asking patient about infectious diseases

[Anonymous]

Is this a HIPAA violation? Say someone had fluid loss (ex. blood) and you asked them if their blood might contain something you need to be worried about, is that a violation? if so is there a way to "ask" if you suspect without exactly asking?

I hope that makes sense, I can try and clarify if not....

 

[Handsome Robb]

Absolutely not.

As a provider you have every right to know about any infectious diseases that patient has. especially if bodily fluids are present. When you find out they do have something you absolutely need to pass it on to the provider you are giving a report to.

It's for our safety. I have parents that I would like to out live thank you very much.

 

[Akulahawk]

No. Asking the patient is NOT a violation, if it's YOUR patient, it's very good practice. The HIPAA violation would be disclosing that info to someone NOT involved in that patient's care. The patient is allowed to disclose their info to whomever they desire... however healthcare providers do not have that luxury.

There have been many times that I would have loved to have gotten follow-up about patients so that I can better improve my own practice, only to be denied by HIPAA chantings...

 

[Aidey]

Screw the presence of body fluids or not, that information is part of their medical history and thus it is appropriate to ask.

 

[Anonymous]

Okay that is what I thought but an instructor said something that had me confused so just wanted to make sure. Does that also apply for HIV/AIDS? I thought he said there was something in the Ryan White act that prohibited EMS from asking a patient if they were infected...

 

[Akulahawk]

Okay that is what I thought but an instructor said something that had me confused so just wanted to make sure. Does that also apply for HIV/AIDS? I thought he said there was something in the Ryan White act that prohibited EMS from asking a patient if they were infected...

For practical intents and purposes, you should be asking about any infectious disease, not just HIV/AIDS. If you focus on that, you might forget to ask about other specific diseases. Far better to ask a more general question to elicit a response that covers HIV, Hep B, Hep C, Ebola...

 

[Anonymous]

For practical intents and purposes, you should be asking about any infectious disease, not just HIV/AIDS. If you focus on that, you might forget to ask about other specific diseases. Far better to ask a more general question to elicit a response that covers HIV, Hep B, Hep C, Ebola...

Makes perfect sense, I appreciate the responses.

 

[Aidey]

The Ryan White act isn't relevant to obtaining a medical history since you have a legitimate reason to obtain that history. What it is relevant to is if you get an exposure. The Ryan White act no longer covers EMS, and if you get and exposure you can not use Ryan White to force the pt to provide a blood sample for testing. Some individual states have their own laws that make up for Ryan White no longer applying, but in other states you are SOL.

 

[Underoath87]

The only issue is if there are bystanders/family members within earshot when you ask. If there is anyone around besides your partner and the patient, just ask discreetly, rather than shouting: "sir, do you have AIDs or hep C??".

 

[bigbaldguy]

Ask away but remember they might not know or they may be lying. BSI BSI BSI.

 

[Anonymous]

The only issue is if there are bystanders/family members within earshot when you ask. If there is anyone around besides your partner and the patient, just ask discreetly, rather than shouting: "sir, do you have AIDs or hep C??".

Ask away but remember they might not know or they may be lying. BSI BSI BSI.

both good points. thank you!

 

[Ramis46]

This also goes for your other ems Help such as fire department or Police right, I learned in school that we could not disclose that information to other help... not counting your partner...?

Or am I wrong.

 

[Tigger]

This also goes for your other ems Help such as fire department or Police right, I learned in school that we could not disclose that information to other help... not counting your partner...?

Or am I wrong.

If they are directly assisting with patient care I can't see how that would be a problem. I would also consider it my obligation to inform other providers on-scene of any exposure risk just as we often consider sending facilities responsible to disclose exposure risks before transferring patients. Obviously you could just wear your BSI at all times, but that's not foolproof and if there was a needle stick and no one came forward and mentioned the Hep C part (for example) that would be bad.

 

[EpiEMS]

This also goes for your other ems Help such as fire department or Police right, I learned in school that we could not disclose that information to other help... not counting your partner...?

Or am I wrong.

Pretty sure it's a violation of the law to disclose it. Apparently, it's even against the law to subtly indicate to your partners or co-workers to BSI up if they haven't done so already.

 

[MochaRaf]

Pretty sure it's a violation of the law to disclose it. Apparently, it's even against the law to subtly indicate to your partners or co-workers to BSI up if they haven't done so already.

