Inappropriate Pics Found on PT

[nwhitney]

And exactly, which part of HIPAA would that violate? (Hint: None.)

Edit: There are also exemptions for LE conducting an investgation

Turns out that would be a violation of HIPAA in this case. Two different supervisors, our agency attorney, and our HR rep all have said so. Also the state dept. of human services also agreed it would have violated HIPAA and state law.

 

[BGKc00rs]

That's what I was thinking. I'm just going to give the officer the patients name, not anything medically related about that.

That is exactly what I was thinking. You are reporting possible abuse and nothing about the medical condition. I would not hesitate to report something like this either to the supervisor or the police.

 

[Draconicwraith]

I fail to see how HIPPA can stop us from reporting a possible crime. Or, for that matter, how this would violate HIPPA in this situation. Giving the name alone has nothing to do with HIPPA, since nothing medical is being reported.

 

[socalmedic]

I don't normally get involved in this, but here goes what I know. below in italics are excerpts from the CFR, in bold are my interpretations.

Disclaimer: only you know the whole story, but based on how I understand the event I think all these sections apply and you bet I would report it, using the appropriate procedure.

In CA, I am required to report directly to LEO and file a written report within 24 hours to CPS/HHS. the opinion of my supervisor has no baring on how this is filed. If I tell my Sup then he is now required to submit a report as well in addition to mine. employees of the same organization who are reporting the same event may be included by name on the same report. ex, CPS would get a report from me with both my name and my partners name, from the fire department with all the FF's names, from the SO with every officer who was on scene documented, and from the hospital with every person who provided care to the patient.

I hate to say it but in the simplest form of the law your supervisors and lawyer are wrong. by posting here you felt there was a legitimate violation and failed to properly report the incident to the authority who is responsible for identifying if law was broken. we are not cops, we do not have the right or authority to judge if a crime has been committed. we have the responsibility to inform an LEO of all the information we know so that they may investigate.

"To respond to a request for PHI for purposes of identifying or locating a suspect, fugitive, material witness or missing person; but the covered entity must limit disclosures of PHI to name and address, date and place of birth, social security number, ABO blood type and rh factor, type of injury, date and time of treatment, date and time of death, and a description of distinguishing physical characteristics. Other information related to the individual’s DNA, dental records, body fluid or tissue typing, samples, or analysis cannot be disclosed under this provision, but may be disclosed in response to a court order, warrant, or written administrative request (45 CFR 164.512(f)(2))"

this sections tells you what you are permitted to disclose to Law enforcement or the authority having primary investigative responsibility when you are required to report, you are legally requested to report, or if any other section states that you may report

"Child abuse or neglect may be reported to any law enforcement official authorized by law to receive such reports and the agreement of the individual is not required (45 CFR 164.512(b)(1)(ii))."

this may not apply here, however the pictures where not part of a complete book, by separating them from the original source they are no longer considered academic. artistic is interpreted differently by individuals and can per interpreted differently based on the age of the child. key to remember here is that you as the mandatory reporter are not conducting the investigation. Once you have the feeling that abuse or neglect MAY have occurred you MUST report this in most instances, to the authority responsible for determining if a crime has been committed. ie, giving the LEO the information necessary to determine if the person is a known or suspected offender. additionally public intoxication is usually an immediate cause for revocation of probation or parole in which the person has very reduced rights to privacy.


