HIPPA and schools- Student rights

[jiminyC_fan]

Does anyone know if a school nurse can contact a doctor without the parent's consent or permission under the HIPAA law?

Long, long, long story short. My grandson's school nurse contacted the doctor direct after not agreeing to what he said in his seizure disclosure for my grandson's IEP. My daughter got wind of it and asked that the nurse contact her direct and she will get the answers from now on. Principal states they have the right to contact the doctor under HIPAA. All the info the nurse typed up was incorrect. Luckily, the Doctor called my daughter.

I've been trying to research but not really coming up with much.

Thanks for any insight and or links.

 

[chloelovesdisney]

I signed a HIPAA waiver for the school when my son was enrolled, possibly she doesn't recall doing so.

 

[jiminyC_fan]

Good point. I'd be surprised if she did forget it since she has been dealing with this for eight years. I will ask her.

 

[chloelovesdisney]

I would be a little surprised if the doctor released any records without it. Anyone can ask for anything, the person giving the information is the one on the hook without the waiver.

 

[design_mom]

I don't recall signing a HIPAA form at my children's school. Just the standard "I agree to allow them to transport to __ hospital, etc."

I wonder if the school nurse would be bound by HIPAA laws? I'm no expert of course. But there's nothing stopping me from calling my husband's doctor, my mother's, etc. and telling him what I think. I think there *are* laws limiting what the doctor is allowed to share with me about his patient. It sounds like the doctor handled it properly by not talking to the nurse, and letting your daughter know that she called.

 

[chloelovesdisney]

I don't recall signing a HIPAA form at my children's school. Just the standard "I agree to allow them to transport to __ hospital, etc."

I wonder if the school nurse would be bound by HIPAA laws? I'm no expert of course. But there's nothing stopping me from calling my husband's doctor, my mother's, etc. and telling him what I think. I think there *are* laws limiting what the doctor is allowed to share with me about his patient. It sounds like the doctor handled it properly by not talking to the nurse, and letting your daughter know that she called.

The HIPAA waiver was given to me by the person that oversees IEP implementation at the school, not with the general enrollment papers.

 

[design_mom]

The HIPAA waiver was given to me by the person that oversees IEP implementation at the school, not with the general enrollment papers.

Ah, okay.

Although, my son had an IEP for a couple of years in elementary school and I don't remember signing one then either. But it was just for speech therapy, so maybe they didn't do one just for that... or maybe I've just forgotten.

 

[jiminyC_fan]

Thanks everyone. I have written a text to my daughter asking her if she signed something. My daughter doesn't mind sharing info since it's in her son's interest but what does bother her is not knowing they are contacting the doctor. She has been through all sorts of things with doctors and has finally found one that she has a great relationship with. She doesn't want the school running to the doctor for minor info that she, herself, can provide. She wants him there for her in an emergency and not tired of always having to deal with the them for little things. This is the first doctor that will call her back ASAP. This is the first doctor willing to dig deeper. He has a severe non controlled seizure disorder called Doose.

 

[Sadie22]

The nurse would be carrying out the doctor's orders under the doctor's supervision and should be contacting the doctor for clarification whenever necessary, shouldn't she?

 

[smokeyblue]

Quite honestly, anyone can ask whatever they want of whatever health professional they want to. The provider who is being asked for such information is the one who holds the liability in this matter. The question is is there a release or not? If so, what provider is it for, how long is the release good for and what specific information is the provider permitted to release?

I would imagine that your daughter is an excellent historian with only your grandson's best interest at heart; but the school nurse simply would not be doing her due diligence if she didn't follow-up with any question she had with the provider. If something is incorrect or was misunderstood, of course your daughter should get things clarified.

Simply put this is not a HIPPA issue. It would be fully within reason for your daughter to let the school know exactly what you said, that she's found such a great medical provider, that she doesn't want to burden him with any extraneous communication because she values the great care he is giving her son and that she prefer that questions be funneled through her first.

 

[jiminyC_fan]

Quite honestly, anyone can ask whatever they want of whatever health professional they want to. The provider who is being asked for such information is the one who holds the liability in this matter. The question is is there a release or not? If so, what provider is it for, how long is the release good for and what specific information is the provider permitted to release?

I would imagine that your daughter is an excellent historian with only your grandson's best interest at heart; but the school nurse simply would not be doing her due diligence if she didn't follow-up with any question she had with the provider. If something is incorrect or was misunderstood, of course your daughter should get things clarified.

