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HIPPA Policies

1 week 2 days ago #96864 by Lindsey
I have been an ED attending for over 20 years and practicing medicine for almost 35 years. I had a 27YOF present in the ED (with both parents although Mom left halfway through) with extreme chest pain and one of the worst panic attacks I've personally ever seen in all of my years in medicine. She was violently shaking, vomiting, dry-heaving, and even threw a couple of SVT episodes. She stated she had been suffering from the panic attacks only over the past 6 months, never before. No triggers. Patient stated that her life has never been as happy and as stable as it has been over the past year. Patient did disclose that she was divorced from a five-year domestic violence relationship with her now-current ex-husband, but she sought counseling and did not feel the attacks and anxiety were at all attributed to that. Patient had a fall walking her dog about 18 hours earlier which resulted in a trimalleolar fx with dislocation. Patient was actually out walking her dog at that hour (0400) due to a panic attack. She was seen at the ED in a larger town one county over, which is where she resides. She was with her parents in the ED in my town only due to immobility and needing support. FX was reduced in the other ED, and ORIF scheduled there at the Orthopedic Hospital for 2 days out. Patient also has a hx of RA, stage IV endometriosis, HTN, and pericardial effusion. Patient was on meds for all of these, but no controlled substances. EKG was abnormal, but from the records we could see, it had been her normal for around 6+ months. Ordered CBC, Chem 7, and urine screening. Initially treated patient with Promethazine which worked for around 2 hours. Drug screen came back clear except for trace amounts of THC. I found out later that PT was forthcoming about this with a nurse during a private moment. I did not see that in the chart until afterwards. While patient was asleep from the Phenergen, I felt obligated to share with her father the results of the drug screen. I wanted to explain to him how THC could be causing this new-found anxiety and panic attacks and it is probably something that he would want to discuss and may want to get her some help for. I did not however, discuss these results with the patient as she obviously would not have been surprised and I felt like it was something that could be handled with her family. I did not want to embarrass her. When she started waking back up, the panic attack also came back. At this point I treated her with Lorazepam IV, which completely knocked it out. I sent her father home with an RX for seven 2 mg Lorazepam tablets. Five days after I saw the patient I was called in to meet with both the Emergency Department Medical Director as well as the HR manager. It was in this meeting that I found out that the patient's father was unfortunately abusive and the PT had not only reported a HIPPA violation and opened an investigation against me at my hospital, but she had also reported me to the OCR and the North Carolina Board of Medicine for disclosing her test results with her father. They are all three doing separate investigations, but I have not really been able to get any definitive answers about whether or not my actions were in compliance with the HIPPA policies. I personally felt that those results indicated a potential problem whereas the patient was putting herself and others in danger, and therefor I was within my rights to share that information with her closest family member who was present with her in the ED for the entire duration of her visit. She never asked him to step out at any point and so I also felt like that by doing that, she was consenting to his knowledge of everything. I am just curious to know if anyone else has ever been in a similar situation, and if so, what the results were. Also, I am curious as to what the majority of you believe and would do if put in this situation.
5 days 1 hour ago #96869 by sahmd
I'm sorry you are facing so many problems from this case. I am no HIPAA expert, but there are definitely a lot of gray areas with HIPAA. I hope everything turns out okay for you.

For your own protection, you might want to review your post here and edit out a lot of the details. I may not be able to identify the patient from your story, but anyone involved in the case could, including those investigating you. You do not need more HIPAA troubles!

Good luck!
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