Specific question about HIPPA
November 1, 2016 6:05 AM   Subscribe

I am a nurse. Is it legal and ethical for me to, with the patient's consent, refer my patient to a reporter to do a story?

Specific scenario I am imagining:

1. I approach my patient: "Hey, there is a reporter doing a story about (x issue that you have experienced). Would you like me to share your phone number with that reporter? It's totally optional if you'd like to participate."

2. [if the patient says they are interested] I tell the reporter my patient's name and phone number.

I've had a lot of HIPPA trainings, I've taken law and ethics for nurses, and I have tried to research this online, but I don't understand the answer to this question.

I do not care to hire a lawyer to answer this question, and I understand you are not giving me legal advice - I'm trying to learn the commonly accepted norms and expectations in this arena.

(I have been involved in working with my employer and the media before - where my employer handled all the legal side of my talking to the media and sharing patient info, however, in this case I was not thinking of referring the reporter for a story about my employer, and I don't really want to deal with my organization's PR department, but rather hope to connecting a reporter directly to patients who have experienced this specific circumstance that is unrelated to my employer. FYI, I am not really worried about or asking about what is the smartest thing to do from an HR point of view, but rather, are there aspects of HIPPA or commonly understood medical ethics that should make me think twice before connecting a consenting patient with a reporter.)
posted by anonymous to Law & Government (28 answers total)
Why don't you give the reporter's contact info to the patient?
posted by Etrigan at 6:09 AM on November 1, 2016 [54 favorites]

Why not give the reporter's contact info to the patient instead of vice versa?
posted by decathecting at 6:09 AM on November 1, 2016 [8 favorites]

Unless you have written consent from the patient, you should not share their information with the reporter. As others have said, give the reporter's information to the patient and let them follow up if they choose. I also have concerns about you walking too close to the line regarding HIPAA issues. You could potentially lose your nursing license and be jailed for violating HIPAA. Stay far away from the line. You put your nursing license at risk.
posted by eleslie at 6:16 AM on November 1, 2016 [2 favorites]

You would need signed, carefully-worded consent to divulge personal health information to a third party. Give the reporter a heads up, maybe tell the reporter patient's initials or other non-PHI info, and give the reporter's contact info to patient.
posted by supercres at 6:16 AM on November 1, 2016

Give the reporter a heads up, maybe tell the reporter patient's initials or other non-PHI info

Don't even do that.
posted by grouse at 6:21 AM on November 1, 2016 [24 favorites]

You should not do this at work without your employer's explicit consent, same as anyone would for any other non-work related thing they'd want to present to their clients/customers.
posted by ThePinkSuperhero at 6:22 AM on November 1, 2016 [10 favorites]

I'm sorry but as a nurse you should be sending any press to your hospital's media relations or legal department. Don't risk your career just because you don't want to deal with them. Do the right thing.

I work at a hospital, though not with patients, and every year we have mandatory HIPPA training that covers stuff like this. The answer is always, always, always to send the reporter to the media relations people.

I realize this is not the answer you want.
posted by bondcliff at 6:35 AM on November 1, 2016 [14 favorites]

1. As others have said, if you were to do this, the patient should be given the reporter's contact info, not vice versa.

2. I would want my supervisors to give me an ok before even that, however, because the ethical issues are, in my mind, a bigger issue than the legal issues. Is there any possibility (not probability -- possibility) that your client is going to feel pressured to talk to this reporter? Will they worry that their healthcare will be jeopardized if they don't (i.e., that there's any possibility that you'll refuse to treat them if they don't talk to the reporter)? Again, this is not a question of probability or of your own likely actions; it's a question of how the patient might feel, which needs to take into account the patient's current medical stability, the patient's current emotional stability, the patient's need (or non-need) for ongoing care, the patient's need (or non-need) for ongoing care from your facility, the patient's need (or non-need) for ongoing care from you personally, your overall relationship with the patient (i.e., has it been conflictual in the past? Has the patient seemed overly dependent on you in the past?), the potential benefit vs. harm to the patient in talking to this reporter, the potential benefit vs. harm of this patient's story being publicized, and your organization's overall general policies for such things, because if you're deviating from them, there better be a damned good reason that takes into account all of the above.

