Confidentiality?? PLEASE HELP!!

[YesIAm]

A friend of mine (who works at a well known New England Hospital in clinical research) was admitted to the hospital after blacking out and hitting his head on the ground as the result of smoking marijuana. In the hospital, low and behold, he was cared for by none other than his PI, who is a M.D./PhD who happened to be doing his rounds in the ER at the time

The PI, also his boss, must know the reason for his admission as he was the one who seen my friend. My question is, does the PI have a right to fire him, although he was not technically working when he was admitted?? Arent there confidentiality laws that would protect him or something?

Thanks!

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[uptoolate]

HIPAA should ordinarily protect against that information from reaching his PI- now that his PI has that info, I don't know. I would suspect that he would be okay because it would be a bit tricky legally for the PI should your friend decide to make an argument against his/her dismissal.

 

[stinkycheese]

He shouldn't have treated your friend anyway -- should have gotten another attending or a resident to do so -- but since he already did, no, he cannot fire him, and he should excuse himself from further care of your friend immediately anyway.

 

[GuyLaroche]

Children, don't do drugs. I hope your friend gets fired. That's the only way he'll learn.

I should say that I suspect he won't get fired. On what grounds can his PI fire him? To fire him based on this information would require his boss to state his reason for firing him, and stating the reason would be breaking the confidentiality agreement. So, your friend is very unfortunately safe.

 

[CarleneM]

Don't most hospitals have employee programs set up for staff struggling with drug and alcohol problems? It seems that would be a more appropriate first step for the PI and for the hospital, especially since the drug use was not on the job. Now, i don't know that your "friend" has a real problem with marijuana- he could have been using it as a one time thing or very intermittently- but I think that the proper course of action for the hospital would be saying either go through this program or leave.

 

[dopaminophile]

He shouldn't have treated your friend anyway -- should have gotten another attending or a resident to do so -- but since he already did, no, he cannot fire him, and he should excuse himself from further care of your friend immediately anyway.

Agreed. The PI has a major loss of objectivity here both as your friend's physician and as his boss. He should have never taken the case in the first place--but then again he probably didn't expect your friend's Hx to be what it was. I don't think there are grounds for your friend to lose his job.

 

[nick661806]

Children, don't do drugs. I hope your friend gets fired. That's the only way he'll learn.

I should say that I suspect he won't get fired. On what grounds can his PI fire him? To fire him based on this information would require his boss to state his reason for firing him, and stating the reason would be breaking the confidentiality agreement. So, you're friend is very unfortunately safe.

You've got to be kidding, marijuana is barely even a drug. Im sure this guy learned his lession when he wakes up with a huge cut on his head.

 

[Haybrant]

You've got to be kidding, marijuana is barely even a drug. Im sure this guy learned his lession when he wakes up with a huge cut on his head.

wholeheartedly agreed; one of the biggest flaw in the legal system is that marijuana is considered a class 1 substance.

 

[stinkycheese]

Don't most hospitals have employee programs set up for staff struggling with drug and alcohol problems? It seems that would be a more appropriate first step for the PI and for the hospital, especially since the drug use was not on the job. Now, i don't know that your "friend" has a real problem with marijuana- he could have been using it as a one time thing or very intermittently- but I think that the proper course of action for the hospital would be saying either go through this program or leave.

It would be a HIPAA violation for anyone in HR to be informed of this incident. Additionally, it would be a violation for the PI to report it in an official capacity. Nobody's physician has a right to divulge information to one's employer without his consent, save for the cases where a patient may be getting ready to kill someone at work, or to kill himself at work.

 

[2tall]

I don't believe the story. You didn't say his PI fired him, but I'm assuming that's your friend's fear. Hospitals and I'm assuming research institutions require drug screening. So if his boss later makes a him take a drug test (he'd fail)...PI could fire him.

I don't know what type of clinical research your friend does. If your friends misdeeds put patients and subjects in jeopardy, then the PI should fire him. I'm sure your friend could take legal action in that case.

Still I don't buy the story.

 

[MedicineBird]

You've got to be kidding, marijuana is barely even a drug. Im sure this guy learned his lession when he wakes up with a huge cut on his head.

sounds like you are rationalizing for yourself

 

[Law2Doc]

A friend of mine (who works at a well known New England Hospital in clinical research) was admitted to the hospital after blacking out and hitting his head on the ground as the result of smoking marijuana. In the hospital, low and behold, he was cared for by none other than his PI, who is a M.D./PhD who happened to be doing his rounds in the ER at the time

The PI, also his boss, must know the reason for his admission as he was the one who seen my friend. My question is, does the PI have a right to fire him, although he was not technically working when he was admitted?? Arent there confidentiality laws that would protect him or something?

