We provide each patient with a summary of our protocol for dispensing of pain meds, the anticipated length of time post op., etc. We have the patient sign the form authorizing any and all pharmacies to provide a prescription profile upon request, giving the patient a copy. This has been a lifesaver for our office. Lisa L






From: "Christiansen, John (SEA)" <[EMAIL PROTECTED]>
Reply-To: "Christiansen, John (SEA)" <[EMAIL PROTECTED]>
To: "WEDI SNIP Privacy Workgroup List" <[EMAIL PROTECTED]>
Subject: RE: Here is a good Privacy Issue that will cause problems
Date: Wed, 15 Jan 2003 14:21:00 -0800

This was a very big issue in one small city where I spoke on HIPAA a couple
of years ago, because the chief of police (!!!!) had recently been busted
for drug-seeking behavior - everybody wanted to know how it would play out
under HIPAA.

If I read this question right, what happened here was that one pharmacy sent
another a letter including PHI ("Joe Doaks is trying to buy lots of
controlled substances"), without patient authorization. So, is there an
applicable exception?

You might be able to argue that the treatment exception applies: Both
pharmacies are providing health care to (filling prescriptions for) Joe,
possible misuse of drugs is a legitimate consideration in providing care
(due to potential for drug interactions and overdosing), so it would be
legitimate to say that this is a permitted disclosure from one provider to
another for treatment purposes. However, if Joe finds out this kind of
communication is going on, he may not take it well, and may disagree. Given
the personalities of many drug abusers, he probably will. This is the kind
of scenario that leads to OCR complaints and lawsuits. If your drug seeker
has deep pockets and a reputation to protect - numerous celebrities come
immediately to mind - a lawsuit might even be likely. So, if I were a
pharmacy, I might very much want OCR guidance stating that this kind of
pharmacy-to-pharmacy communication is permitted under the treatment
exception; I don't want it a gray area.

Disclosures to law enforcement have their own exception. However, in
discussions with in the small city referenced above, it became clear that a
lot of people simply gave out information to the plainclothes investigators
based on the investigators' oral representation of their authority - no
subpoena, no warrant, no letter, no badge or ID check, in some cases over
the phone (without a verifying callback procedure). This is highly risky - I
think you probably ought to be able to get the benefit of the law
enforcement exception without having checked authority, but the regs specify
what you are permitted to rely upon and that you have to have "reasonable
safeguards" against unauthorized access, which authority verification would
seem to be. So you may be at risk in disclosing without checking even if the
recipient turns out to be telling the truth about his law enforcement
authority. And if he's not what he says he is - if, as by anecdote happened
to a couple of organizations discussed at the presentation, he (or she) is
actually an ex-spouse, or parent - then you're in real hot water. (I would
hope not criminal charges, but under the wrong facts I bet an aggressive
prosecutor could make a case.) And if HIPAA isn't enough, in Washington
state unauthorized disclosure of patient information is actionable medical
malpractice, too.

So: Read the rules; trust, but verify (authority); lobby for clarity; and
when in doubt, don't disclose.

John R. Christiansen
Preston | Gates | Ellis LLP
701 Fifth Avenue, Seattle, Washington 98104
*Direct: 206.613.7118 - *Cell: 206.683.9125
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-----Original Message-----
From: Bentz-Miller, Judith [mailto:[EMAIL PROTECTED]]
Sent: Wednesday, January 15, 2003 1:15 PM
To: WEDI SNIP Privacy Workgroup List
Subject: RE: Here is a good Privacy Issue that will cause problems



This is a huge issue in my area, because we actually have a "hotline" set up
in the county and I don't think we can keep it around. I am lucky enough to
be invited to a meeting with a state police detectives, physicians, and
pharmacists next week regarding HIPAA and I am sure it will come up. I will
report to the group my findings then.

I do think this is more of a common occurrence than we think it is. Make
sure you ask the right questions with your groups.

Judith Bentz-Miller
Privacy Officer
Arnett Clinic
765-448-8843

-----Original Message-----
From: Rebekah Savoie [mailto:[EMAIL PROTECTED]]
Sent: Wednesday, January 15, 2003 3:53 PM
To: WEDI SNIP Privacy Workgroup List
Subject: Here is a good Privacy Issue that will cause problems


Today, a clinic that I work with received a letter from a local pharmacy
about a patient that was a "Drug Seeker" as we call them. Over the
course of 30 days he had been to several doctors and several pharmacies
and received over 350 total pills all a controlled substance.

What happens to the pharmacy's ability to do these types of things
under Privacy?

Clearly, pharmacist were communicated information back and forth to
each other and to physicians on this person. They even sent letters to
all physicians in the area.

Problem? yes or no

Rebekah Savoie, CCS-P
Healthcare Consultant

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