HIPAA & schools/school nurses

[zurgswife]

Does HIPAA include school nurses? Can school nurses make health records available to any employee in the school?

 

[NookOfTheNorth]

I'm a teacher and my sister was a school nurse for many years, but we never discussed HIPAA. Can a nurse make records public? Maybe, but only those items that pertain to the classroom. In the past, I have received information about students with diabetes, chronic kidney infections, allergies, etc, and at this time, that pertinent information is also on our students electronic files so to speak so all teachers can access it.

I've never had a school nurse just show random things. On the other hand, I know my sister has has to keep quiet about those things that a student did not want revealed to a parent, generally pregnancy related. And, if I have had a health concern about a student, I've informed the school nurse, but she's never whipped out their file right then there. I think they have their own protocol that needs to be followed--kind of like the guidance counselor.

I've put a call into my sister to see what she has to say.

 

[mannasn]

Assuming we're talking about a public school, here?

Schools have a different privacy component for students - the Family Educational Rights and Privacy Act (FERPA). Schools usually don't fall under HIPPA because they don't bill/charge for health-related services.

Below taken from schoolnurse.com:

All health records generated on behalf of a student in schools (not school based health clinics) are part of the student's education record, regardless of whether the school nurse generating them is an employee of the school system or a local health agency.

The Family Educational Rights and Privacy Act (FERPA) (20 U.S.C., 1232g; 34 CFR Part 99) is a Federal law that protects the privacy of student education records. The law applies to all schools that receive funds under an applicable program of the U.S. Department of Education.
FERPA gives parents certain rights with respect to their children's education records.
Parents or eligible students have the right to inspect and review the student's education records.
Parents or eligible students have the right to request that a school correct records which they believe to be inaccurate or misleading.
Generally, schools must have written permission from the parent or eligible student in order to release any information from a student's education record. However, FERPA allows schools to disclose those records, without consent, to the following parties or under the following conditions (34 CFR, 99.31):

* School officials with legitimate educational interest;
* Other schools to which a student is transferring;
* Specified officials for audit or evaluation purposes;
* Appropriate parties in connection with financial aid to a student;
* Organizations conducting certain studies for or on behalf of the school;
* Accrediting organizations;
* To comply with a judicial order or lawfully issued subpoena;
* Appropriate officials in cases of health and safety emergencies; and
* Juvenile justice system, pursuant to specific State law.
Schools may disclose, without active consent, "directory" information such as a student's name, address, telephone number, date and place of birth, honors and awards, and dates of attendance as long as parents and eligible students are given enough time to request their information NOT be disclosed.

Schools must notify parents and eligible students annually of their rights under FERPA. The actual means of notification (special letter, inclusion in a PTA bulletin, student handbook, or newspaper article) is left to the discretion of each school.4

 

[zurgswife]

Thanks so much for the great info....Looks like we are probably screwed again due to the fact it is private school...but I put a call into the Family Complance office to see what an "an applicable program of the U.S. Department of Education" actually is....

 

[adrien32]

The nurse also needs to comply with any privacy restrictions placed on him/her under state law, including laws specifically applicable to nurses.

 

[Rock'n Robin]

If it makes you feel any better, all we get at my school is a list of which kids have which illnesses that we HAVE to know about--for example, kids who have epilepsy (we should be aware in case they have a seizure), allergies, such as bees (which fly in my windows a lot in the fall), or ailments which mean they are exempt from rules--for example, if they may need water we need to know, since kids are not "supposed" to have food or drink outside of the cafeteria. We never get any kind of information unless we may need it to manage the child in our classroom. This is a public HS.
Robin M.

 

[zurgswife]

The nurse also needs to comply with any privacy restrictions placed on him/her under state law, including laws specifically applicable to nurses.

Ok...something to look for on the state level.

Thanks guys...I realize it sounds stupid but we have been at war with my kids school with how they deal with diabetes. We have a school nurse who is only there 3hrs a week for paper work so for all purposes we really don't have a school nurse. Though she helped write the policy for how diabetics were to be treated at the school and what actions could or couldn't be done. They agreed that my kids blood sugar numbers and any information about their treatment at school would be in a private log only to be accessed by only 5 approved people. We'll I've found out that even though we have told them previously that they had other people accessing these logs...they said oh no we didn't do that. It happened again today.

It may seem trivial but we live in a very very small town and all the teachers/administrator and students/parents pretty much know each other. I've had people jump to conclusions about my diabetic kids and I want to have the info private because I don't want people learning things that aren't there business and form opinions that are incorrect.

 

[challada]

As noted above, schools comply with a form of HIPAA law regarding privacy of medical records.

In our school(s), we have one school nurse (part time) for every 4 buildings...so less than 1/2 day per building per week. So really, they are plan managers. The REAL people in charge, are the school secretaries in every building (in more ways than just health issues). Most buildings, they are the ones who do administration of medication, documentation, etc. They also keep all the meds, files and document records under lock and key.

So are you saying your child's stuff is laying out open for anyone to see or that lots of folks actually go looking for it on a regular basis?

Having had diabetics before, I would say the only folks who have regular access to the daily testing is the school secretary and the school nurse. Even classroom teachers don't know the specific numbers. Frankly, I'm not even sure why they would or should care about it except that they don't want your kid going into shock or such.

How often do your kids need to test at school? Would a pump be an option for them to help w/regulation (and the privacy issue)?

 

[zurgswife]

As noted above, schools comply with a form of HIPAA law regarding privacy of medical records.

In our school(s), we have one school nurse (part time) for every 4 buildings...so less than 1/2 day per building per week. So really, they are plan managers. The REAL people in charge, are the school secretaries in every building (in more ways than just health issues). Most buildings, they are the ones who do administration of medication, documentation, etc. They also keep all the meds, files and document records under lock and key.

So are you saying your child's stuff is laying out open for anyone to see or that lots of folks actually go looking for it on a regular basis?

Having had diabetics before, I would say the only folks who have regular access to the daily testing is the school secretary and the school nurse. Even classroom teachers don't know the specific numbers. Frankly, I'm not even sure why they would or should care about it except that they don't want your kid going into shock or such.

How often do your kids need to test at school? Would a pump be an option for them to help w/regulation (and the privacy issue)?

Thanks for your comments. It's just that they make a promise for one way to handle things then they let anybody who happens to be filling in for the secretary go into the info. In a normal town it wouldn't matter so much but we all belong to the same church...everybody knows everybody...

My kids are on the pump which actually requires more testing..

 

[CajunDixie]

Good luck getting the school to do anything to stop the busybodies. Last school year DS was having problems with a cough at school. Teachers kept sending him to the nurse. She sent him to the guidance counselor because she didn't hear any wheezing or rattling in his chest. The guidance counselor diagnosed him as either being diabetic or having panic attacks. Then proceeded to share his thoughts with DHs stepmom, she's a secretary there and with her friend, another secretary there. He did all that before he even bothered to talk to us. I ended up having to take him to the Dr. and get a note specifically stating he had neither problem. He has mild asthma. That counselor was later at the HS when older DS signed up for freshman classes and would not even come near our table to see if we needed help. He very noticably avoid us. I asked DS who he was and he grinned and said Your favorite guidance counselor.