Thanks!

I doubt the PI could outright fire him for knowledge gained in this manner, but I suspect he could probably require him to get some sort of counseling/rehab and be subjected to random drug testing if your friend wanted to continue to work in his lab and the work situation warranted it.

 

[bjackrian]

It would be a HIPAA violation for anyone in HR to be informed of this incident. Additionally, it would be a violation for the PI to report it in an official capacity. Nobody's physician has a right to divulge information to one's employer without his consent, save for the cases where a patient may be getting ready to kill someone at work, or to kill himself at work.

Right, I don't think that the PI could leigitmately force the guy to get treatment, but suggesting that he get treatment might be a good idea. If the PI and the patient both work for the same place (a university I presume), it should be fairly easy to try to steer the patient towards some kind of rehab.

Having said that, I agree that this doctor should not have treated this patient. Every hospital I've ever worked has told me that if I ever see a patient who I know, either in person or through a chart, to drop the chart and get someone else to cover it to avoid a situation like this one. I'm sure the PI didn't mean any harm, but that's why policies like that exist. Since the doctor did treat this patient, I think it would be unethical to fire him for what, in many ways, was the PI's mistake.

 

[YesIAm]

Agreed. The PI has a major loss of objectivity here both as your friend's physician and as his boss. He should have never taken the case in the first place--but then again he probably didn't expect your friend's Hx to be what it was. I don't think there are grounds for your friend to lose his job.

Thanks you guys. As I understand, his PI noticed him in the ER and came to see what was wrong, rather than being the one actually assigned to his care. There was really no way for him to explain why he was there without telling the truth, and he did not want to lie with thoughts that the the PI could/would find out anyway. Actually where he works, Y@le, employee's of the university are not screened for drugs, whereas hospital employees are, as I understand. He is still scared $hitless of what is going to happen on Monday..we'll see. Thanks a lot.

 

[MoosePilot]

People need to be willing to take responsibility for their actions.

 

[2tall]

so instead of saying, "I fell and hit my head." or being a little less vague and saying, "I blacked out and hit my head." he chose to say, "I was smoking reefer/a joint/a blunt/pot/whateva, blacked out, and hit my head." I don't believe he as you said he did not want to lie with thoughts that the the PI could/would find out anyway. People don't think that fast and he obviously didn't put much thought into the whole situation.

If he was that comfortable with sharing the reason for his admit, then he shouldn't have anything to worry about at work on Monday. I'll try not to entertain this thread any longer.

Why is everyone bringing up rehab for marijuana use? You gotta be kidding me!

 

[stoic]

sounds like you are rationalizing for yourself

no, he's pretty much right on.

 

[VFrank]

no, he's pretty much right on.

I agree that marijuana shouldn't be a Class 1 substance --I actually think this is the official standpoint of the American College of Physicians. In any case, I was asked in an interview if I thought marijuana should be legalized. I said yes. I was accepted.

 

[CarleneM]

Why is everyone bringing up rehab for marijuana use? You gotta be kidding me!

i think most of us will agree that smoking some marijuana on ocassion doesn't warrant going to rehab. however, hospitals/schools/etc don't really share that attitude and often will refer people to substance abuse education programs and whatnot. i was just saying that if something negative does come of this, that would be a more likely first step than outright firing.

 

[stinkycheese]

People need to be willing to take responsibility for their actions.

But people's PHI shouldn't be abused in order to "make" them become responsible for their actions. Additionally, smoking pot outside of work doesn't seem like a valid reason for someone to be fired anyway, so tell me in this case, what sort of "responsibility" must the person be held to?

 

[Will Ferrell]

The injured kid is dumb if he actually admitted that was the reason he fell down. He should have just said he slipped on a banana peel or something.

How the hell did he hit the ground as a result from just smoking? Where can I get some of that ****? Just playing

 

[MoosePilot]

But people's PHI shouldn't be abused in order to "make" them become responsible for their actions. Additionally, smoking pot outside of work doesn't seem like a valid reason for someone to be fired anyway, so tell me in this case, what sort of "responsibility" must the person be held to?

Abused? This privacy thing is getting out of hand. You can't separate things to the extent that you as an employer can't act on information you gained as a doctor, particularly since it wasn't sought, but offered by the patient voluntarily since he didn't have a good explanation for being there. If you're concerned about your privacy, give a response like, "I had a temporary dizzy spell and fell down. Don't worry about me." then tell the hospital your privacy concerns.