Simply put this is not a HIPPA issue. It would be fully within reason for your daughter to let the school know exactly what you said, that she's found such a great medical provider, that she doesn't want to burden him with any extraneous communication because she values the great care he is giving her son and that she prefer that questions be funneled through her first.

Well written and understood. Thank you. This is pretty much how she handled it so far.

 

[Pea-n-Me]

The school nurse is not some nosy neighbor or family member looking for dirt on your grandson.

The school nurse is the licensed, professional health care provider responsible for providing medical services to your grandson while he is at school. As such, she has not only a right, but a responsibility, to make sure whatever instructions the physician left, are clear to her, should a medical event arise and a medical protocol needs to be followed. There is an inherent medical-legal relationship between this particular physician and the school nurse.

I don't know what state you're in, but this is how the law reads in MA:

Is an authorization required before physicians and other covered providers are permitted under HIPAA to discuss the treatment of a patient with a school nurse, regarding a patient enrolled at the school?
No, an authorization is not required. The HIPAA Privacy Rule permits a health care provider to disclose protected health information about an individual, without the individual's authorization, to another health care provider for that provider's treatment of the individual. See 45 CFR 164.506 and the definition of "treatment" at 45 CFR 164.501.

I, personally, would be thankful this nurse took the time to clarify any issues that are unclear before a need arises, and I would tell my daughter not to worry about her "bothering" your grandson's medical team. All medical parties understand this is how it works in the medical world. In a court of law, information provided by your daughter in the event of a medical emergency would NOT be sufficient as a medical mandate - this information must come from the physician. The school nurse is obligated to follow the protocol as it's written. If your daughter feels the information the nurse has is incorrect, then obviously it should be clarified between all of them, but there would have to be a three way dialogue. It's possible something changed that your daughter is not aware of, and the info the nurse has is "right", seeing as she clarified it, etc. Just a possibility. You said this has been an issue for eight years? Has his information been updated in his school medical file?

 

[indygirl99]

The school nurse is not some nosy neighbor or family member looking for dirt on your grandson.

The school nurse is the licensed, professional health care provider responsible for providing medical services to your grandson while he is at school. As such, she has not only a right, but a responsibility, to make sure whatever instructions the physician left, are clear to her, should a medical event arise and a medical protocol needs to be followed. There is an inherent medical-legal relationship between this particular physician and the school nurse.

I don't know what state you're in, but this is how the law reads in MA:

Is an authorization required before physicians and other covered providers are permitted under HIPAA to discuss the treatment of a patient with a school nurse, regarding a patient enrolled at the school?
No, an authorization is not required. The HIPAA Privacy Rule permits a health care provider to disclose protected health information about an individual, without the individual's authorization, to another health care provider for that provider's treatment of the individual. See 45 CFR 164.506 and the definition of "treatment" at 45 CFR 164.501.

I, personally, would be thankful this nurse took the time to clarify any issues that are unclear before a need arises, and I would tell my daughter not to worry about her "bothering" your grandson's medical team. All medical parties understand this is how it works in the medical world. In a court of law, information provided by your daughter in the event of a medical emergency would NOT be sufficient as a medical mandate - this information must come from the physician. The school nurse is obligated to follow the protocol as it's written. If your daughter feels the information the nurse has is incorrect, then obviously it should be clarified between all of them, but there would have to be a three way dialogue. It's possible something changed that your daughter is not aware of, and the info the nurse has is "right", seeing as she clarified it, etc. Just a possibility. You said this has been an issue for eight years? Has his information been updated in his school medical file?

Exactly what Pea has said here. The school nurse IS the medical provider for your grandson while he is at school and as such will clarify anything not clear with the doctor. And does not need "consent" to do so. You in fact give that "consent" by placing your child in the school system.

Another point of fact is that the nurse must follow what the doctor says, not the mom, if there is a difference in the plan of care. So your concern would need to be taken up with the doctor first the nurse second.

I can tell you from personal experience about 90% of the time the parents had provided the wrong information and the rest was misunderstanding/confusion on the nurses part. Our clinic welcomes calls from the school nurse, we don't see it as a problem at all. We want to make sure the child get the best most correct care possible.

 

[Kellykins1218]

Our IEP paperwork always includes a page that we sign that says who the school can share information with. We have our pediatrician on the list so, yes, the nurse would be allowed to contact the doctor about one of our kids.

