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The Health Insurance Portability and Accountability Act of 1996 is a vital set of regulations that stipulates the manner in which protected health information should be handled. It seeks to achieve the major goal of ensuring proper protection of individual health information necessary to facilitate provision and promotion of high quality health care for public well-being (U.S. Department of Health and Human Services, 2013). The Act is formulated in such a way that it effectively balances between the need to allow dissemination of vital information while also offering protection and privacy to those who seek health care services. This background forms the basis upon which a decision can be made with regards to the case study in question. In the described situation, a nurse voluntarily reports to have violated the HIPAA Act by disclosing the identity of a patient, a young woman of 15 who was admitted to a hospital for emergency delivery. The nurse demonstrated negligence in her conduct by disclosing the patient’s identity but a further investigation should be conducted into the incident before a decision on whether to fire the nurse is made.
Requirements Needed to Perform the Investigation
The security of protected health information should be valued by all physicians and personnel of healthcare facilities. Despite the emphasis on the need to protect patients’ privacy, there are always cases of failure in security measures, so some breaches are inevitable. Instances of mistakes connected to handling patients’ protected health information can have an adverse effect on the reputations and financial security of the people involved. Therefore, it is vital for privacy officers to act swiftly in conducting investigations into reported cases of breach of regulations.
First, the regulations require privacy officers to inform the affected parties to enable them take viable actions aimed at decreasing the possibilities of being victims of identity theft or harm (Duffy, 2016). The case study under analysis involves a patient who is a minor. It is vital to understand that HIPAA regulations apply to all patients, including the young ones, hence the due process of investigation should be followed. The privacy officer is expected to report the case to the management of the health care facility through the human resource department so as to set the stage for further inquiry.
Second, the privacy officer is required to refer to the procedures stipulated in the employee’s collective bargaining agreement or employee handbook before initiating the investigation. The privacy officer should seek to ascertain that the employee had signed the collective bargaining agreement and to obtain the employee handbook for use in the course of the investigation as part of the evidence that the employee, nurse in this particular case, was taken through the due process of HIPAA regulations training.
Furthermore, the privacy officer must adhere to the elements of the breach investigation process. All organizations are expected to have a general policy that is applicable when conducting investigations (Cannon & Caldwell, 2016). Before commencing the investigation process, the privacy officer should establish a breach response team that would help looking into the matter until its eventual conclusion. Additionally, the officer should take viable corrective action steps to help determine the sanctions that an employee should be subjected to if the investigation confirms that a breach of regulations took place.
Evaluating the Incidence as a Breach of Privacy According to the HIPAA Law
Before ruling on whether the nurse breached privacy as per the HIPAA regulations, it is vital to critically examine it in view of the rules included in the law. In HIPAA, a breach is defined as unpermitted access, disclosure, or use of patient health information in a manner that is contrary to the HIPAA privacy rule and which compromises the security or privacy of protected health information (Cannon & Caldwell, 2016).
The discussion on whether the incident is an actual breach of law starts by an analysis of whether the involved nurse is an entity to whom the law applies. The privacy rule is applicable to, among others, health care providers, both as institutions or individuals, who are involved in the process of health care provision. As per the regulations, all health care providers, including those who provide medical or health services through Medicare are subject to the Act (Talib, Silver, & Alderman, 2016). Based on this, it should be understood that the nurse in the case study is a covered entity who is obligated to abide by the regulations and not disclose a patient’s protected health information. Therefore, before looking at the other factors involved in the case, it is worth noting that the nurse breached the law. This is a preliminary judgment that is still under scrutiny. A look at other important aspects will help determine whether the nurse breached the Act or not.
It cannot be concluded that the nurse breached the HIPAA without examining the nature of information that was shared in order to understand whether it qualifies as protected health information. The Health Insurance Portability and Accountability Act is clear on what should be regarded as individually identified health information. The information covered by the regulations includes demographic data that is used to identify people. It includes names, birth dates, social security numbers, etc. (Talib et al., 2016). In this case, the nurse had disclosed the name of the patient. An individual’s name is individually identifiable information, hence, it is right to say that the nurse had disclosed what is regarded as protected health information. Hence, she broke the law.
Moreover, the nurse breached the regulations on the access to and uses of private health information. As a health care provider in the facility where patients are taken for emergency delivery, the nurse had a right to information on the personal identity of the patient, such as her name and age. However, the HIPAA regulations restrict the use of this information. The policies are clear on the members of the workforce who are permitted to access protected health information in the course of executing their duties. Furthermore, the law stipulates the conditions under which the information should be accessed (Ford, English, Dowshen, & Rogers, 2016). In this regard, it is right to say that the nurse had the right to get information about the identity of the patient. However, this right comes with a responsibility to protect the information by avoiding any illegal disclosure. To this effect, it is clearly a breach of the law for the nurse to disclose the identity of the patient to her daughter.
