Ethics Question

I am curious to hear what y'all think about a situation that is going on at Russ' hospital. An upper level resident came into the hospital several times with his wife and looked at the records of a friend of theirs who was in the hospital totally breaking HIPA rules. A nurse who had previously done something similar was fired! 8O The board is trying to figure out what sort of punishment this resident should get. They don't want to have a double standard for nurses and doctors, yet ... they don't want to ruin his career after all the years he has put in. By the way, another resident who had "extenuating circumstances" when he did it, was suspended for a month. Any comments?

Robin

Wow! So were they looking at the records just for the heck of it? Or did the friend ask them to do that? That seems so blatant....they must have known that would be a really, really bad idea. 8O

[SuzySunshine]

If the friend asked him to look them up for him I think the penalty should be less but if he looked them up without the patient's permission I think that constitutes a huge suspension if not firing. At Stanford, residents (and med students) are given a VERY strict warning about looking up records on patients that aren't their own because Stanford gets lots of the local sports stars. For example Barry Bonds' dad was at Stanford in his final months, two residents that looked up his records were told if that ever happened again they were gone and everyone else was told if you ever do it your gone. I think looking at people's medical records that you don't have any business looking at is a major personal violation!

[PrincessFiona]

I'm saying wow too....and like Nellie am wondering why they were looking at the records...did the friend know that he was looking at the records ie the friend had asked him to have a peek to check on his values or something?

I remember awhile back we ran into the similar issue with my ob....Thomas checked my ultrasound/blood test results and it caused a problem....when I took the poll in the call room nearly every person who took it said that their spouse would have a look too...but technically...it's not right.

What bothers me is that this guy took his wife with him to do it.

I know Thomas is very stinky about the patient records thing. I had asked him once this year to see if a friend of ours who had a baby was still in the hospital so that I could go up and visit her and he told me he wouldn't even check THAT. I just called myself and then went up...but he wouldn't even consider checking to see if she was still there for me to visit...which had nothing to do with her medical records. I didn't want a progress report Also, his nurse had 'female' surgery and he didn't stop by and see her while she was an inpatient because he wanted to respect her privacy. When his nurse came back to work she was offended that he HADNT come. He explained to her that he didn't want to interfere in her private life and that he had felt that that was personal...but she still had her feelings hurt. We've debated whether or not he should have stopped by to see her because it seems to have kind of caused some hurt feelings

well, I'm off on a tangent here now..sorry about that.

Kris

[migirl]

Wow, that seems highly inappropriate, but I think the punishment should depend on the resident's intent. If he was innocently looking something up for the friend or whatever, then the punishment should not be as severe as if he had some other less honorable motives. His actions seem so overt though, kind of strange.

On a side note, I 'accidentally' committed this crime when I was younger. I was in middle school, I think, and I didn't know the phone number of this girl I knew from school. I knew that she was a patient of my dad's, so I happened to be in his office and got her file out and looked up her number and called her up! I didn't think anything of it, but I got in really big trouble! My classmate got really upset and started crying because there were sensitive things in her file (which I didn't even look at, but that wasn't the issue I guess) and told her parents who complained to my dad, and I got a major lecture from my dad about patient privacy. I still feel kind of bad about it, even now.

Don't you need consent to access a patient record? It concerns me that my friends may have access to my complete medical record, including all the bits not relevent to this admission or treatment.

I guess consent is this key. This is the basis of Australian privacy law.

pretty unethical all the same - I wonder what the friend is thinking. Does the friend know that their records have been accessed?

[SueC]

I do think it is especially wrong that he took his wife with him on more than one occasion. I can't imagine my husband ever taking me up to the hospital to look through files. When I have gone up to eat with him, I even feel funny about the patient names written on the chalkboard in the fellows room (one had been a former patient of mine). I do think it should depend on the guys intent. It sounds to me like he and his wife were just being nosy, which should not go unpunished. I'm sure the guy by now has heard of HIPAA and knew what he was doing was wrong. Then again, if his friend asked him to look then thats another story.

