“That’s HIPPA”

This past week, an article posted by EMS 1 caught my eye.  It tells the story of a Minnesota man who had his video camera confiscated and was eventually charged with “interfering an ambulance crew.”  According to the article he was videotaping the interactions between a man living in his building and sheriff’s deputies who were accompanied by EMT’s who intended to transport him to the hospital.  I am not going to get into the article and story itself, as I really truly feel like this should be a non-issue.  In the society we live in today people have video capabilities and use them on a daily basis to shoot a variety of things.  It is part of the social media YouTube society that we live in.  What I found truly alarming was the reaction from the EMS community.

The article received over 150 comments on the EMS 1 Facebook page, many stating that there was a “HIPPA” violation.  First of all, it needs to be pointed out that the abbreviation for the law is “HIPAA” and not “HIPPA” and no, the headline of this post was not a typo, I meant to do that.

HIPAA, which stands for Health Insurance Portability and Accountability Act, is a law that has multiple parts.  Title II which deals with health care fraud and abuse is the one that is most important to EMS providers.  Covered entities of the HIPAA laws are those who record, collect, or store a patient’s health care information potentially for billing purposes.  Most HIPAA education began in the early 2000’s but judging from the comments that I saw this week; I cannot help but feel like it might be time for some reeducation.

Over the years, I have encountered HIPAA on a number of different levels.  I have been told by facilities that I “should not open the sealed envelope” that was containing a patient’s medical information because I would be violating their HIPAA rights.  I have heard HIPAA cited as a stumbling block for QA/QI officers in getting information on patients who were delivered to a medical facility.  Simply put, so many entities that are HIPAA covered keep the information more safely guarded than a professional poker player’s hole card.  No one wants to be the one to catch one of those horrid fines we have all heard about over the years, so they overregulate themselves for better or worse.

The result, however, is such a fear of HIPAA laws by field providers that they have turned into EMS’s version of some monster living under a child’s bed, or hiding in their closet.  “Don’t get out of bed late at night, or the boogie man will get you” is the best translation I can find to “Don’t let anyone film you because you’ll be violating someone’s HIPAA rights.”  We are far too terrified of the law, and many people just don’t understand it.

One of the biggest misconceptions of the law is the general public’s role in it.  Many people forget that only HIPAA covered entities are subject to HIPAA laws.  That means that the general public who is standing around at a motor vehicle accident, or watching you wheel someone down a hallway is not covered by HIPAA.  If that was the case, every nosy neighbor who told someone else that Granny Smith went to the hospital with chest pains would be getting a visit from HHS.

This also applies to the media, both traditional and amateur.  Like I said earlier, almost everyone has a camera and can video tape anything they want in public.  There have been countless examples of this; from the New Hampshire activists filming their friend being put in an ambulance to the Miami-Dade firefighter who declared that an amateur videographer was a “combative bystander” when he refused to back up from a MEDIVAC scene.

The bottom line is, while filming someone’s medical emergency might be a morally questionable tactic, when done in public it is legal.  My advice to anyone in that kind of situation would be for them to quickly and safely move the patient to the more private confines of the back of their ambulance.  If the person is still nosing around, leave the scene.  Go someplace safe: a parking lot down the street, around the corner, or just begin transporting.

Throwing HIPAA laws in the face of the general public is not only an incorrect tactic but it also makes us look bad as a profession.  There are lots of resources out there about HIPAA laws, and I strongly encourage anyone with questions to seek out the assistance of their department’s educators or upper management, the legal community in general or their own legal department if they have any doubts about their own knowledge of the law.

And above all else, please remember its HIPAA not HIPPA!

  • Jon Drake

    I’ve been told by numerous people here in Rhode Island (from physicians to EMT’s and folks on the state regulatory board) that hospitals can’t perform M&M conferences with EMS personnel because of HIPAA. When I mention that Massachusetts hospitals are mandated by the State OEMS to hold them monthly, I get a blank stare and then some half-assed response that they must all be in violation of the HIPAA law. The problems with the understanding of the parameters of the law are even farther reaching than you might suspect.

    • Skip Kirkwood

      If you want to, you can go to the National EMS Management web site. There is a letter linked there from an Assistant Secretary at the U.S. Department of Health and Human Services that clearly establishes that sharing patient information between hospitals and EMS doe NOT violate HIPAA.

      Good for you, Jon!

  • Brian Trotta

    The biggest problem in the original story is that the crew was concerned about the patient’s privacy. If you’re so concerned about his privacy, why are you conducting an assessment out in the open? Bring the patient into your truck and close the doors. Presto! Instant privacy.

  • MedicSBK

    It’s one thing to set your department’s bar a little bit higher in hopes of making sure there are absolutely NO slip ups. It’s another not just to misinterpret the law but to practically REWRITE it and that is what so many agencies do. This creates confusion, spreads fear, and completely clouds what HIPAA actually is, what it means, and who it effects.

    • Steve Whitehead

      Setting the departments bar ” a little higher” is problematic as well. The most common HIPAA fine is imposed on agencies for NOT releasing information when they are obligated to do so, not for inappropriately disclosing information. (Source Page, Wolfberg and Wirth)

  • Amazing timing Scott. While you were posting this, I was having this EXACT conversation with the chiefs of the local fire / EMS service concerned about pictures and postings by their own staff and the general public. We went through this exact clarification as well as an explanation of how the department should go about educating their personnel as to what to do when they encounter these situations.