 

[IDoDis]

OP, since your grandson has a severe seizure disorder, I would assume that he has a health care plan on file with the school nurse. That would have to be the case. Therefore, your daughter provided information which allows the school nurse to contact the doctor. How would a school nurse help a child who had any kind of ongoing medical issue without being allowed to contact the child's doctor? So yes, the nurse was in her full right to contact the doctor and the doctor was in his/her full right to respond.

 

[RitaE]

I'm not sure of the exact State Law here but the IEP school paperwork always includes a Medical Record release form, which we always decline to sign for reasons that really don't have anything to do with the OPs specific questions. Basically my objections don't have anything to do with the current school nurse but severe problems with her predecessor that once prompted me to tell her that if the problem was something like my son was dying in front of her eyes she could give him CPR but for anything else, hands off and call an ambulance, call me and otherwise do not touch my kid. But, that lady got fired.

I'll say that the Nurse doesn't provide direct care to my son such as with the OP and seizure incidents and my son doesn't have anything such as prescriptions he takes during the day that the Nurse is required to administer. But I do know that even in cases of me traveling from Doctor to Doctor around here I have to sign a release form for Medical Practice A to release records from Medical Practice B. They don't have a right to see my private information simply because they are all my Doctors or other Medical Care providers.

 

[The Mystery Machine]

Does anyone know if a school nurse can contact a doctor without the parent's consent or permission under the HIPAA law?

Long, long, long story short. My grandson's school nurse contacted the doctor direct after not agreeing to what he said in his seizure disclosure for my grandson's IEP. My daughter got wind of it and asked that the nurse contact her direct and she will get the answers from now on. Principal states they have the right to contact the doctor under HIPAA. All the info the nurse typed up was incorrect. Luckily, the Doctor called my daughter.

I've been trying to research but not really coming up with much.

Thanks for any insight and or links.

Who Is Not Required to Follow These Laws
Many organizations that have health information about you do not have to follow these laws.

Examples of organizations that do not have to follow the Privacy and Security Rules include:

• Life insurers
• Employers
• Workers compensation carriers
• Most schools and school districts
• Many state agencies like child protective service agencies
• Most law enforcement agencies
• Many municipal offices

http://www.hhs.gov/hipaa/for-individuals/guidance-materials-for-consumers/index.html

 

[pryncess527]

It depends on how the school is set up, but our privacy rules for medical records often fall under FERPA, not HIPAA. But FERPA does allow us to consult with other professionals about a student without getting consent first.

 

[jiminyC_fan]

Thanks everyone. This wasn't the case of questions about care she might administer. It was about asking the doctor to reword his document about his diagnosis. She actually asked him to change it. HER version of was full of mistakes and he didn't allow it. His case is severe and rare. She can't ask a doctor to change it because it's not what she is familiar with. He has several types of seizures not one. He has failed 18 meds.

The school nurse is not some nosy neighbor or family member looking for dirt on your grandson.

Fortunately most nurses are professional. This particular nurse will talk to parents about other children not their own. Believe me, there is a lot of dirt on this nurse that I do not care to go into on a public forum. Her contact with this doctor had nothing to do about care. She, also, recommended a med. She isn't a doctor specialized in Epilepsy and she sure as heck shouldn't be recommending medication.

It depends on how the school is set up, but our privacy rules for medical records often fall under FERPA, not HIPAA. But FERPA does allow us to consult with other professionals about a student without getting consent first.

I wondered if it fell under FERPA. Thanks

Thanks to all for your insight.

 

[roseaster]

I'm not exactly sure what this medical plan includes, I'm not familiar with those things, but I'm a nurse and my concrete example as to why this is not a HIPAA is this:

If I have a doctor's order for 5000 mg of a medicine, and I questioned whether the dose was wrong, then I question it with the person who wrote it, not the patient (or the patient's parent in this case) It is healthcare provider to provider communication.

It would actually be irresponsible of the nurse to use the mother as a go between. Like with anything, the more people a message goes through, the more likely it is that the message will be miscommunicated.

Your daughter shuld actually want the nurse to communicate with his doctor, so that all providers are on the same page as far as treatment. Not the doctor saying "I wanted this." and the mother saying,"I told the nurse that." and this nurse saying, "The doctor wants this, the mother told me that."