 

[stinkycheese]

Abused? This privacy thing is getting out of hand. You can't separate things to the extent that you as an employer can't act on information you gained as a doctor, particularly since it wasn't sought, but offered by the patient voluntarily since he didn't have a good explanation for being there. If you're concerned about your privacy, give a response like, "I had a temporary dizzy spell and fell down. Don't worry about me." then tell the hospital your privacy concerns.

I hope this is a joke. The OP's "friend" was stupid for telling his PI everything, but there is no way that a person in America should be afraid of getting complete medical care because it may jeopardize their job. That PI has no business using that protected health information against his employee in any way.

When you are a doctor, will you respect your patients' right to privacy, or will you believe patient rights are "out of hand?" If Joe Schmoe comes to the ER for an infection, and the doctor is his PI, and Joe finds it important to tell the doc that he has HIV, should the doctor then have a right to use that information against Joe in the workplace? Say Joe does blood draws in the hospital, should the doctor be allowed to tell then?

Once you start advocating for a decrease in patient rights and a blurring of professional boundaries, the slope starts getting slippery and is all downhill from there.

 

[MoosePilot]

I hope this is a joke. The OP's "friend" was stupid for telling his PI everything, but there is no way that a person in America should be afraid of getting complete medical care because it may jeopardize their job. That PI has no business using that protected health information against his employee in any way.

When you are a doctor, will you respect your patients' right to privacy, or will you believe patient rights are "out of hand?" If Joe Schmoe comes to the ER for an infection, and the doctor is his PI, and Joe finds it important to tell the doc that he has HIV, should the doctor then have a right to use that information against Joe in the workplace? Say Joe does blood draws in the hospital, should the doctor be allowed to tell then?

Once you start advocating for a decrease in patient rights and a blurring of professional boundaries, the slope starts getting slippery and is all downhill from there.

No, it's not at all a joke. What about the PIs rights as an employer? Making a piece of information "off limits" to one of two roles a person might play is ridiculous. What if a man's wife came to him for treatment and said she had HIV because she wanted good care, would he then have to sleep with her because he shouldn't have that information as husband, only as doctor?

You say that's a reduction to the absurd? No, it leads into the ethical safeguard medicine has always had in that situation - don't see a doc that you have an outside relationship with. He shouldn't have seen that doc. If I read one of his posts right, the friend wasn't being treated by that doc, but saw him in the ED while he was being treated and spilled his guts. If he was treated by that doc, bad show on the doc's part and bad show on the patient's part. You can't honor HIPAA within your own head.

 

[45408]

you guys really think someone's gonna get fired for smoking some chronic? Highly unlikely, fellas.

 

[tigress]

To the person who mentioned drug screening, no research institute I've ever worked in required it. Probably some hospitals do, but not just for researchers. Also, as Prowler said, he's not going to get fired for smoking marijuana. At the most he'll get a lecture. Now I'm going to make a huge generalization and I don't want to invite flames, but most people in research are fairly liberal and understanding, and while they might not actually approve of using marijuana, I doubt they would go so far as to fire somebody because of it. If it were a harder drug, maybe...in that case, the privacy issue would come into play.

just my 2 cents

 

[stinkycheese]

No, it's not at all a joke. What about the PIs rights as an employer? Making a piece of information "off limits" to one of two roles a person might play is ridiculous. What if a man's wife came to him for treatment and said she had HIV because she wanted good care, would he then have to sleep with her because he shouldn't have that information as husband, only as doctor?

There is a huge difference b/w those situations, and you know it. I don't think it would be absurd for the PI to more closely monitor his employee after that, but using information he learned in a clinical setting against the employee in a professional manner is completely unethical.

You say that's a reduction to the absurd? No, it leads into the ethical safeguard medicine has always had in that situation - don't see a doc that you have an outside relationship with. He shouldn't have seen that doc. If I read one of his posts right, the friend wasn't being treated by that doc, but saw him in the ED while he was being treated and spilled his guts. If he was treated by that doc, bad show on the doc's part and bad show on the patient's part. You can't honor HIPAA within your own head.

He shoudn't have said anything, but he was probaby paranoid after having hit the bong In any case, the PI was not there as a PI, but as a physician at the institutionl. Anything he learns on the job stays there. And has no place in employee discipline AT ALL.

 

[MoosePilot]

There is a huge difference b/w those situations, and you know it. I don't think it would be absurd for the PI to more closely monitor his employee after that, but using information he learned in a clinical setting against the employee in a professional manner is completely unethical.



He shoudn't have said anything, but he was probaby paranoid after having hit the bong In any case, the PI was not there as a PI, but as a physician at the institutionl. Anything he learns on the job stays there. And has no place in employee discipline AT ALL.

