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Hipaa laws

Discussion in 'Pharmacy' started by sosoo, Sep 2, 2017.

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  1. sosoo

    sosoo 7+ Year Member

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  3. Carboxide

    Carboxide 7+ Year Member

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    Refuse. 100%.
     
  4. steveysmith54

    steveysmith54 Member 10+ Year Member

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    Lol... I'd ask to be excused to use the restroom and simply run... can't ask me for any info if I am not there
     
  5. PharmD500

    PharmD500 SDN Gold Donor Gold Donor

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    Oh no. Had I been doing the wrong thing? I always cooperated with the police when they made requests. Just like I did with the board of pharmacy or other regulatory agencies.
     
  6. Carboxide

    Carboxide 7+ Year Member

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    They have to have a warrant, or you are violating HIPAA.

    I'd just say they had to talk to my manager if they refused to accept that answer.
     
  7. steveysmith54

    steveysmith54 Member 10+ Year Member

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    When you work for a chain and bigger institutions, you have hippa privacy officers and administrators that you refer to.
     
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  8. PharmD500

    PharmD500 SDN Gold Donor Gold Donor

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    Police officers would come all the time and ask to see the pseudoephedrine logs, etc.

    Sometimes they would be after people with fake scripts or other controlled substance issues. I've never seen a pharmacist not cooperate. Frankly, I want to help them because those types of "patients" are not really patients in my book. They're criminals who make the lives of retail pharmacists difficult.

    Once they start locking up pharmacists and holding us criminally responsible for deaths related to opioid overdoses, you guys will be singing a different tune, and will thank the officers for trying to go after the idiots. I think some states may already be implementing laws to hold pharmacists accountable for opioid related deaths.
     
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  9. PharmD500

    PharmD500 SDN Gold Donor Gold Donor

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    I don't think they need a warrant if they have probable cause, right?
     
  10. Carboxide

    Carboxide 7+ Year Member

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    Wrong.

    Re sudafed books, I am not sure if those are included or not. A patient's specific Rx history is definitely included and should never be shared without a warrant.
     
  11. Carboxide

    Carboxide 7+ Year Member

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    #1 rule of pharmacy: don't get your license taken away. If this RN had taken that sample she would have been guilty of assault and would definitely have had disciplinary action taken by the board. If you break HIPAA you will be fired and possibly lose your license. That ain't no joke.
     
  12. PharmD500

    PharmD500 SDN Gold Donor Gold Donor

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    The cop was wanting to take the sample. He wasn't requesting the nurse to do it.

    And I wasn't talking about that situation. I was talking about cops and pharmacy.
     
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  13. LoveWillSaveTheDay

    LoveWillSaveTheDay

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    You can report anything you feel is an "immediate threat to human health and safety." If you or your superiors called them to come, then you're clear on any information pertaining to the situation (like forged scripts). That also depends on state laws too. But if they just show up, unannounced asking for something, then no.

    Now, if someone bought sudafed and then got busted for meth right infront of the store (happened to a close friend of mine) then I'd turn over the log for that person. Though they already have enough evidence for the arrest so they technically wouldn't need a copy of the log.
     
  14. lord999

    lord999 Moderator Emeritus 10+ Year Member

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    I guess you all don't read your HIPAA notices. You might want to do that.
    Caremark

    For information, there's almost always a public health or law enforcement exception. Again, this data is already collected.

    This circumstance above is a little different as a compelled collection is actually Fourth Amendment territory.

    No community pharmacy is stupid enough to have a categorical no on release of information.

    VA and the Feds are different, and as such, there's a bit more defined circumstances, but I can release to local law enforcement for reasons not requiring a warrant. A forced procedure on the other hand, that's Buck v Bell (by the way, an atrocious precedent) and the hell that's going to happen without the Ethics committee or a warrant.
     
    Last edited: Sep 3, 2017
  15. PharmD500

    PharmD500 SDN Gold Donor Gold Donor

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    Exactly!

    And I have never in my life heard of a pharmacist getting their license taken away or being fined for HIPAA violations for cooperating with the police.

    If the police come and ask reasonable questions or want to see the controlled substances or pseudoephedrine log, I'm going to cooperate. If they want a complete print-out of all the meds for a patient, I'm going to call upper management to see if a warrant is needed, because it probably is. I'm not even in retail anymore, but that's the approach I took when I worked retail. So did all the other pharmacists I worked with.
     
  16. Apotheker2015

    Apotheker2015 2+ Year Member

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    Every company has their policies and upper management want to be notified right away. I see that as a good thing. Otherwise, the responsibility of how the situation is handled, its course and outcome may just fall on the pharmacist on duty. You do not want to obstruct justice but simply ask for a moment to communicate with your immediate supervisor who should be on their way shortly to assist them. They can wait.