Basically, you're in a position of power over this patient, so asking them to do something has potential risks. How big those risks are, and how willing you should be to risk them, is highly dependent on a number of factors that we, as people not involved in this patient's care or in your organization's policies, can't advise you on.
posted by lazuli at 6:44 AM on November 1, 2016 [13 favorites]

Unless something pretty damn serious and dangerous is going on and the choices are to let said dangerous practice continue or risk your career to save the lives that are at stake as a result of ongoing dangerous practices, don't go to the media or refer anyone to the media.

Even then, report these cases through the proper legal channels before going to the media.

This just sounds like a reporter doing a story on living with x or y condition, in which case, there are lots of other ways for the reporter to find such people. Don't involve yourself.
posted by zizzle at 7:12 AM on November 1, 2016 [3 favorites]

No way, no way, no way. Not worth it.
posted by pintapicasso at 7:31 AM on November 1, 2016 [2 favorites]

Yeah, actually, I retract my suggestion that you give the reporter's contact info to the patient. I hadn't considered the possibility that the patient might feel pressured to talk to the reporter because one of her/his caregivers suggested it, and might worry that what s/he says or doesn't say might affect her/his care. Definitely don't do that. Send everything through PR/legal/media relations, who have thought through these issues more than you (or, clearly, I) have.
posted by decathecting at 7:41 AM on November 1, 2016 [5 favorites]

If I were the patient this would make me feel very uncomfortable.
posted by ferret branca at 7:51 AM on November 1, 2016 [4 favorites]

Mod note: A few comments deleted. It's HIPAA rather than HIPPA, duly noted; having some kind of dust-up over spelling isn't going to help OP with their question. Also please don't use this as a place to speculate about OP's motives or whatever. Thanks.
posted by LobsterMitten (staff) at 7:52 AM on November 1, 2016 [3 favorites]

I've been a hospital employee (though not a nurse), and I definitely would not consider this ethical. Less clear on whether it would be legal, but I would err on the side of assuming not, or else speak to my supervisor and the hospital's general counsel, if I really wanted to know. But I probably wouldn't get that far, because the ethical issues of making my patient feel pressured or harmed in any way that might compromise their health care experience would make this a non-starter for me.

I would not do this, unless it's some kind of whistle-blower immediate-harm situation so grave that it's far beyond the scope of the question as you've asked it.
posted by Stacey at 8:05 AM on November 1, 2016 [2 favorites]

It's totally optional if you'd like to participate

A note on wording only: this is language of complete authority and would sound really weird and intimidating in the guise of reassurance, like it was in your power to say whether it was optional. and like it's an official hospital reporter that you are authorized to speak on behalf of (or a non-hospital-affiliated reporter that you are authorized to speak on behalf of - freaky either way from a patient perspective.)

that is, saying nothing to the legal aspects, this is how I as a patient would expect to be approached for participation in a clinical trial or asked about my medication regimen. Something where I am answerable to the person asking. not something that is totally outside the medical person's sphere of expertise and authority.
posted by queenofbithynia at 8:09 AM on November 1, 2016 [3 favorites]

At most, I would give the reporter's contact info to the patient and let the patient take any initiative they wanted to in contacting the reporter (or not).

But, I have to say that as a patient, I would be really uncomfortable being approached about this type of thing. I would not want to feel like my nurse or doctor was viewing me more as a news story rather than trying to take care of me. I'm NOT saying this is what you're doing at all, just this is how it could come across to at least some patients. I would imagine that anyone in a vulnerable population and/or predisposed to feel nervous about health care could feel even more so this way.

