What would you have done? Question regarding HIPAA

[twester]

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Today, I was selling some clonidine to a patient's husband. The PCP had taken great care to emphasis the SIG for this new script. I went ahead and emphasized the instructions and the importance for the patient to not stop taking the medication suddenly. The patient's husband was appreciative of the counseling and I felt good about the encounter.

After the patient left, the pharmacist on duty pulled me aside and told me that what I'd done was a HIPAA violation and that I should have just told the man to have his wife call with questions. I'm not going to try to decipher the language of the Act to see if I really did violate the law, I kind of stand by what I did for the following reasons:

1. The man brought in the script. He knew his wife was getting clonidine.
2. The wife was elderly. The SIG was involved beyond T PO QD. Clonidine can be problematic in the elderly. I have a professional duty to make every attempt to ensure patient safety.

If the man was picking up something that had been called in, I might have done that differently, but since the script was brought in by the spouse I felt that HIPAA was kind of irrelevant.

What do you guys think? What are the policies at your pharmacies?

 

[Aznfarmerboi]

Today, I was selling some clonidine to a patient's husband. The PCP had taken great care to emphasis the SIG for this new script. I went ahead and emphasized the instructions and the importance for the patient to not stop taking the medication suddenly. The patient's husband was appreciative of the counseling and I felt good about the encounter.

After the patient left, the pharmacist on duty pulled me aside and told me that what I'd done was a HIPAA violation and that I should have just told the man to have his wife call with questions. I'm not going to try to decipher the language of the Act to see if I really did violate the law, I kind of stand by what I did for the following reasons:

1. The man brought in the script. He knew his wife was getting clonidine.
2. The wife was elderly. The SIG was involved beyond T PO QD. Clonidine can be problematic in the elderly. I have a professional duty to make every attempt to ensure patient safety.

If the man was picking up something that had been called in, I might have done that differently, but since the script was brought in by the spouse I felt that HIPAA was kind of irrelevant.

What do you guys think? What are the policies at your pharmacies?

Not that my opinion matters a lot, but your pharmacist was right technically. Unless the wife indicates so, the husband shouldnt be recieving counseling on her prescription. This is the equivalent of a mother picking up medication for her daughter 18 years and older. . . and you counseling the mom on what her daughter was taking.

In my opinion Clonidine is problematic anywhere (not just elderly), and you were right to be concerned. I also have to ask, how often is it prescribed to young people anyway. 🙂

 

[Old Timer]

HIPAA does permit friends or family members to pick up prescriptions for a patient. But the pharmacist is required to use professional judgment and look out for the patient's best interest when allowing someone else to pick up the prescription. Keep the necessary information to a minimum and invite the patient to call you by phone if they have any questions or need counseling. HIPAA also allows health professionals, at their discretion and with certain limitations, to speak to relatives, friends, or caregivers...unless the patient specifically requests them not to. Keep the patient's best interest in mind when discussing their health information with relatives, etc, and only discuss items pertinent to the current health condition.

The Pharmacist Letter

I think you were fine and if the patient is not well, speaking to the spouse is fine.

 

[soyroger]

Since the wife is elderly is the husband considered one of her caregivers? If so then that's a HIPAA exception and you're within the law, probably still liable if a problem arises down the road, but within the law.

 

[YapYap6]

Well, as we all know, everything that leaves the pharmacy is the responsibility of the pharmacist in charge. I agree that you did a good thinking making the emphasis on the SIG. Even if it would step on a technicality of HIPAA in the process, I'd do the same. We regularly inform next of kin that the patient shouldn't have alcohol etc. with x medication, I don't see how an emphasis on the SIG would really be such a huge deal.

 

[RxWildcat]

I don't think you did anything wrong, did your pharmacist explain why he thought you were in violation of HIPAA?

 

[Twins fan]

To me the OP is in the right. If a patient has another person drop off and then pick up a new rx, the patient is implicitly accepting that their representative will be counseled on the new med so that the information can be passed on back to the patient (mostly intact we hope🙂...nothing like the medication counseling telephone game). Unless of course the patient has contacted the pharmacy and says they do not want the representative to be counseled.

It seems to me that twester stayed well within the bounds of HIPAA as interpreted in Old Timer's quote from The Pharmacist Letter.

 

[nnguyenc]

if you acted in good faith and in accordance to HIPPA
then you are fine...

you have to consider the extent of the matter
(i.e. if you were counseling on mood stablizer or STD meds to
their significant other...then you have step back and evaluate the situation again)

 

[rosestar]

I currently work in an emergency room and our yearly HIPAA compliance review states that if a friend/family member requests/receives PHI on the patient's behalf then it is not a violation of HIPAA.
The counsultation with the patient's husband, in my mind, would fall under that category. I think that the pharmacist does not understand HIPAA fully... and who does... and wants to cover himself.

 

[twester]

Thanks, folks, for your input. I verified the circumstances with our legal department and, yeah, I violated the letter of the law - but exercised reasonable judgement. Legal had no real problem with it. (But they emailed me a giant PDF document that I had to read and sign off on. )