    One more thing, they can't just stroll into the pharmacy - sure, they have access to the pseudoephedrine logs but they're standing on the other side of the counter. Patient profiles -I agree- are off limits.

    That nurse is being too kind. I would be sitting with my attorney right now crunching numbers to make sure my student loans get paid off after all is said and done.
     
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  17. BenJammin

    BenJammin No Apologies 5+ Year Member

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    I am authorized by federal law to release PHI without patient consent to law enforcement in certain situations. So yes, I will comply.
     
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  18. Apotheker2015

    Apotheker2015 2+ Year Member

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    The officer wanted to draw blood? That's an absolute no-go. That nurse was in charge of that patient. What if the officer is a psycho and not a cop and decides to slit the patient's throat? Or does a terrible job with the blood draw and sticks himself with the needle first and then uses the same needle to draw and gives the patient HIV and Hepatitis C? Then the nurse would be responsible because she would have then granted access to that patient.
    She really should have called 911, made more noise and called a charge nurse, maybe even hit the code blue button so that a stampede of people show up in that corner of the hospital. They only did that because she was outnumbered. And the security guards, if I understood the scene correctly, were useless.
     
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  19. PharmD500

    PharmD500 SDN Gold Donor Gold Donor

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    When did I say they can stroll into the pharmacy? They've always been on the other side of the counter when I've dealt with them.
     
  20. Digsbe

    Digsbe 5+ Year Member

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    To my knowledge: Board inspectors/DEA agents/FDA agents investigating a case may review PHI pursuant to their cases (board inspectors on routine inspection).

    Law Enforcement must have a judge's warrant, I don't think being implicated/involved in a case is enough when it comes to giving them records. Some cop can't come in and say "I think he's driving high on Dilaudid show me his records on the PDMP."

    Either way, unless you are a board inspector I'm not authorizing the release of anything until consulting legal higher ups.
     
  21. Apotheker2015

    Apotheker2015 2+ Year Member

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    No one said you'd said that. I think you are misreading tone there. I was elaborating on the topic and not antagonizing.
     
  22. PharmD500

    PharmD500 SDN Gold Donor Gold Donor

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    I sure hope people aren't randomly letting people into the pharmacy if there's no valid reason for them to be there.
     
  23. Apotheker2015

    Apotheker2015 2+ Year Member

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    Right. I will say, though, that most people do not know they may not enter the pharmacy area without the pharmacist's permission. It's a daily power struggle at my company.
     
  24. PharmD500

    PharmD500 SDN Gold Donor Gold Donor

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    Interesting. When I worked retail, one of the pharmacies got robbed overnight. The cops showed up right away, but somehow they knew to wait for the PIC to show up before entering. I'm glad they knew how to do their jobs correctly.

    Our store managers wouldn't even enter the pharmacy without a pharmacist present. I'm glad they know the law.
     
  25. lord999

    lord999 Moderator Emeritus 10+ Year Member

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    Again, depends on the state if they have harder statutes than the Feds (AZ has compulsory disclosure for OD situations, MN does not as the Prince example reminds the public which is being changed this session). There is nothing in HIPAA preventing an LEO disclosure if it is declared (even for specious reasons like your example). However, it is up to you on whether or not you comply, unless your state happens to be one that compels you to disclose (DC happens to be a jurisdiction that you have to, it's on their MPJE as it's unusual). That said, should something go wrong because you did not disclose when you were in a legal position to do so through erroneously thinking that you could not, that's something you can get penalized for. It's different to say "your reasons are not compelling me to think that this is a useful disclosure", and that's fine, but it is quite another to say that disclosure is illegal when it isn't. On the other hand, kicking the upstairs is usually ok, except in imminent emergencies, wh

    https://www.hhs.gov/sites/default/f...ergency/final_hipaa_guide_law_enforcement.pdf

    For your specious example:

    • To report PHI to a law enforcement official reasonably able to prevent or lessen a serious and imminent threat to the health or safety of an individual or the public.

    That's arguably a good reason to disclose if you think driving high would be a serious threat. If you don't think that the reason is good enough, that's ok, but it can be good enough. What a warrant does is pretty much puts the judicial authority as the responsible party, but hilariously enough, I'm pretty sure that your legal departments do not allow pharmacists directly to serve pursuant to a warrant; those are handled by Headquarters as there's considerations to worry about that might have the company resist on grounds (Walgreens and CVS have that policy the last time I checked).

