[YoMom]

An emergency room nurse at our local hospital is also the foster mom for the two young children of my son's live-in girlfriend. The girlfriend accompanied my son during a recent visit to the ER for him to obtain treatment for an overdose of a prescription medication he "borrowed" from a friend--yes this was stupid, but he has definitely learned a valuable lesson from this experience. The foster mom/ER nurse was present when they entered the ER; however, she was not the nurse who treated him at the ER.

Two weeks later the girlfriend was scheduled for a routine court hearing related to her custody case--these court hearings are scheduled to check on her progress in meeting the requirements established by the DA, her DHS case worker, and her CASA worker. The day before the court hearing, the DHS case worker notified my son's girlfriend that a "last minute background check" had been conducted on him, which revealed the ER visit. The girlfriend was further informed that this "new information" would impact her custody case (and it did).

After later contacting the hospital, we confirmed that a court order to obtain a copy of my son's ER report had been initiated the day prior to the court hearing (no other medical records from any other medical facility were specified in the court order). Of course, we do know that the hospital must release medical records in response to a court order and that this in itself is not a HIPPA violation. When we asked the CASA worker what prompted the court order to obtain my son's ER report, she tried to convince us that the background checks for individuals involved in child custody cases routinely included an examination of their medical records. However, the initial background check conducted for my son did not include an examination of any medical records. Additionally, no previously scheduled court hearings have been preceded by a "last minute" additional background check.

We suspect the ER nurse/foster mom leaked the information concerning my son's ER visit to the court officials and have notified the hospital accordingly (just verbally to their medical records department director--a formal complaint has yet to be filed with the hospital or the Office of Civil Rights). The hospital official indicated they take these concerns very seriously and asked us to submit a written report of our concerns (no complaint procedures were available). At this point, we are hesitant to submit the written report or take any further action because we don't want our actions to negatively impact the child custody case. However, we do think the hospital needed to be aware of our concerns so they could conduct an investigation, and if confirmed, take appropriate action against the employee.

What should we do now?

[JudyKayTee]

I don't see a violation here. Maybe it was the Nurse, maybe it was somebody in billing or records, maybe it was another patient -

I don't know where the line is drawn in a case where a person believes someone's behavior (your son's) could put children at risk - can they breach HIPAA or not? And if they come upon the info in their course of their employment does that mean they cannot report it?

Seems that your son made a serious error in judgment here, particularly in light of a pending custody matter and that's probably the concern of the person who reported him - if, in fact, someone reported him.

I'm going to sound harsh here but do you think the girlfriend and your son should regain custody in view of the fact that they have apparently lost custody at least once and he has made this "mistake"?

Last minute backgrounds sweeps are not uncommon in NYS - I don't know where you live.

If you feel justified, sure, file a report -

[YoMom]

My son has only recently entered the picture and was not involved with the case when the girlfriend lost custody of her children. Of course, once the information was revealed to the courts there was a need to investigate further and to establish an appropriate plan of action. No one is defending my son's actions--he knows he made a terrible decision and there would be consequences if the ER visit were reported. This situation is not one the hospital was required to report to law enforcement--if it had been, there would have been a record of the report in my son's ER report and there was none.

Knowledge of my son's ER visit put the ER nurse/foster mom in a very difficult situation. However, I don't really think HIPAA examines what might motivate an employee of a health facility to violate a patient's privacy. The bottom line is, it appears someone with knowledge of the ER visit and with knowledge of the girlfriend's custody case reported private medical information to the DA without my son's authorization to do so.

[JudyKayTee]

Knowledge of my son's ER visit put the ER nurse/foster mom in a very difficult situation. However, I don't really think HIPAA examines what might motivate an employee of a health facility to violate a patient's privacy. The bottom line is, it appears someone with knowledge of the ER visit and with knowledge of the girlfriend's custody case reported private medical information to the DA without my son's authorization to do so.

HIPAA is not an Agency in and of itself - it's a privacy law which is enforced by the Office for Civil Rights of the Department of Health and Human Services. Therefore, that's the office that looks at violations.

You are incorrect - the motive IS examined if there is a complaint. For example, if a Pharmacist becomes aware of a situation which endangers a minor it is his/her duty to report the same to the authorities. And that is most definitely not a violation of HIPAA.

What do you believe the Nurse's reason for reporting the incident was if it was not to protect the children from a potentially bad situation? It doesn't sound like she has an interest in this other than protecting those children.

I still believe if it was the Nurse who reported the situation and that information did play a part in the result of that particular hearing (which it seems you believe to be true) she was not in violation of HIPAA because the information she provided influenced the decision - your son's rights under HIPAA were superseded by her requirement to safeguard the children.

If she provided info which did NOT change the decision or which was NOT substantial, then, well, perhaps she could be found in violation but I don't see that happening here.

[J_9]

As a very soon nurse to be, I have to side with Judy here. Whenever there is a patient that I treat that is in possible danger or puts others in a possibly dangerous situation, it is my duty to report that.

Now, I don't know if this nurse/foster mom is the one who did the reporting, however, she did have a duty to the children to protect them from any situation that may place them in harms way, should he decide to make this "terrible decision" in their presence.

Had the children been in their custody when this happened, it would have been a reportable incident and they would have risked losing the children. I realize the children were not in their custody, but a custody hearing was upcoming, so, again, it is a reportable incident as the health and safety of the children are of main concern.

[Fr_Chuck]

Let me see the foster mom for two children knows that the mom brings her boyfrined in for a overdose of illegal drugs ( they were not his)

Yes, not only should she, I would say she has a duty to report this and did the right thing. I am sorry it effected the case in a way that you may not hve wanted it, but the actions shows a issue with the home life and needed to be addressed by the court.

A report that someone is using a controlled subject that was not thiers falls into a criminal issue with a duty to report.

Sorry not the answers you are waniting to here, but as his mother, you need to realise that they need to get their life in order first and keep it in order for some time, before having small children in that atomosphere

[JudyKayTee]

Let me see the foster mom for two children knows that the mom brings her boyfrined in for a overdose of illegal drugs ( they were not his)

Yes, not only should she, I would say she has a duty to report this and did the right thing. I am sorry it effected the case in a way that you may not hve wanted it, but the actions shows a issue with the home life and needed to be addressed by the court.

A report that someone is using a controled subject that was not thiers falls into a criminal issue with a duty to report.

Sorry not the answers you are waniting to here, but as his mother, you need to realise that they need to get their life in order first and keep it in order for some time, before having small children in that atomosphere

There was also the ability here to report the overdose of illegal drugs to the authorities (and you are right, they were illegal - not his prescription) and the very real possibility of several arrests (minimally the boyfriend and whoever handed him the drugs) and yet the hospital/Nurse did not do that. They simply attempted to protect the children.

I don't know, now that the situation has been brought to the attention of a Court, that that still won't happen.

This is more complicated than a mistake or misunderstanding -

I think I'd count my blessings at this point and not make the situation worse by attempting to report anyone for anything.