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What would you have done? Question regarding HIPAA

Discussion in 'Pharmacy' started by twester, Jun 16, 2008.

  1. twester

    twester Senior Member 7+ Year Member

    Aug 3, 2004
    Denver, CO
    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?
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  3. Aznfarmerboi

    Aznfarmerboi Senior Member 10+ Year Member

    May 18, 2005
    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. :)
    Last edited: Jun 16, 2008
  4. Old Timer

    Old Timer SDN Advisor SDN Advisor 10+ Year Member

    May 16, 2007
    The Pharmacist Letter

    I think you were fine and if the patient is not well, speaking to the spouse is fine.
    Last edited: Jun 17, 2008
  5. soyroger

    soyroger New Member 5+ Year Member

    Jan 12, 2006
    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.
  6. YapYap6

    YapYap6 2+ Year Member

    Apr 30, 2008
    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.
  7. RxWildcat

    RxWildcat Julius Randle BEASTMODE! Moderator Emeritus 5+ Year Member

    Mar 25, 2008
    I don't think you did anything wrong, did your pharmacist explain why he thought you were in violation of HIPAA?
  8. Twins fan

    Twins fan Aspiring Rock Star 2+ Year Member

    Oct 8, 2007
    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.
  9. nnguyenc

    nnguyenc 7+ Year Member

    Mar 19, 2008
    Northern Virginia
    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)
  10. rosestar

    rosestar Clemson Tiger 4 Life 2+ Year Member

    May 22, 2008
    Northern Virginia
    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.
  11. twester

    twester Senior Member 7+ Year Member

    Aug 3, 2004
    Denver, CO
    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. :laugh:)

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