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Scenario: You are the healthcare organization’s privacy officer

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Scenario:

You are the healthcare organization’s privacy officer. As part of your duties, you must make regular rounds on the patient care units and make observations of staff activities while in the facility.

 

This morning, you arrive at work and get into the empty elevator to go up to your fourth-floor office. As you are sipping your coffee, two nurses get into the elevator with you. The nurses are returning from their morning coffee break to their unit. They begin discussing a patient on their unit. Student nurse Sally states “I have never taken care of a patient with mental health issues before. What if the doctor wants information?” The mentoring nurse states that she should not worry; the doctors will identify themselves and will ask for specific information. Nurse Sally states that the psychiatrist will work with the medical doctors to help identify any issues that the patient may have. The nurses proceed to get off at the second floor.

 

Two staff members enter the elevator on the second floor. They are laughing and joking about Mrs. Annabel Smith in room 420. Some visitors also enter the elevator. The lab technician states to the housekeeper, “I couldn’t believe the size of that tumor! It was as big as a grapefruit.” The housekeeper says, “What are they going to do now? I hope that they will remove it soon. When I saw the x-ray at the nurses’ station, it looked bigger than a grapefruit!” The lab tech tells the housekeeper, “I will check tomorrow and let you know.” The staff members get off on the fourth floor.

 

You finally reach the fourth floor, which also has a nursing unit. As you proceed down the hallway, you are shifting your briefcase and trying not to spill your coffee.  While trying to juggle your coffee, you drop your briefcase and several file folders fall out. You set down your coffee on the floor to gather your papers. This happens in front of a patient room, which has the door open. You overhear the physician explaining to the patient that she must have surgery due to kidney stones. The doctor is explaining how the surgery will be done, the risks, benefits, and alternatives to the surgery. The doctor also explains that the pain will continue until the surgery is performed. You finally gather all of your paperwork stuff it in your briefcase and proceed to your office.
 

 

As you walk by the nursing station, you notice some lab results and radiology results on top of the counter on the visitor side of the counter. You also notice a nurse placing some extra copies of patient registration sheets in the confidential bin. Dr. Bones is talking loudly on the phone to another physician, Dr. Scoper about Mr. Joe Pro Athlete in room 417. Dr. Bones is trying to convince Dr. Scoper to see this patient as soon as possible. Mr. Athlete is worried that if he does not receive arthroscopic surgery on his elbow, he will be unable to play next season. Mr. Athlete’s contract expires at the end of this season and he is worried about his longevity and his contract negotiations. Dr. Bones shares that Mrs. Athlete is very high maintenance and likes to have a new BMW every other year. The Athlete family is also building a multimillion-dollar home in Newport Coast. Dr. Bones further tells Dr. Scoper that Mr. Athlete knows that his wife will leave him if he does not sign another long-term contract worth millions. You noticed that Nancy Nosey, the unit secretary, is shuffling papers next to Dr. Bones while he is talking on the phone. As Nancy is shuffling papers, she is sorting through copies of patient reports and registration sheets. She is taking the extra registration sheets and preliminary report copies and placing them in the trash bin.

 

Before you reach your office, you receive a message on your internal pager. The message is asking you to come to the Registration/Admitting office. You use the phone at the nursing station and the caller is asking you to come down to Registration because a patient, Mrs.

Particular has a question about the patient directory. While you are on the phone, you see an opaque envelope that is labeled ‘lab results” in the “in box” behind the counter in the nurses’ station. You return to the first floor.

 

When you arrive in Registration, you discover that the patient went to the cafeteria for a cup of coffee. You decide to wait for the patient’s return. As you are waiting, you listen to the registration staff explain the Consents and Notice of Privacy Practices (NPP) to a patient.

The registration staffer is admitting a patient who does not speak English. The patient’s primary language is Spanish. The registration staff member looks in her desk for the consents translated into Spanish, but cannot find them. She gives the patient consent printed in English. She instructs the patient in English to sign the consent and points to the places for her to sign and date. The patient has a sixteen-year-old daughter who drove her to the hospital. The daughter tells her mom that the person wants her to “sign and date the papers.”  The staff member explains that the Notice of Privacy Practices explains how the patient’s information will be used within the facility. Once the patient signs the papers, the patient will be included in the hospital directory so that visitors will know her location and this will allow callers to speak with her. It will also allow the patient to receive mail and flowers because the hospital can acknowledge her presence. The patient has an estranged, abusive husband who has been stalking the patient. The daughter was busy talking on her cell phone when the staff member was explaining the NPP to the patient. The staffer looks to the daughter to help and the daughter tells the mom, “Oh mom, just sign the papers” and she returns to her phone call. The mother signs the English NPP acknowledgment.

 

Mrs. Particular returns and asks some questions about the patient directory.  She wants an explanation of how she can keep others from knowing that she is in the hospital. Mrs.

In particular, is having some plastic surgery and she wants to be sure that her friends do not know that she is having the work done. You show her the NPP and indicate that there is a place for her to “opt-out” and this would prevent the hospital from acknowledging the patient’s
 

 

presence. This means that if she “opts out” she will not receive visitors, calls, flowers, or mail because the hospital cannot put through the calls or acknowledge visitors. She states that that is exactly what she wants, so you show her where to sign. You give this information to the Registration/ Admitting supervisor who promises to take care of the issue.

 

You finally get a chance to get to your office and begin working. About two hours later, you receive a call from the Administration. You are instructed to turn on the television to Channel 7 for “breaking news.” You glance outside and see TV vans and a reporter in front of the facility. Channel 4 states that Mrs. Athlete is leaving Mr. Athlete. This is big news because the Athletes are Orange County’s “famous, power couple.”

 

The phone rings and it is a volunteer who tells you that there is a florist at the front desk who refuses to leave. The florist “knows that the patient is here.” The volunteer informs you that the patient has “opted out”. She asks if you will come down to speak with the florist.  You state that you will be downstairs in a few minutes. Before you leave, the phone rings again. It is an irate patient who states that her son has sent her flowers but she can’t get them delivered because the “stupid hospital” won’t tell the florist that she is present.

 

You sit down and sigh, “It is going to be a long day and it is not even noon!” You began to make of list of things that need to be addressed.

 

Questions:

1. What steps could the Privacy Officer have taken when hearing the conversations in the elevator? 

 

2. What instructions could the Privacy Officer provide to the lab and radiology staff responsible for the delivery of reports? 

 

3.  How could the Registration staff improve their service and explanations to patients? 
    

 

4. What information could be included in an inservice to physicians to help ensure the privacy of the patients? 

 

5.  Identify and discuss any patient rights violations. 

 

6.  Identify and discuss any confidentiality violations.

 

7.  You have 15 minutes at the hospital-wide employee meeting next week. 

     What will you discuss as some major in-service points for the hospital ancillary staff?

 

Definitions:

Confidential bin: a “trash bin” that is used to house confidential patient information until it can be shredded or destroyed. Once an item is placed in the bin, it may not be retrieved without the permission of the privacy officer.

Registration/face sheet: a document in the front of a medical record that has the patient’s demographic, insurance, and preliminary diagnosis information.