"(1) Permitted disclosures. A covered entity may, consistent with applicable law and standards of ethical conduct, use or disclose protected health information, if the covered entity, in good faith, believes the use or disclosure:
(i)(A) Is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public; and (B) Is to a person or persons reasonably able to prevent or lessen the threat, including the target of the threat. (45 CFR 164.502(j))"

child pornography is known to cause serious psychological harm to children and has lasting affects for the rest of the victims life. possession of child pornography is a felony and not a victim-less crime, it can be prosecuted without the child in questions knowledge. while we have already agreed that these pictures were torn from a different book can you identify what book they came from? did you see the library book with missing pages? if not can you be absolutely positive that they are from a legitimate academic or artistic source? remember just because they came from a book or magazine does not make it legal, freedom of the press has its limitations. I would report let the experts decide if its a violation of law


"Except when required by law, the disclosures to law enforcement summarized above are subject to a minimum necessary determination by the covered entity (45 CFR 164.502(b), 164.514(d)). When reasonable to do so, the covered entity may rely upon the representations of the law enforcement official (as a public officer) as to what information is the minimum necessary for their lawful purpose (45 CFR 164.514(d)(3)(iii)(A)). Moreover, if the law enforcement official making the request for information is not known to the covered entity, the covered entity must verify the identity and authority of such person prior to disclosing the information (45 CFR 164.514(h))."


basically if the cop says that they need the information for a legitimate investigation, YOU MUST PROVIDE THAT INFORMATION, once you have identified who the officer is. HIPAA is meant to protect PHI but is not to interfere with reporting crime when you believe in good faith that a crime has been committed by the individual in question.


http://www.hhs.gov/hipaafaq/permitted/law/505.html

here is a link to the HSS FAQ, do not rely on these summaries but instead use them to guide you through the actual CFR (Code of Federal Regulations) here:


http://www.gpo.gov/fdsys/pkg/CFR-2011-title45-vol1/pdf/CFR-2011-title45-vol1-sec164-512.pdf

 

[JPINFV]

I fail to see how HIPPA can stop us from reporting a possible crime. Or, for that matter, how this would violate HIPPA in this situation. Giving the name alone has nothing to do with HIPPA, since nothing medical is being reported.

...then why aren't positive tox screens automatically reported to the police? After all, if you're high on meth, you've committed a crime. This is ignoring the fact that it's questionable that a crime was committed. It's gone from "kiddy porn" to "ballet pictures."

 

[Clipper1]

In CA, I am required to report directly to LEO and file a written report within 24 hours to CPS/HHS. the opinion of my supervisor has no baring on how this is filed.

It seems you are quoting a child abuse statute for reporting. Without knowing the type of photos, it would be difficult to go by that statute. If it was just sketches or magazine type photos, you could not use that statute which means you would need to check your policy for involving law enforcement. Employers really hate the police coming in and interrogating everyone along with a big media scene which could also violate the privacy of other patients without some warning especially if the person in question is already in custody and not of immediate harm to anyone. Pornography also has room for interpretation. Some would claim taking a photo, even just a bare butt shot, of a newborn is pornography. A lot of parents have been dragged through the legal system since places like Walgreens are required to report actual photographs of naked children. An explicit cartoon could be pornography to some. There are numerous prime time shows on TV which could be too pornographic for some which others might only rate as PG.

If the photos in question has looked like child pornography, at least one of the several people mentioned would probably have taken a closer look and initiated some investigation.

 

[socalmedic]

Disclaimer: only you know the whole story, but based on how I understand the event I think all these sections apply and you bet I would report it, using the appropriate procedure.

artistic is interpreted differently by individuals and can per interpreted differently based on the age of the child.

It seems you are quoting a child abuse statute for reporting. Without knowing the type of photos, it would be difficult to go by that statute...

...Employers really hate the police coming in...

may I suggest that you read the entire post... I made it fairly clear TWICE that I had not seen the photos in question and that it would be based solely on interpretation...

my stance is still that if the child between the ages of starting school and the age of consent you should probably not have nude pictures of them, even if they are your own children. just because its printed on magazine paper does not make it legal, my friend prints his own magazines in his garage and they are the same quality print as anything you buy at the store. does this give him the right to print images of naked children? not in most communities.

 

[JPINFV]

my stance is still that if the child between the ages of starting school and the age of consent you should probably not have nude pictures of them, even if they are your own children. just because its printed on magazine paper does not make it legal, my friend prints his own magazines in his garage and they are the same quality print as anything you buy at the store. does this give him the right to print images of naked children? not in most communities.

