The most important issue addressed by this case is the confidentiality of a patient’s medical records. The legally and ethically protected right of confidentiality of one’s medical records demands that a patient’s records not be revealed to anyone who is not currently treating that patient without that patient’s consent, preferably in writing. Since the case indicates merely that Dr. Jerome is a neighbor of Ida M. and has cared for members of her family, but not that he is actually one of Ida M.’s treating physicians, Nurse Smith should not give Ida M.’s chart to him. Nurse Smith should politely tell Dr. Jerome that since Ida M. is not his patient, hospital regulations (as well as federal law and undoubtedly the statutes of the state in question) prohibit her from giving him the chart. If Dr. Jerome insists upon reviewing Ida M.’s chart, Nurse Smith should contact her supervisor, as well as Ida M.’s attending physician. It is doubtful that she would face disciplinary action for refusing to give the chart to Dr. Jerome, since Dr. Jerome’s request is inappropriate and Nurse Smith’s acceding to that request would violate hospital regulations and the patient’s Bill of Rights, as well as probably be illegal.
The Patient’s Bill of Rights, promulgated by the American Hospital Association (2010) states in pertinent part that, “The patient has the right to expect that all communications and records related to his/her care will be treated as confidential by the hospital, except in cases such as suspected abuse and public health hazards when reporting is permitted or required by law. The patient has the right to expect that the hospital will stress the confidentiality of this information when it releases it to any other parties entitled to review information in these records”. This is a formalization of the ethical duty of health care providers to protect the patient’s privacy, including medical records. Clearly, neither of the exceptions listed in the Patient’s Bill of Rights exists in this case.
The federal Health Insurance Portability and Accountability Act (HIPAA) of 1996 prohibits the release of a patient’s medical records without his or her consent except for purposes of treatment, payment for health care services or for matters of health care operation (n.d.). These rules are enumerated in 45 C.F.R. §164. Here again, none of the listed exceptions applies. While the HIPPA privacy rules do not explicitly require written permission for the release of records, most health care providers consider it prudent to obtain written permission.
If a state law provides even more protection for the privacy of a patient’s medical records than do the HIPAA privacy rules, federal law does not preempt state law. This means that the more protective state law applies. For example, New York State Public Health Law, §17 delineates who may request records. Generally, this is the patient or his authorized representative. As opposed to HIPAA, New York State Law requires written consent for the release of records (2010).
In summary, Nurse Smith should not give Ida M.’s chart to Dr. Jerome. She is on solid ethical and legal ground in so refusing.
References
(n.d.). Summary of the HIPAA privacy rules. Retrieved from
http://www.hhs.gov/ocr/privacy/hipaa/understanding/summary/index.html
(2010, March 12). Patient Bill of Rights. Retrieved from
http://mhcc.maryland.gov/consumerinfo/hospitalguide/patients/consumer_help/bill_of_rights.htm.
(2010, March 31). New York Public Health – Title 2 - §17 Release of medical records.
Retrieved from: http://law.onecle.com/new-york/public-health/PBH017_17.html.
