obligation not to speak to the police about a patient unless the patient has given you specific permission to disclose specific information in this specific context. I absolutely would not talk to a police officer in your situation, because I would respect the fact that my patient might not want me to, and it's the patient's decision, not yours.
posted by decathecting at 5:12 PM on September 25, 2013 [5 favorites]

This is not a question you can seek outside advice on (ie from a nonprofit or whatever) because you could very easily lose your job or worse.

As others have said, talk to the hospital's legal staff. And honestly your administration has already messed up - how to handle this should have been a policy you already knew well.
posted by kavasa at 5:20 PM on September 25, 2013 [6 favorites]

"Please refer all questions to my supervisor."
posted by KokuRyu at 5:31 PM on September 25, 2013 [6 favorites]

Given the vagueness of the circumstances you state, your common sense would likely be your guide here. There are likely very many good reasons to answer an officers' questions that could assist in a time sensitive ongoing investigation or help locate a missing person, but this would entirely depend on the types of questions being asked. A blanket "because you're a cop I need to talk to lawyer first" firm rule is a bit childish, and could end up causing unintentional harm.
posted by Debaser626 at 5:31 PM on September 25, 2013 [3 favorites]

I am assuming the OP cannot elaborate on the case at hand. However, I would add that what usually makes these situations so difficult for me personally is that they often involve someone who was driving under the influence, thereby endangering other innocent people's lives, children, etc. And those people have lived and died under my care as well.

I'm not trying to guess at what's going on, but seeing answers assuming that there could never be a good reason to talk to the police about your patient, I wanted to point out that there can be more to the story.
posted by treehorn+bunny at 5:33 PM on September 25, 2013 [2 favorites]

Best answer: Agreed that supervisors and/or hospital lawyers are the people who need to handle this, but for a little more info here's the University of Chicago's take on it.
posted by katemonster at 5:33 PM on September 25, 2013

Best answer: as far as I know, even confirming the existence of a patient at any point in time is technically a federal offense as well as being against every hospital's own legal policy.

There are specific exemptions for disclosure to law enforcement. You can read about them here.

Honestly, though, even after reading that, if I were in your shoes I still wouldn't feel comfortable talking to the police (even ignoring my "never talk to the police" instincts). This, I think, points to the greater issue: it shouldn't be your responsibility to correctly interpret the Privacy Rule in this situation, and it's absolutely appropriate to kick it up the chain of command to supervisors/hospital legal counsel.
posted by pullayup at 5:38 PM on September 25, 2013

Best answer: Here's a summary of your HIPPA duties according to HHS:

http://www.hhs.gov/ocr/privacy/hipaa/faq/disclosures_for_law_enforcement_purposes/505.html
posted by Ironmouth at 5:39 PM on September 25, 2013 [5 favorites]

After reviewing that document, its the regulations that define your duties. There appears to be a relatively narrow band of disclosures you can legally make. Looks extensive and detailed.
posted by Ironmouth at 5:42 PM on September 25, 2013

I will second the advice above about not disclosing anything - you're a nurse and it's not your job to figure out whether this is acceptable on the spot. I mean, you should know what disclosure laws are, but it's easy to have clouded judgment when it's a cop who is presumably acting in an official capacity.

From an ethical standpoint, and without knowing anything about the nature of the questions, I would at least report this incident to a supervisor, and maybe even to the supervisor of this officer. If you just say no, a "good" cop (that is, one who is good at finding information) will just ask someone else who is more cooperative.
posted by antonymous at 5:48 PM on September 25, 2013

I would also suggest being friendly no matter what you are allowed to talk about. They are trying to do their job, you are trying to do yours. There is no reason to bring politics into it.
posted by gjc at 5:56 PM on September 25, 2013 [1 favorite]

Response by poster: Hi folks, thanks for your advice.

I think I phrased my question poorly. While I appreciate some of the more general opinioning, I really am looking for either the type of legal information linked by a few folks above, or for advocacy organizations or individuals who do academic/legal/advocacy work around privacy/ethics/health care etc who might suggest some more ways that folks are thinking about this issue.

Thanks so much.
posted by latkes at 5:57 PM on September 25, 2013

I'm the health privacy specialist for the New Zealand Privacy Commissioner, and the actual legalities depend strictly on your jurisdiction. In New Zealand health professionals are permitted to disclose health information to police officers when they need it to carry out their lawful functions, for instance.

But you cannot go wrong by pushing him up the chain and that is absolutely how you should proceed. Cops will try and circumvent the process and this can have major consequences for you if you get it wrong, so don't let them.
posted by Sebmojo at 7:14 PM on September 25, 2013

Best answer: This isn't specific, but only because I don't know where you work: in the US, as far as I know, most (if not all) hospitals are required to give patients a full description of their privacy rights, and all the hospitals I've interacted with have a "privacy officer" or ombudsman or whatever. The HIPAA stuff also makes it pretty blatantly obvious that all the decisions, liability, etc., fall on "the covered entity." Given these facts, I'd be very surprised to learn that any hospital wants front-line staff to make these kinds of calls in the heat of the moment, outside of life-or-death situations.

As far as advocacy, research, etc., I suggest reviewing materials on the Privacy Rights Clearinghouse site, not least because they provide links to other resources on each of their pages, and they have a section that shows their speeches/testimony/etc. on specific issues (which gives you hints as to when and where other useful organizations may have spoken up.)
posted by SMPA at 8:10 PM on September 25, 2013

Oh, and the clearinghouse tags all their pages, though it's not immediately obvious that they do it - this is the "medical privacy" tagged stuff.
posted by SMPA at 8:14 PM on September 25, 2013

Mod note: A couple of comments deleted. Okay, the OP has heard "don't talk to the police," and "send them to your supervisor(s)" so this doesn't really need to be repeated again. The actual question, stated twice now, is: where to find online resources for legal information, or advocacy organizations or individuals who do academic/legal/advocacy work around privacy/ethics/health care.
posted by taz (staff) at 3:18 AM on September 26, 2013