Confidentiality
OBJECTIVES:
After you take this class, you will be able to:
- Detail the rights of people to privacy and confidentiality.
- Apply privacy and confidentiality laws and ethics into all aspects of care.
PATIENT AND RESIDENT RIGHTS
All people, and patients, have basic rights. The laws of the United States and our 50 states givesthese rights to all of us.
All patients have all these basic human rights. They also have other special rights when they are being cared for in their own home, a community home, in an assisted living home, a nursing home or a hospital. All people must be given a copy of these special rights when they come to a hospital, assisted living or nursing home and when they are being cared for care in the their own house or a group home.
You must know about these rights when they work in health care. We must know what these rights are and how we can make sure that we uphold them while we take care of our patients.
Our rights go back as far as 1789 when the United States passed the Bill of Rights. Since then, the United States, all of our 50 states, and others, like as the American Hospital Association, have also done things to protect the rights of patients.
Patients and residents have the right to:
- respect
- dignity
- personal privacy
- confidentiality
- freedom from abuse and neglect
- control their own things
- know about their medical condition and treatments
- know about their different treatment options
- know about the risks and benefits of the care that they want to have and/or are thinking about having
- pick their own doctor(s)
- know the names of the people that are giving them care
- make their own decisions about the care they want and do NOT want
- refuse care
- competent care
- agree to or refuse to be a part of a research study
- complain about care
- freedom of religion;
- social freedom;
- health care services that they can use
- billing information; and
- correct bills.
THE RIGHT TO PRIVACY AND CONFIDENTIALITY
The American Hospital Association
The American Hospital Association states that,
"The patient has the right to privacy. Case discussion, consultation, examination, and treatment should be conducted to protect each patient's privacy."
and
"The patient has the right to expect that all communications and records pertaining to his/her care will be treated confidentially 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 emphasize confidentiality of this information when it releases it to any other parties entitled to review information in these records." (American Hospital Association, 1992, 2010)
Federal Laws
Not too long ago, our country passed the Health Insurance Portability and Accountability Act (HIPAA). This law became our first nation wide law that protects the rights to privacy and confidentiality.
HIPPA gives each and every person in the United States the right to:
- ask for and get their own medical record; and
- to have their medical information private and confidential.
We could be found guilty of violating this law if we do not follow it closely. You must know about this law and what things you must do in order to follow it. Ignorance is not a good defense against a violation of it. It is a crime when you do not follow it. You can also get both civil and criminal punishment.
HIPAA states that all people:
- must have their records and other personal information kept confidential by those that take care of them
- can give their records and information to others only when they, not others, agree to it;
- have a right to their own records without delay. They should be given to them in less than 30 days; and
- can complain about privacy issues to the Health and Human Services' Office for Civil Rights at (866) 627-7748. (United States Government, 2004, 2010)
We must NOT, therefore, give any information to others unless the person has given us permission to do so.
You MUST:
- know about this law and all other laws;
- know all the things that you must do to so that you can follow this and other laws;
- know the things you must NOT do;
- know and follow your place of work policies and procedures at all times, including those that speak to confidentiality;
- tell your patients and their family members about their HIPAA rights, when you are asked to do so;
- tell your patients and their family members about what you must do in order to follow HIPPA and your job policies and procedures;
- keep all records in a highly safe, secure, and confidential manner.
State Laws
All of our states have patient and resident bills of rights. They are almost the same for each state. Florida State rights are below as an example. Check with your own state to find out more about your state's bill of rights.
Florida Bills of Rights
The Florida State Patient's Bill of Rights states:
"(a) Individual dignity.--
- The individual dignity of a patient must be respected at all times and upon all occasions.
- Every patient who is provided health care services retains certain rights to privacy, which must be respected without regard to the patient's economic status or source of payment for his or her care. The patient's rights to privacy must be respected to the extent consistent with providing adequate medical care to the patient and with the efficient administration of the health care facility or provider's office. However, this subparagraph does not preclude necessary and discreet discussion of a patient's case or examination by appropriate medical personnel." (Florida State Statutes, 2004, 2010).
Similar to the Patient's Bill of Rights, the State of Florida has a Resident's Bill of Rights to protect those in our long-term care facilities.
