Intern Report 8.26

 

internreport

Case Presented by Barry Kang, MD

Questions:


1)
Patient is brought into resuscitation as a trauma code 1. He has been shot multiple times in the chest. He is intubated and is swept off to the operating room. As your are leaving the resuscitation bay a DPD officer approaches you and asks you about the patient and what is going on. What do you respond?

a) I’m sorry sir the only thing I can tell you is that the patient is in critical condition and that he is one his way to the operating room.
b) His name is John Brooks and he got shot multiple times in the chest and abdomen. He had to be intubated and is in critical condition. He was just taken to the operating room.
c) He is middle age African American male who has sustained multiple gunshot wounds and was just taken to the operating room.
d) Here is FIN number with his name, age and birthday. He has sustained multiple gunshot wounds to the chest and abdomen. He was just taken to the operating room.

 

2) You have just seen an interesting case in MOD 2 and the patient was just sent up to the MICU. The intern in MOD 2 has just started their shift at 9am. You think it’s a great case to learn from and want to tell the intern about the case. What should you do?

a) Give them a sticker and tell them to look up the labs, ECG, HPI and physical you just finished dictating. After that ask them what they think.
b) Give them the ECG and ask for their interpretation.
c) Present them the HPI and physical and show them the ECG without the top strip with the reading and patient information.
d) Don’t talk to them about the case because it would a HIPAA violation.

 

3) You come in for a shift and check your mail box in 3R, you have received a subpoena from a law firm requesting the medical records and your testimony about a patient you had seen about 6 months previously. It turns out the patient is suing his employer since he was hurt at a job site and received care from you after the accident. What should you do next?

a) Ignore it. Someone else will deal with the legal aspect, you didn’t get into medicine to deal with legal system.
b) Send all the medical records to the law firm. It’s ok since they are representing the patient.
c) Contact the patient and ask them to fill out a medical release form.
d) File the form away and take care of it when you have more time.

 

Bonus Question: You walk into MOD 6 to evaluate a patient for altered mental status. You see an 85 year old male who looks thin. He has stool caked onto his backside and after you clean this off you see multiple decubitus ulcers along his backside. Over the course of his ED evaluation his mental status has improved and you begin to talk him about what happened. He states that he lives at home with his son. He says sometimes his son doesn’t come and check on him all day. He is unable to ambulate on his own and has to sit in a dirty adult diaper. What is your role in this situation?

a) Tell the patient he can file a report of abuse if he wants.
b) Tell him that you are sorry for his living conditions and tell him a geriatric consult has been put in for further evaluation.
c) Report elder abuse and admit the patient for placement in a nursing home since he is not getting the care he needs at home.
d) Ignore the situation and move on to the next patient.

 

Answers & Discussion
1) Answer B – According to Michigan State law MCL 750.411 a physician or surgeon who is caring for a person suffering from a wound or other injury inflicted by means of a knife, gun, pistol, or other deadly weapon or means of violence, has a duty to report that fact immediately by telephone and in writing to the chief of police or head of the police force in that area they are practicing in. The report shall state the name and residence of the person if known, along with his or her whereabouts, the cause, character, and extent of the injuries and may state the identification of the perpetrator if it is known. So in this case the best answer would be B given the fact that you know the patient’s name and other pertinent information about the gun shot wounds. Answer D has more information than mandated by law and given the fact that HIPAA states that you are only allowed to give information if the patient is a victim of a crime, unless mandated by state law this may be too much information in the eyes of HIPAA.

2) Answer B – HIPAA states that you are only allowed to share protected health information for treatment, payment or healthcare operations. Treatment is defined as the provision, coordination, or management of healthcare or related services for an individual by one or more healthcare providers. Basically this states that information may be exchanged between anyone directly involved in the patient’s care or for any referral of care between providers. If the intern is not going to be involved in the patient’s care then they should not be in the patients medical record or other sensitive patient identifiers or information.

3) Answer C – Michigan state law states that the only time you are allowed to release protected health information in a legal arena is with a court order, which is a written order by a judicial officer or court of law. A subpoena may be issued from a lawyer and this may be for records or for an appearance in court. The only other time a physician is able to release protected health information without the patient’s consent is when the patient files or notifies the physician they intend to file a malpractice lawsuit MCLA 600.2157. Preferably you can refer the law office to medical records after the law office obtains the patient’s written consent.

Bonus) Answer C – MCL 400.11a states the healthcare providers are mandatory reporters for elder abuse. This report must include, under Michigan State law, name of the abused, description of the abuse, neglect or exploitation, the abused age, the name and address of the abused guardian or next of kin, and any information that might help determine why the abuse/neglect is occurring. Michigan statue voids the physician-patient relationship privilege in these situations.

 

Key Points

  • When working in the ED you do not have the right to open up and look at anyone’s chart You must have a doctor patient relationship, in other words you are directly caring for the patient
    look over and review the states laws in the area you are practicing state laws will give more specific instruction while HIPAA provides a more overarching guideline
  • When dealing with HIPAA specifically you’ll never be faulted for withholding/protecting a patients medical information
  • In the end similar to medicine in general if you do what is best for the patient you will have at least at start of a defense if your decision is ever questioned.

 

References:

http://www.legislature.mi.gov/(S(tn13qcy04xk0b0aitgdcuqan))/mileg.aspx?page=getobject&objectname=mcl-750-411

http://www.michbar.org/journal/article.cfm?articleID=509&volumeID=38&viewType=live

http://www.hhs.gov/ocr/privacy/hipaa/faq/disclosures_for_law_enforcement_purposes/505.html

http://www.michbar.org/journal/article.cfm?articleID=509&volumeID=38&viewType=live

https://www.michigan.gov/documents/dhs/DHS-Pub-269_423962_7.pdf

http://www.americanbar.org/content/dam/aba/migrated/aging/about/pdfs/APS_IA_LTCOP_Citations_Chart.authcheckdam.pdf

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