Hospice Risk Management

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Hi,

Let's take closer look at the types of things to consider under HIPAA for the list of ethical issues for risk management.

RESPONSE:

1. HOSPICE Risk management and ETHICAL DILEMMA in regard to HIPAA issues/compliance (Keep in mind the patient, family involvement/decision and legal aspects)

HIPAA is a federal law that gives you rights over your health information and sets rules and limits on who can look at and receive your health information. End of life decisions involve giving over your rights, sometimes to an person. However, all compliance requirements of HIPAA still apply.

Patients Rights:

You have the right to:

? Ask to see and get a copy of your health records.
? Have corrections added to your health information.
? Receive a notice that tells you how your health information may be used and shared.
? Decide if you want to give your permission before your health information can be used or shared for certain purposes, such as marketing.
? Get a report on when and why your health information was shared for certain purposes.
? If you believe your rights are being denied or your health information isn't being protected, you can:
? File a complaint with your provider or health insurer, or
? File a complaint with the U.S. Government (www.hhs.gov/ocr/).

Many ethical dilemmas have no clear answer. However, the HIPAA provides some directives in terms of the use of private information and who has the right to that information. HIPAA and Advance Directives must be considered working partners.

"When hospital policy dictates that information is not to be provided, unless a proper Health Insurance Portability and Accountability Act Release from the patient is in the hospital file, the doctor is placed in a tough spot. Does the doctor go against hospital policy and face a significant criminal penalty (up to $50,000 and one year in prison for disclosing protected health information)? Even though HIPAA does permit disclosures of health information without individual authorization for specific public responsibilities, such as identification of the body of a deceased person, or the cause of death,or "emergency circumstances", the hospital or medical center's policy will be what the doctor has become familiar with, not the legal nuances of HIPAA and Advance Directives. Thus, it is prudent planning to utilize HIPAA and Advance Directives together. Make certain that health care and medical proxies, and the like, contain a HIPAA release. Time is critical in the employment of these documents. A HIPAA Release incorporated within the document minimizes the confusion and emotionality of the moment, and worst case scenarios that you might imagine" (http://www.livingwills-freelegal.org/HIPAA_and_Advance_Directives.html).

Let's take a closer look at the information that I located on the following ethical issues.

1. Patient that is unable to make his/her own medical decision due to mental or physical impairments and there are no family members available.

I have not located any information discussing this ethical issue in regards to HIPAA. However, the court sometimes appoints a person to act on behave of a person.

Patient: Patient that is unable to make his/her own medical decision due to mental or physical impairments

Family: There are no family members available.

Legal: Sometimes the court can appoint someone to make these decisions as in this case, as in the Terri Schiavo case (see http://www.cmaj.ca/cgi/content/full/172/9/1197?ck=nck).

2. DNR- (Do Not Resuscitate)

Patient: Authorized and signed consent or power of attorney

Family: Can make the decision when given the power of attorney to make these decisions by the patient.

Legal: Under HIPAA, the medical staff must follow the directives given by the patient (signed consent) or the representative given the power of attorney by the patient in an advanced directive that has been ...