Residents have the right to:
(b) Be treated with consideration and respect and with due recognition of personal dignity, individuality, and the need for privacy."
and
"(d) Unrestricted private communication, including receiving and sending unopened correspondence, access to a telephone, and visiting with any person of his or her choice, at any time between the hours of 9 a.m. and 9 p.m. at a minimum. Upon request, the facility shall make provisions to extend visiting hours for caregivers and out-of-town guests, and in other similar situations." (Florida State Statutes, 2004, 2010).
THE RIGHT TO PERSONAL PRIVACY
People do not give up their rights because they are in a hospital, nursing home or a group home. They do not give them up when they are being taken care of by others.
Patients and residents have a right to:
- private visits and talks with family, friends, clergy and all other people;
- talk on the phone to others without us listening in;
- get and send letters that are not opened or read by others;
- their own personal space with their own things;
- expect that visitors, including health care workers, knock on their door before walking in; and
- personal privacy when bathing and during other activities.
You must:
- leave the room when a person has a visitor, unless the person wants you there;
- leave the room when a person is on the phone, unless the person wants you there;
- NEVER open letters unless the person asks you to;
- NEVER read a letter unless the person asks you to read a letter to them;
- NOT open personal things, like a pocket book or wallet, unless the person asks you to;
- knock on a closed door and wait until the person asks you to come in;
- give the person privacy when they are taking a bath or getting care.
THE RIGHT TO CONFIDENTIALITY
Personal information must be kept confidential. Only those with a need to know about the person get this information.
For example, the person's doctor has a need to know about the person and their health state so that they can better take care of the person. You can, therefore, speak to the doctor about the person. If you are talking to the nurse or doctor about the patient, speak in a low voice so that nobody else hears what you are saying.
On the other hand, a person who works in the cleaning department does NOT have to know about the person and their state of health. Therefore, you must NOT talk to them about the person and their health. They do not have a need to know this. They can do their job without it.
You must NEVER talk about a person, or their condition, with anyone who is NOT taking care of the patient. Do NOT talk about patients in the halls, the elevators, a coffee shop, a public diner or in your own home. Do NOT speak to anyone on the telephone about the person. You can NOT be sure it is the person's doctor even if they tell you that they are the doctor. Obey the work rules that tell you how and when you can speak to doctors, and other people on the phone.
Examples
Miss T. has hepatitis. She does not want any of her room mates or friends to know she has it. She is afraid that they may think they can catch it if they are near her. Should you tell her friends that Miss T. has hepatitis and that they cannot get it from her?
Answer: No
Mark has a head injury and he forgets things. Should you tell his friends about the head injury so they are more patient with him when he forgets things?
Answer: No
The phone rings and you pick it up. A voice on the other end says, "Hello, this is Dr. Jones. How did Paul Burke sleep last night? Should you tell him that Paul slept well.
Answer: No
All patient charts and records must also be kept in a safe place so that people not caring for the person cannot read them.
- Do NOT read the charts of patients that you are not taking care of.
- Do NOT give anyone a chart unless you know for sure that the person is taking care of the patient and they have the need to know about the person and their condition.
Summary
We must uphold the law and the privacy of our patients every day. It is a very important part of patient care.
References
American Hospital Association (1992, 2010). “The Patient's Bill of Rights”. [online].http://www.library.dal.ca/kellogg/Bioethics/codes/rights.htm.
Berman, Audrey, Shirlee Snyder, Barbara Kozier and Glenora Erb. (2010). Kozier & Erb's Fundamentals of Nursing: Concepts, Process, and Practice. 8th Edition. Pearson Prentice Hall.
Florida State Statutes (2004, 2010). Chapter 381.026. “The Patient's Bill of Rights and Responsibilities”. [online]. http://www.flsenate.gov/Statutes/index.cfm?App_mode=Display_Statute&Search_String=&URL=Ch0381/SEC026.HTM&Title=->2004->Ch0381->Section%20026#0381.026.
Florida State Statutes (2004, 2010). Chapter 400.428. “The Resident Bill of Rights”. [online].http://www.flsenate.gov/Statutes/index.cfm?mode=View%20Statutes&SubMenu=1&App_mode=Display_Statute&Search_String=&URL=CH0400/Sec428.HTM.
U.S.Government (2004). HIPPA. [online]. http://www.hhs.gov/ocr/hipaa
Copyright © 2010 Alene Burke