Your standard puts the PI in an untenable position. He might have suspected or might come to suspect that his employee is a drug abuser, but under your standard he can't act on that information because he found out as a doctor. An ethical standard that puts him in that place is stupid and I personally reject it. I'd either fire him or quit as the PI. I wouldn't be willing to be the boss but unable to lead/manage.

 

[stinkycheese]

Your standard puts the PI in an untenable position. He might have suspected or might come to suspect that his employee is a drug abuser, but under your standard he can't act on that information because he found out as a doctor. An ethical standard that puts him in that place is stupid and I personally reject it. I'd either fire him or quit as the PI. I wouldn't be willing to be the boss but unable to lead/manage.

When you are a physician, unfortunately your rights in a professional capacity are trumped by your patient's rights. I hope you learn that in medical school.

 

[jhugti]

I think that most physicians wouldn't even think twice about a patient whose reason for admission was a fall after smoking marijuana. In the scope of what most doctors (never mind ER physicians) see in a day, smoking marijuana is so close to the trivial extreme as to be nearly laughable.

Also, let's not forget that in the 60s and 70s, when its likely this physician trained, there was a better than good chance he or his close friends "abused" this drug themselves. I really doubt that this guy's lab job is in jeopardy because his PI knows he uses weed on occasion.

 

[MoosePilot]

When you are a physician, unfortunately your rights in a professional capacity are trumped by your patient's rights. I hope you learn that in medical school.

I hope you learn that asserting something is a "right" doesn't make it so.

What right is the PI abusing?

 

[2tall]

I just thought of something. I don't know if anyone's mentioned it, but the "friend" told his boss he smoked the weed. The boss did not read it in "friend's" chart.

All this talk about protected health information is null and void.

Basically the question is...should a boss fire a guy who revealed he passed out annd conked his head from smoking a joint.

Moral of the story: I think you know. Do I win a prize or something?

 

[VFrank]

I just thought of something. I don't know if anyone's mentioned it, but the "friend" told his boss he smoked the weed. The boss did not read it in "friend's" chart.

All this talk about protected health information is null and void.

Basically the question is...should a boss fire a guy who revealed he passed out annd conked his head from smoking a joint.

Moral of the story: I think you know. Do I win a prize or something?

No, you don't win a prize. Just because the patient told his doctor about the weed instead of passing him a note about it doesn't mean the patient's rights to privacy are "null and void." Oh man, you have a lot to learn ...

 

[stinkycheese]

I hope you learn that asserting something is a "right" doesn't make it so.

What right is the PI abusing?

The patient's right to privacy, which is a central tenet of HIPAA.

I hope you learn that just because you don't agree with something doesn't mean that you can take liberties -- especially where patient privacy is concerned.

 

[2tall]

It wasn't his patient. Didn't the OP clarify that?

 

[2tall]

Thanks you guys. As I understand, his PI noticed him in the ER and came to see what was wrong, rather than being the one actually assigned to his care. There was really no way for him to explain why he was there without telling the truth, and he did not want to lie with thoughts that the the PI could/would find out anyway. Actually where he works, Y@le, employee's of the university are not screened for drugs, whereas hospital employees are, as I understand. He is still scared $hitless of what is going to happen on Monday..we'll see. Thanks a lot.

I want my prize!

 

[YesIAm]

I want my prize!

That is right, his PI was not assigned to his care, moreless wanted to make sure he was alright/what happened etc. My friend knew that the PI would find out the truth anyway, he's more embarrassed than anything now. Worst of all he is planning on applying to medical school next year and the PI was his number one reccomendation as they have been working for some time together. I'm not sure what is going to happen, I'll keep you updated for sure. Thank you all for responding.

 

[2tall]

I don't think your friend has reason to worry. They have an established relationship. He was open and honest about his mishap. When you make a mistake, admit it! It's always easier that way. Initially, I thought it was stupid to mention the maryjane. Now, I'm glad he was candid. Own up to your mistakes. It takes guts...shows character. I'll remember that. Perhaps this really IS a TRUE story.

As for the LOR...assuming he remains in his research position and the PI agrees to write one, there shouldn't be a problem. It's pretty serious if someone writes something negative in a recommendation. Hasn't is garnered legal action in the past (I'm not sure of medschool applicants, but employment in other arenas)?

You didn't mention his PI's immediate reaction. Was the PI shocked...amused? Also, it depends on the type of relationship they have. Employer/employee. Mentor/mentee.

V, frankly my dear...you're right. I DO IN FACT have a lot to learn. It's sorta why the medical school component of my life is important. Perhaps you should review the thread and notice that I was not referring to the sacred doctor-patient relationship.