I guess I need to throw out my OB/Gyn book, because I'm pretty sure there's a rather graphic picture of congenital adrenal hyperplasia in it.

 

[Clipper1]

may I suggest that you read the entire post... I made it fairly clear TWICE that I had not seen the photos in question and that it would be based solely on interpretation...

my stance is still that if the child between the ages of starting school and the age of consent you should probably not have nude pictures of them, even if they are your own children. just because its printed on magazine paper does not make it legal, my friend prints his own magazines in his garage and they are the same quality print as anything you buy at the store. does this give him the right to print images of naked children? not in most communities.

I did read your post. I was referring to the part where you would call the police.

In CA, I am required to report directly to LEO and file a written report within 24 hours to CPS/HHS. the opinion of my supervisor has no baring on how this is filed.

In a controlled situation where you already have the property and the person in your facility, it would be best practice to continue to maintain control over that situation by advising your employer. Other patients do not need to have their schedule interrupted or privacy compromised needlessly. Your employer will then be directly responsible

I guess I need to throw out my OB/Gyn book, because I'm pretty sure there's a rather graphic picture of congenital adrenal hyperplasia in it.

That is also a good point since we do have photos of sexual abuse which include children in our medical library. The photos could have been cut out of any medical text if the are not sexually explicit.

 

[Handsome Robb]

I guess I need to throw out my OB/Gyn book, because I'm pretty sure there's a rather graphic picture of congenital adrenal hyperplasia in it.

Dude stop twisting people's answers. That's obviously in an academic capacity. It doesn't take a doctor to figure out he's not talking about medical textbooks

 

[JPINFV]

Dude stop twisting people's answers. That's obviously in an academic capacity. It doesn't take a doctor to figure out he's not talking about medical textbooks

Yes, and it doesn't take a doctor to understand we're dealing with hearsay and no actual knowledge of what the pictures contained. They've been described as girls doing ballet or as naked girls, which regardless seem to have come from a published book. Somehow I don't think there's very many books containing naked ballet girls out on the market. However my knowledge of the availability of books containing girls doing ballet or how easy it is to find pictures of naked girls that aren't medical in nature, yet published is [thankfully] significantly lacking.

So the question is, are these naked girls, or girls doing ballet? It doesn't take much to see the substitution there, but there's a rather significant legal difference.

 

[socalmedic]

I guess I need to throw out my OB/Gyn book, because I'm pretty sure there's a rather graphic picture of congenital adrenal hyperplasia in it.

Never thought I would have to ask you to re-read my post. you disappoint me with your recent change in agenda. you used to be one of the more knowledgeable and helpful posters here, lately though the only thing you have to contribute is snarky one liners taken out of context. I remember when Mr. Brown started to act this way as well.

I did read your post. I was referring to the part where you would call the police.



In a controlled situation where you already have the property and the person in your facility, it would be best practice to continue to maintain control over that situation by advising your employer. Other patients do not need to have their schedule interrupted or privacy compromised needlessly. Your employer will then be directly responsible


That is also a good point since we do have photos of sexual abuse which include children in our medical library. The photos could have been cut out of any medical text if the are not sexually explicit.

this will be my last response to you on this topic... here it goes.
yes, in a controlled situation I would call for Law Enforcement. A controlled situation is the best time to do it, he isnt going anywhere and the cops have time to investigate before the subject even knows what up. lastly, your supervisor does not take responsibility because you told him and you never loose the responsibility to report as a mandatory reporter.

I seriously doubt the "media" will be anywhere near the facility at all. they wont know what is happening until an arrest is made, which at that point the subject will be long gone from the facility. and for the record, I don't really care about the public inebriates schedule, If they had things to do that day they shouldn't have been out drinking.

good bye everyone, Robb hold down the fort for me.