All of this to say: there are procedures in place to protect patients from feeling pressure or other negative reactions, which is why your hospital has the PR department in place. At a minimum, I would talk to your supervisor about the specific situation and why you feel it is inappropriate to go through PR channels in this specific case. If there is a serious concern about patient safety and the hospital is covering it up, I could see the argument for raising this with a patient and telling them, OPTIONALLY, that they can contact the reporter if they wish. But I would say that's only for extreme circumstances.
posted by rainbowbrite at 8:12 AM on November 1, 2016 [5 favorites]

Here's a dramatic, tangentially-related story about what can happen when patients are involved in media without proper consent in place.
posted by ThePinkSuperhero at 8:23 AM on November 1, 2016 [1 favorite]

Option 3: Tell the patient about the story and pass along the reporter's info. Then you haven't broken HIPPA either legally or morally.
posted by yes I said yes I will Yes at 8:31 AM on November 1, 2016

Re: commonly understood medical ethics

Don't give out patient information of any kind unless you need to for work. As it is, patient confidentiality is difficult to maintain within legit work processes. Don't add to the problem. If you don't realise this is a big problem in healthcare pay a bit more attention in the next couple of weeks and see how often you see/hear/have access to patient information that you don't need to know.

You have an uneven relationship whether you think of it that way or not. The patient is in your care and relies on you. You may also represent The Hospital or Doctors or Medicine to them. Health care professionals are authorities to a lot of people. You asking them to do something can make them feel pressured to say yes or they may agree thinking that you're recommending this as a good thing for them. It won't seem optional or neutral to a lot of people.

Your patients, I'm assuming, are unwell. In many cases, this might mean they can't give informed consent. You'd have to do a lot more than just give them a few sentences about reporter X looking to interview people about condition Y to fulfill ethical requirements for informed consent. It would take so much paperwork and approvals to draft the required documents that you may as well pass it on to HR. You alone, just speaking to the patient, is not enough.

I'm guessing you're trying to promote awareness of a condition or something like that. An ethical reporter has other ways to find the right people to interview that won't compromise your job or the care of the patient. Another option is maybe work can give you the okay to be interviewed as someone who has treated people with condition Y.
posted by stellathon at 8:32 AM on November 1, 2016 [7 favorites]

I have often put patients in contact with each other to share stories and experiences.

Always approach with a casual tone, explain the situation and ask, "Would you be interested?" Move quickly and easily to a new topic if your patient is not interested. Don't use the word "optional" or say "not required." That suggests an expectation.

You know your patients best. You are approaching a patient whom you've judged might like to participate. If you have a standard signed release form specifying the reporter, the scope of information released and the purpose, you are covered legally. This is a very low risk and good ethics situation.

Having said that, though, I have always given contact information to the patient and let him or her do the calling.
And having said THAT, if dealing with a reporter I would always go through my hospitals public relations department.
posted by SLC Mom at 8:33 AM on November 1, 2016 [1 favorite]

It's totally optional if you'd like to participate.

As others have said, you are in a power relationship with a patient such that saying something is totally optional does not necessarily sound totally optional. Giving out a patient's phone number absent a signed piece of paper saying this is okay puts you on terribly shaky ground and I doubt you actually have the authority to get a patient to sign this sort of piece of paper. There is a HIPAA officer at your workplace (not a lawyer you'd pay for) and the only way to tell if this is letter of the law legit is to ask them.

You might want to suggest that the reporter go somewhere more casual for this information like a $TOPIC support group which was not necessarily under the HIPAA guidelines. The only way I could see this scenario working is if you had some of the reporters cards to hand out. You should, under no circumstances, put yourself in the middle of this transaction.
posted by jessamyn at 9:13 AM on November 1, 2016 [2 favorites]

Good lord, absolutely not.

Others have covered the ethical problems with this idea - specifically the power differential and the informed consent issues. I'll offer two more points. First, a hospitalized patient is in pain and traumatized and vulnerable. It's wildly inappropriate to ask this patient to think about some reporter's needs at that point, rather than about their own need to heal.

Second, OH MY GOD the ways this can go wrong. Say a patient feels (or says they felt) pressured/confused into a conversation with a reporter. The reporter then publishes a story which the patient - for whatever reason - feels violated by. They regret their participation. They want to sue for whatever damage they feel they have incurred. Guess who's going to get sued?
posted by fingersandtoes at 9:23 AM on November 1, 2016 [1 favorite]

You say this has nothing to do with your employer, but of course it does, because you are talking to the reporter and the patient as a nurse who is employed by the hospital. If the patient or the patient's family later files a complaint, you can be sure the hospital will be named.