It has been a while since I read my textbook in regards to this topic, but I am pretty sure that if you are providing care to the patient it is YOUR right to ask. That of course doesn't mean that the patient will tell you, as it is THEIR right not to disclose that information...

From my experience, most of the people tend to lie about any infectious diseases they may have... In all realism, the question is really irrelevant as we should always be using proper BSI precaution appropriate with the given scenario. I know it sounds silly, especially since 25-30 years ago it was considered "cool" to walk into the ER covered in blood... But now that we are so much better informed it is only in our own best interest to take the fullest precaution we can.

You guys remember how they always used to drill in our heads that anytime we encounter someone with a cough we should automatically assume they have TB? Well the same can be said with anytime we come across any bodily fluids... It never hurts to be extra careful...

And just on a side rant, PLEASE never wear your gloves WHILE driving the ambulance... You always see some whacker doing it every now and then, but last week I saw it six times in one day outside the local ER where people drove into the bay wearing their gloves.... Aside from cross-contaminating all your equipment, you look ridiculous!! /endrant

 

[DrParasite]

Pretty sure it's a violation of the law to disclose it. Apparently, it's even against the law to subtly indicate to your partners or co-workers to BSI up if they haven't done so already.

no it's not. It's called looking after your partner. If you are my partner, and you didn't tell me, than I am going to request another partner, and make sure everyone knows that you are not looking out for your partners. It's a small world, and it would ruin your reputation.

Plus, how pissed would you be if you had a senior moment, forgot to put your gloves, on, and your partner knew this person had something and didn't give you the heads up?

You need to tell the hospital staff in your report as well. And if you mention it to the staff who is treating the patient, that's ok too.

Do your best to assess the patient, treat all patients like they are super contagious, and try not to broadcast PHI to the public if it's possible. But you need to ask them if they have any communicable or non-communicable diseases, it's part of your assessment.

 

[Tigger]

no it's not. It's called looking after your partner. If you are my partner, and you didn't tell me, than I am going to request another partner, and make sure everyone knows that you are not looking out for your partners. It's a small world, and it would ruin your reputation.

Plus, how pissed would you be if you had a senior moment, forgot to put your gloves, on, and your partner knew this person had something and didn't give you the heads up?

You need to tell the hospital staff in your report as well. And if you mention it to the staff who is treating the patient, that's ok too.

Do your best to assess the patient, treat all patients like they are super contagious, and try not to broadcast PHI to the public if it's possible. But you need to ask them if they have any communicable or non-communicable diseases, it's part of your assessment.

I'm thinking his post has some sarcasm, at least I hope so. I agree with you here, what's the difference between the hospital staff and other out of hospital staff?

 

[Veneficus]

Ebola...

I like your sense of humor.

 

[johnrsemt]

I never so much minded people that didn't know or wouldn't tell us about infectious diseases.

What I hate is when hospitals or ECF's won't tell you.
Had one small hospital ICU not tell us about a patient, (because they didn't want to embarass her); that the patient had TB menningitis (sp?) and Leprosy. When we rolled her into Large hospital ICU they had a total cow about it. When the doctor was chewing me out I stopped him by asking him if he really thought I would risk myself, my partner and my family not to mention everyone else if I knew what she had.
The small hospital ended up paying for all of our blood work for the next 2 years to make sure that we didn't get what she had. They were not happy that we refused to have the blood work done there, I told them that I wanted it done in a hospital that actually cared about the EMS people.

 

[NYMedic828]

Absolutely not a HIPPA violtion.

You are the immediate care giver to that patient, any information they have disclosed to you on their own will or by family members/bystanders if the patient was unable to do so was consensually given.

If you take that information elsewhere outside of the care for that patient, now you have violated HIPPA.

I ask patients all the time "sir do you have any bloodborne diseases such as HIV or Hepititis." I ask during the history after getting their meds. It is pertinent past medical history information and by asking with the rest of the history else it does not make them feel like you are profiling them because they may look a certain way.

In the end, people lie A LOT. Many are also in deniable that they may have HIV and in their mind they don't even think they are lying when they say no. Moral of the story, always protect yourself. Wear gloves, wash your hands, goggles/mask if needed and clean your uniform.