    Again, information is treated very differently than intervention. There's rarely a hard stop for law enforcement to request information, and immediate circumstances can compel the matter as well as state statute. The only thing I would do is compel the uniformed LEO to make the request in writing in front of me with the reason (I don't take telephone requests due to spoofing) and sign with his authority number. Anyone has questions about it, I have it written down as a temporal matter and that would be hard to override.

    That nurse actually faced a very different situation than information. Blood draws have always fallen into the search and seizure areas as an intervention (and for that reason, there is always a protocol involved). The equivalent sort of request to us would be to wake someone up with amphetamines and naloxone, which while it can be compelled, that does need a court order to execute as that is an intervention.
     
  26. Apotheker2015

    Apotheker2015 2+ Year Member

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    Well, store managers know they are not able to enter the pharmacy unless a pharmacist is present. They don't have keys. However, not all know that the pharmacist and his/her license decides who comes in and out of the pharmacy while he/she is on duty. I find that 50% of the store managers of the stores I visit sometimes know that and I would not dare. The other 50% come and go as they please as if the pharmacy were "electronics" or "home".
     
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  27. owlegrad

    owlegrad Uncontrollable Sarcasm Machine Staff Member SDN Administrator 7+ Year Member

    If the store manager doesn't have keys how do the floaters get in?
     
  28. Apotheker2015

    Apotheker2015 2+ Year Member

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    There is a lock box in the store manager's office. Only pharmacists have access to the combination and you must return the keys to the lock box. I believe the float keys are kept in the safe in the back office at CVS. Thus, they're never in the possession of someone without a pharmacist license.
     
  29. owlegrad

    owlegrad Uncontrollable Sarcasm Machine Staff Member SDN Administrator 7+ Year Member

    That is quite the secure system, I am impressed. At CVS the keys are indeed kept in a safe. A safe that every manager and shift supervisor has access to. Indeed every time they open the safe they are 'in possession' of the keys.
     
  30. owlegrad

    owlegrad Uncontrollable Sarcasm Machine Staff Member SDN Administrator 7+ Year Member

    Oh no wait I just remembered there in a paper envelope that only the pharmacist can open. My bad!
     
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  31. Birdstrike

    Birdstrike 5+ Year Member

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    Law enforcement (drug control) has access to the prescription monitoring reports, regarding controlled Rx's. I'm not sure whether or not a warrant is needed, by which types of law enforcement, or if that's even worked out law yet, but I know drug control officers looks at those all the time. They're the one's who created and operate those databases. That being said, I've never been asked by an officer to look up such information on anyone, and I'm sure they have much quicker ways to get the info than to come to some MD or pharmacist and demand the info.
     
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  32. rabbott1971

    rabbott1971

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    I think your analysis is very good, but remember, no state law can lessen the protections set forth in HIPAA; state law can only add further confidentiality (i.e. make PHI harder to release). And HIPAA explicitly states that PHI shall not be released except as set forth in HIPAA. So it is not necessary for HIPAA to restate the prohibition in connection with law enforcement releases; it is covered by the general prohibition against release of PHI.

    I'm not sure what you meant by "There is nothing in HIPAA preventing an LEO disclosure if it is declared." I don't know what "declared" means, and the general prohibition against release of PHI would still apply absent an exception.

    I also don't think you can characterize a policeman's verbal demand for PHI as an administrative request, so I'm skeptical of the "write it down" plan you described. Was that procedure approved by your hospital or practice group attorney? It just doesn't seem right, but I would not mind hearing more about it.

    This law is challenging to read for non-lawyers, and many lawyers mess it up too. But if anyone wants to give it a shot, here it is. Start with (f).
    http://www.publichealthlaw.net/Reader/docs/HIPAA.pdf
     
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  33. CetiAlphaFive

    CetiAlphaFive

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    I thought the 100% kosher way was to show up in court in response to the subpoena and only hand over the goods after asking the judge to order you to in court
     
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  34. lord999

    lord999 Moderator Emeritus 10+ Year Member

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    Sorry, "declared" in the sense is a formal request that is backed with the LEO authority traceable, basically, not an informal request (which can be fulfilled at discretion, but I choose not to, period). The classical informal request is the local jail calling asking for a med profile for someone they arrested, where in the three that I used to routinely practice at, learned to never word it that way but to word it as "Is there anything on the arrested person's medical profile that would be medically problematic to not administer overnight in jail?" (like antiseizure meds). That information request doesn't actually have to be fulfilled (unless they go through the trouble of finding one of the authenticated jail medical professionals to request it under covered entity rules in which case not answering can cause problems later), but we can choose to do so as a professional regard to LEO.

    https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=3233
    Actually, you can possibly define police queries as an "administrative" request as it is not a healthcare one but usually are a category all of their own due to the immediate legal implications. In terms of a written matter and not verbal request, the "written with authority" policy was cleared through OLC years ago before HIPAA as we had one too many incidents with this matter, I used to do the same thing when I was a lowly Walgreens pharmacist as the Board regulations for my old state also had that codified in the regulations at the time (not statute). That written request wasn't optional then. For subpoenas, warrants, and administrative requests from the practice Boards that were not named to a specific pharmacist or pharmacy, that was passed to HQ to be filled (but the ones that were directly named usually were fulfilled by the party). Even if there wasn't specific statute or regulation, a request like that, I want a record for it as I know I'd face questions later about the matter. It's is not an inappropriate or burdensome request to commit it to writing.