So as others have said, go through the proper channels at work, be it PR or the legal department. Maybe start with your supervisor, and let him or her take it from there.
posted by merejane at 9:53 AM on November 1, 2016 [1 favorite]

Also, more generally -- if you have a legal question that is in any way related to your employment (even if the only connection that you see is that you are an employee), the question should be asked of your employer.

I am not your lawyer or your hospital's lawyer, but I was a lawyer in the legal department of a hospital for several years. As much as I love AskMeFi, I would not have been happy to learn that an employee was asking legal questions on this forum! The legal and PR departments at your hospital are there for a reason -- use them, not an internet forum, for legal questions that come up in your role as a hospital employee. Again, if any legal problems arose from this scenario, the hospital would most certainly have to deal with the fallout, because you are a hospital employee.

And you don't have to hire your own attorney to ask legal questions that in any way relate to your employment. Once more: treat this like any legal question you have in your role as as nurse, and pursue it through the proper channels at work.
posted by merejane at 10:06 AM on November 1, 2016 [3 favorites]

I had this whole spiel written about how, since the story isn't about your employer, you might be in the clear (ethically... no clue about the legal aspect) to give the reporter's info to the patient once and never mention it again but I deleted it.

The fact that your instincts pointed you in the direction of sharing patient info (but looking for a "safe" way to do it) is a big red flag to me about your judgment regarding what would, or would not be an appropriate referral. All the stuff I had about who is going to benefit vs. who could be harmed, etc. etc. assumes a better grasp on the issues at stake than your question lays out.

Maybe I'm misjudging you, or coming down overly harshly, but I really think that you should stay away from this story, for the good of your career and your patient. Let the reporter find their own sources -- that's their job.
posted by sparklemotion at 10:17 AM on November 1, 2016 [1 favorite]

One way to facilitate this connection appropriately would be to have the reporter ask your organization about putting up a flyer in the office lobby. ("Have condition X? We'd love to get your perspective for a story in the Times! Contact Y for details.")

It'd be up to your organization whether they even want to provide that level of "endorsement," but there'd be far less potential perceived pressure than if you personally offered the reporter's contact info to your patient.
posted by cogitron at 10:50 AM on November 1, 2016 [5 favorites]

Having just been to the hospital, I would vastly prefer coming home with a flyer or contact info that I vaguely remembered than a poorly-timed phone call asking questions I only vaguely remembered agreeing to. The hospital is such an overwhelming environment for patients; I was about as well as someone could be, am usually pretty with-it, and I still missed a significant detail about a new prescription. Anything extra is going to make it harder for them to get well, aside from the legalities.

I got mad enough getting an email survey while I'm still feeling like shit--what you describe is probably something that would have me calling the hospital and checking details. Another vote for not giving the patient info to the journalist.
posted by tchemgrrl at 4:16 PM on November 1, 2016 [2 favorites]

I don't know what the reporter is looking into, but normally as a journalist and editor, we would get directly in touch with hospital PR for any information we needed for a story. Of course, there are valuable medical stories to be told that don't involve hospital PR as the middleman, but think about the kinds of stories those might be—you as a nurse and hospital employee almost certainly should not be the person to be making connections for investigative reporting about the hospital, doctors, or conditions a patient might have on the basis of your personal knowledge of their situation, unless we're talking some kind of major whistleblowing situation. This didn't sound like it's that.

And yeah, seriously, as someone who's a frequent caregiver to two people who have spent significant time in the hospital, I can tell you, we really wouldn't be interested in talking to reporters about anything to do with this experience in most cases. This is for a variety of reasons; there are numerous reasons these situations are so highly regulated. As a nurse, I think you are probably aware of what patients look to you for: accurate and prompt medical attention, turning off those horrible noises machines make, help cleaning up one's body in some cases, conveying one's wishes to doctors, administering medication... It's awesome if we can connect in a personal level for the brief period of time we're together in the hospital, but it's not necessary, and anyone even seeming to push something like this on us would probably be viewed as suspiciously by us as one of the itinerant clergy members who roam the hospital.

Avoid this.
posted by limeonaire at 10:26 PM on November 1, 2016 [2 favorites]

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