Patricia Hamby
HIPAA Compliance Project Manager
XANTUS Healthplan of Tennessee, Inc.
(615) 463-1612, Office
(615) 279-1301,
Facsimile
http://www.xantushealthplan.com/hipaa/page3.html
--------Original Message-----
From: Clay, Roy III (NO) [mailto:[EMAIL PROTECTED]]
Sent: Wednesday, January 15, 2003 5:26 PM
To: WEDI SNIP Privacy Workgroup List
Subject: RE: Here is a good Privacy Issue that will cause problemsI don't think you could justify a broadcast like "If this guy shows up in your office, don't let him have Percocet!" The pharmacist can communicate with the doctors that have written prescriptions for the patient but I don't think it can go any further than that unless there is some state law to support your actions. One would have to wait for the patient to go to another doctor and get a prescription and bring it to the pharmacy before the pharmacist could then notify the new doctor. This could be done before the prescription was filled in order to prevent the abuse. However it does not solve the problem of going to a new doctor and a new pharmacy.
Roy G. Clay, III
Interim Compliance Officer
Louisiana State University Health Sciences Center New Orleans Campus
Phone: (504) 568-6130
Fax: (504) 568-6378
Email: [EMAIL PROTECTED]
-----Original Message-----
From: Leah Hole-Curry [mailto:[EMAIL PROTECTED]]
Sent: Wednesday, January 15, 2003 4:24 PM
To: WEDI SNIP Privacy Workgroup List
Subject: Re: Here is a good Privacy Issue that will cause problems
As with many things HIPAA, I suspect that it will depend on the
circumstances and to whom the disclosures are made. I see three ways in
which the information may be disclosable.1. It seems pretty clear that a covered entity can disclose PHI to
fulfill an obligation under a reporting law (e.g. certain wounds like
gun shot wounds must be reported, and there may be mandatory reporting
for suspected perscription drug abuse)but it would have to be reported
to the entity required under the law or covered under the public health
authority or perhaps health oversight provisions. 164.512(a)(b)(d).2. As was noted, covered entities are allowed to respond to judicial or
administrative proceedings (e.g. subpoena) and, with limitations to law
enforcement, so the same information could be given to such entities in
response to the appropriate request or perhaps, if the activity is
criminal, under the reporting of a crime on premises provision.
164.512(c)(f).3. Finally, under the treatment provisions, the information can probably
be disclosed to other providers. Treatment includes provision,
coordination, or management of health care and related services by one
or more health care providers, including coordination or management of
health care by a health care provider with a third party; consultation
between health care providers relating to a patient; or
referral...164.501. Covered Entities may use or disclose PHI for its
own treatment; or for treatment activities of a health care provider.
164.506(c). Further, minimum necessary rules don't apply to
disclosures by a health care provider for treatment.So in the case below, I think a pharmacy could notify appropriate
authorities if there are mandatory reporting requirements or public
health procedures to do so, and may be able to report it law enforcement
under the "crime on premises" provision if the covered entity thinks the
information constitutes evidence of a crime.
I also think under the pharmacy can communicate with physicians and
other pharmacists that are involved in the persons care to ensure it is
providing appropriate treatment services before dispensing or refilling
medication (in this case appropriate drug amounts, no interactions,
etc). The pharmacist could also probably contact a public agency that
maintains information on "drug seekers" and see if this person has any
history prior to dispensing medication under the provision related to
its own treatment. Finally, the pharmacist could also respond to an
inquiry from another provider about the individual under the treatment
provision.The questions start to come in about whether the pharmacy can disclose
PHI, basically unsolicited, to an entire group of providers in a
community that may or may not have any treatment relationship with the
individual. When you read the treatment definition (provision,
coordination or management of care), and the permissible disclosure
(either for the CE's own treatment purposes of for another provider's
treatment purposes) it appears that this could be justified, and since
minimum necessary doesn't apply, any information could be included.On this last issue though, from a personal standpoint, it seems to run
counter to protecting health information, if any provider can simply
decide that in their opinion someone is receiving too much medication or
is trying to buy drugs for illicit purposes, etc. and because of that,
they can broadcast any PHI to any or all providers in a given community
(or state, or?).Regards, lhc
Leah Hole-Curry, JD
FOX Systems, Inc.
602.708.1045
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>>> "Rebekah Savoie" <[EMAIL PROTECTED]> 01/15/03 12:48 PM >>>
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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