Thanks for the comments. I am not sure what his intent was. However, being an upper resident, he HAD to KNOW that what he was doing was wrong. One of the members of the board that spoke with Russ can't even sleep because she doesn't know the best way to handle this. She also was concerned that it was so blatant. No one here really had a good solution, which is why I thought I would mention it on the board. I agree that intent would sway my decision. I have no idea if the friend asked them to check for her.

I will let you know what they decide to do.

I think that if the friend asked for the record to be checked that the request would be consistent with the HIPAA requirements. But as someone else pointed out, there can be a whole lot of other things in a medical record beyond a blood result or something like that. And to have checked a couple of times?
And what was his spouse doing while he did this? Looking over his shoulder? Standing on the other side of the room so as not to see the record?
If he was being the least bit nosy and not doing this friend a favor that was explicity requested....I think he should be in big trouble. No excuse for not knowing better. Especially if they fired a nurse for doing the same thing. Yes, he did train a lot to get where he is but not giving him a very harsh punishment would be a huge double standard. And possibly open the hospital up to an employment-based lawsuit.

[Meenah]

If he was being nosy and had no legal reason for being in the medical record he should be fired if the hospital has already fired another employee for the same offense. Just my opinion.
Luanne

[DCJenn]

I beleive that unless the circimstances are entirely different and he has verifiable reproducable evidence of same, he probably will be fired.

The HR department can't fire one person and not another for the same offense. It doesn't matter who they are.

Jenn

[Rapunzel]

Wow, sticky ethical matter.

IF the patient in question specifically requested this physician to look at his/her records then I view it as fine. The average patient knows what is in their medical record and if this person didn't want it viewed then they wouldn't request a physician-friend to look up info from it. I think it is then justified.

IF the patient in question knew nothing of the physician-friend accessing his/her medical records then that is an EXTREME violation of privacy and I do think a hospital with a record of firing employees for violation of privacy should at least suspend that resident's privileges for a time period.

My suspicion is that the patient did ask the physician-friend (or the physician's wife) to access his/her medical records. I did say I thought this was ethically fine - although the law (HIPPA) is probably not on my side. So, in that case (ie ethically justifiable but legally wrong) I think the hospital admin has options other than the extreme firing of the individual to consider - such as suspension, severe restrictions for a time period on ability to access patient records and the like, or other "creative" solutions.

As far as the wife was concerned - I am unclear as to her role: Did she simply accompany her husband to the hospital? Did she wait in the lobby or in the resident lounge while he husband went to access the record? Was she by his side while he accessed it? Did he allow her to access the record? The answer to that question also plays into the ethics of the situation (most of these circumstances are ethically viable and one of them is supremely unethical).

Jennifer

[Rapunzel]

I just related this to my husband and he asked, "How did they (the hospital admin) find out?" He has looked up friends' medical records with their permission in the past (just as he has looked up mine with permission).

Jennifer

[SueC]

I was wondering the same thing?

My understanding is that the hospital has a system for monitoring all records accessed and a red flag went up because it showed there were mutlple times he accessed the patient's records and the patient was not a surgical patient. Honestly, I am not sure how it all works but Russ said that there is a lot of security to make sure patients have privacy. How they know about the wife being there, I don't know. I will have to pump Russ with questions when he gets home today.

Luanne - I agree that a doctor should get the same punishment as a nurse but it is a little more gray to me in this situation because the nurse will still be able to go find a job as a nurse at a different place. She is still a nurse. But a resident, wouldn't they be kicked out of the program and have to start over with residency some place else if they can get in? If that is the case, then the punishment is much worse than what the nurse received. Just something that came to mind late last night when I should have been sleeping! I don't know the answer. A lot does depend on how involved the wife was and if the patient asked them to check for her.

Robin