 

[MoosePilot]

The patient's right to privacy, which is a central tenet of HIPAA.

I hope you learn that just because you don't agree with something doesn't mean that you can take liberties -- especially where patient privacy is concerned.

Ok, I hate to get into details, but does it say anywhere in HIPAA that you have to somehow magically forget something you learn about a patient? Or just that you can't pass on his protected information to anyone who doesn't have a legitimate reason to know?

It was not his patient.

The patient volunteered the information to the doctor. It was released by the patient (who is authorized to release whatever information he wants under HIPAA).

The PI now knows the information with no ethical issues. Questions?

 

[dopaminophile]

Ok, I hate to get into details, but does it say anywhere in HIPAA that you have to somehow magically forget something you learn about a patient? Or just that you can't pass on his protected information to anyone who doesn't have a legitimate reason to know?

It was not his patient.

The patient volunteered the information to the doctor. It was released by the patient (who is authorized to release whatever information he wants under HIPAA).

The PI now knows the information with no ethical issues. Questions?

As a disclaimer... I have no sympathy whatsoever for the guy. However, one could argue that because the physician was on duty and came in to see a patient under his colleague's care, there was a reasonble expectation of privacy--even though the PI wasn't directly involved in the patient's care. The patient offered information as a patient to a doctor on duty and on staff... I bet HIPPA would protect it.

 

[MoosePilot]

As a disclaimer... I have no sympathy whatsoever for the guy. However, one could argue that because the physician was on duty and came in to see a patient under his colleague's care, there was a reasonble expectation of privacy--even though the PI wasn't directly involved in the patient's care. The patient offered information as a patient to a doctor on duty and on staff... I bet HIPPA would protect it.

HIPAA would protect it from what?

 

[dopaminophile]

HIPAA would protect it from what?

I think the information that the patient divulged would be protected from being used as grounds for any sort of disciplinary action. I don't know the law all that well so I may be wrong. (as evidenced by my typing "HIPPA" instead of "HIPAA")

 

[2tall]

I think anyone who works/volunteers in a hospital knows that HIPPA is NOT that cut and dry. There is tons of gray areas. This case is one of a multitude. I really enjoy the occasions when the SDN forums turn into the student lawyer version.

 

[MoosePilot]

I think the information that the patient divulged would be protected from being used as grounds for any sort of disciplinary action. I don't know the law all that well so I may be wrong. (as evidenced by my typing "HIPPA" instead of "HIPAA")

Ok, now I'll admit that all I've had is the HIPAA training. I completed the Air Force HIPAA training for volunteers and then the training for doctors because I wanted to know more. I can't find anything about this topic, because the CFRs are extensive.

All I'm saying is that I can't see how the PI could not let the student go either based on the information he received outside the patient's medical care, or, more likely, simply let him go for "unnamed reasons". For all of you who say marijuana is no big deal, great. If you were the PI, you wouldn't let him go. I'm just saying I think he could let him go without getting into legal trouble. A regulation can't make you keep info from yourself.

 

[2tall]

Moose that's why I think it's as gray as it can get. Of course, you can't keep info from yourself. It's a question of its use. Can I use this info against someone (my employee)? Can I use this info to benefit myself (fire a dope fiend)? HIPPA is set up to protect that.

 

[2tall]

As a disclaimer... I have no sympathy whatsoever for the guy. However, one could argue that because the physician was on duty and came in to see a patient under his colleague's care, there was a reasonble expectation of privacy--even though the PI wasn't directly involved in the patient's care. The patient offered information as a patient to a doctor on duty and on staff... I bet HIPPA would protect it.

According to HIPPA if I remember correctly one should only acquire/use information that one needs to perform one's job function. Doctors don't go around asking random patients..."What seems to be the problem?" In this case I don't see any to believe friend assumed PI was his doctor.

How friend assumed PI would find out...I don't know. Did he assume PI would open his chart. The medical staff speaks freely (sorry HIPPA). Did he assume one of PI's colleague's would spill the beans? Maybe.

The worst the could happen to PI - fines and jail time. Civil case would be settled.

 

[45408]

WHEN WAS THE PI BORN?

My money says that the PI was growing up in the 60s or 70s. If you don't think he blazed a few blunts, you're probably busy smoking the ganga now.

 

[45408]

also, if the PI really wants to fire him, he can just institute a lab-wide drug screening tomorrow. End of case. Not a fraction of HIPAA would be violated.

 

[Scarletbegonias]

If I was the PI, I would not let him go.

 

[docbill]

If I had student like that, I would laugh my head off.. and from that day on call him doppy.

From now on anything he sais or do.. the PI will think.. are you stoned?