    Also, free advice for VA practitioners: One thing that's very different than the outside world, we are not authorized under normal circumstances to disclose any information that is under the 7332 clause even with a warrant (and that even overrides HIPAA required disclosures). Look up your PO training if you forgot what information is categorized underneath that. For the state PDMPs, they had to change the 7332 clause specifically to give an exception to that.
     
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  35. BidingMyTime

    BidingMyTime Lost Shaker Of Salt 10+ Year Member

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    Yes, the amazing enveloping opening skills of pharmacists that few others, if any, possess.

    The rare times I've gotten calls, it is from the jailhouse nurse asking what medications the inmate is on. I comply, because it's from 1 medical professional to another, not any different from a hospital calling a retail pharmacy to get a med list.

    But I think people are asking about cops asking about medications someone is taking for evidence, not for medical need. If the RX is fake, then there is no HIPAA, as it doesn't involve any real medical information, so no issues with giving out information concerning the fake RX (just make sure it has been verified as fake with the dr.)

    Now I did have a guy call once, and say he was at the police station and had been arrested and that they found pills from his controlled prescription in his pocket and asked if I would verify to the police that he had a legitimate prescription for it. Then the police officer got on-line, so I verified it. This seemed legit.

    But a random police officer just asking for personal health information? I would tell him no
     
    Last edited: Sep 6, 2017
  36. GroverPsychMD

    GroverPsychMD Gold Donor 7+ Year Member

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  37. Abby Atwood

    Abby Atwood

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    I'm pretty sure that I see VA filled meds on the PMP in my state. I might be misremembering though. It could have been meds written by a VA doctor but filled by a Walgreens or something. Is that true everywhere? I'm wondering if we need to follow up with the VA to ensure only one provider is managing pain.

    I found this document which authorizes disclosure:
    https://www.va.gov/ORPM/docs/201302...einStatePrescriptionDrugMonitoringProgram.pdf
     
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  38. Charcoales

    Charcoales 5+ Year Member

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    Easy question if you work for a chain: "I have to contact my legal department/manager before I can do anything"
     
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  39. lord999

    lord999 Moderator Emeritus 10+ Year Member

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    Right, that literally changed two years ago as there was a fight between the state of TN and VA. We do report to PDMP programs now after that episode, (because TN argued rightly to DoJ that VA easily is the #1 supplier of illicit prescription opioids nationally). Putting it specifically, the federal combined National Acquisitions Center (DoD, DVA, HHS) buys the majority of all Schedule II and Schedule III narcotics such that the DEA literally asks us for how much we want on next year's production quota that gets sent to the manufacturer.

    And yes, considering the throughput of patients in the VA, there's quite a bit of chatter of "drug them and drop them" behavior among the overburdened primary care providers simply because there isn't much to force rationing without increasing suffering.

    But remember, our Mental Health Chief of Operations is this guy still:
    https://www.usatoday.com/story/news/nation/2014/08/25/vets-suicides-data/14554371/

    so don't expect us to make any real progress in this area. Even hiring due to the freezes is basically impossible right now even with clinical authority.
     
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  40. GroverPsychMD

    GroverPsychMD Gold Donor 7+ Year Member

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    In my state they dont show up. May be state specific
     
  41. CetiAlphaFive

    CetiAlphaFive

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    It's the filling pharmacy that reports, not the MD.

    If it's filled at a pharmacy that is required to report, it gets reported
     
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  42. GroverPsychMD

    GroverPsychMD Gold Donor 7+ Year Member

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    I know that. The va here and methadone clinics dont show up on pmp
     
  43. Carboxide

    Carboxide 7+ Year Member

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    Methadone clinics don't ever show because they're giving it in clinic - just like how an oxy given in the ED doesn't show up. It's not an outpatient rx.
     
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  44. ChalupaBatman86

    ChalupaBatman86 2+ Year Member

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    I would make a preemptive citizens' arrest. He can't arrest me if I arrest him first.


    Sent from my iPhone using SDN mobile
     

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