By virtue of being allowed to operate as a nurse in a registered health facility, the nurse must have been taken through the due process of workforce training and management as required by the HIPAA regulations. The Act defines workforce as the trainees, employees, volunteers, and others whose activities or conduct is controlled by the entity. The policy requires covered entities to offer training to all the members of their workforce on the privacy policies that should be adhered to as they perform their duties (Shaw, 2016). The nurse voluntarily informed the privacy officer of the hospital about her failure to abide by the HIPAA regulations, hence confirming her knowledge of the regulations. As such, it is right to conclude that her action was a breach of the law since she violated regulations that were well known to her.
Differences and Similarities Between the Hospital’s Stance and HIPAA as to Whether the Nurse Should Be Fired from Her Job.
In respect to whether or not the nurse should be fired, the hospital’s stance should be analyzed by considering its adherence to HIPAA regulations. First, the hospital’s position does not show strict adherence to HIPAA regulations so the nurse should not be fired. The conditions under which the patient delivered her child are against the requirement of HIPAA regulations. A hospital should have measures in place to guarantee patients’ confidentiality, but this was not the case since the patient delivered in the emergency room as opposed to the obstetrics (OB) department (Shaw, 2016). To this extent, it is clear that the hospital did not create an enabling environment to facilitate strict adherence to HIPAA regulations. Therefore, the hospital’s stance does not provide grounds on which the nurse should be fired. The information about the patient could have originated from another source different from the nurse. Hence, it would be unfair to place full blame on the nurse by firing her. On the other hand, the HIPAA stance is based on clearly stipulated regulations that are meant to be the primary guidelines on how nurses should handle protected health information. To that effect, the Act advocates for the nurse to be fired. She knowingly disclosed the identity of the patient, going against the regulations. Therefore, the HIPAA calls for her to be fired and requires the hospital’s management to put measures in place to safeguard against such violations in future.
Decision to Immediately Fire or Put the Nurse on Administrative Leave
Following the report made by the nurse, the privacy officer should give the matter their immediate attention. The decision to fire the nurse should only be made after conducting an investigation with the aim of determining whether the reported incident was simply a violation or if it was actually a breach in accordance to the definition provided by the HITECH-HIPAA Omnibus Rule (Hasselbacher, 2014). The determination should be made in a timely and accurate manner to give room for appropriate actions to be taken. In order for the investigation to be conducted in a proper environment, the nurse should be temporarily put on administrative leave.
It is unfair to regard the nurse as the only one who could have disclosed the identity of the patient. Hence, an investigation should be conducted to understand the origin of the information. According to Talib et al. (2016), there are challenges to maintaining the privacy of patients due to the difficulties related to hospitalization and discharge procedures. In the case study, it was not possible for the facility to fully safeguard the patient’s privacy because she had to deliver in the emergency room. There was no time to move her to the obstetrics department (OB) for a private delivery. This is a clear indication that the patient could have been seen by other patients who were in the emergency room for treatment or attended their loved ones or members of staff working in the emergency room. As such, there is a chance that the information that had spread in the schools the following day could have originated from another source. In this case, the nurse instructed her daughter not to share the information with anyone. Therefore, it can not be assumed that the circulating information was spread by the daughter. It would be wise to investigate the origin of the information before holding the nurse accountable for the breach of regulations and operational ethics.
It is vital to understand that although the regulations prohibit disclosure of PHI, such a disclosure is permitted if it serves public interest. This is one of the few exceptions within the same regulations which can be used to justify the nurse sharing the information with her daughter. HIPAA regulations permit one to use patient information for public health care operations (Shaw, 2016). The health care providers who seek to use the information for such purposes are expected to be ethical in their conduct by showing evidence of best judgment when making a decision on the permissive uses. Based on this understanding, it can be argued that the nurse used the information to engage in a beneficial activity. The nurse was seeking to provide counsel to her daughter so that she does not fall victim to the same problem that caused the patient’s suffering. In this case, the newborn baby had several medical problems. The complications can be an indication of an attempted abortion since the patient kept her pregnancy a secret without disclosing it to her mother and other family members, such as the aunt who worked in the hospital. The nature of the complications inspired the nurse to have a discussion with her daughter so that she could give her appropriate advice in case she had any issues regarding pregnancy.
The disclosure was made with the intention to assist and the nurse adopted reasonable safeguards upon realizing that she had made an unlawful disclosure. The HIPAA regulations also permit disclosure of information for notification purposes in cases of disaster relief efforts (Cannon & Caldwell, 2016). The privacy rule does not call for the elimination of every risk of an incidental disclosure. However, the rule allows information sharing to occur, but calls for adoption of reasonable safeguards by the entity in question. In the case study, the primary reason behind the disclosure was to enable the nurse to counsel her dater, an activity that can be regarded as a disaster relief intervention. Therefore, it is unethical for the nurse to be immediately fired, though she should be put on leave while the investigation is conducted.
Conclusion
The current case study presents a good opportunity to analyze the conduct on nurses with regards to their compliance with HIPAA regulations, while also factoring in the exceptions provided by the Act. In light of the analyzed policies, it is clear that the nurse failed to comply with HIPAA regulations by making an illegal disclosure of her patient’s identity. However, it is also necessary to note that the due process of admission into the hospital was not followed due to the emergency that ensued, so the patient delivered in the emergency room as opposed to the obstetrics (OB) department where she would be safe from public attention. Before making a decision to fire the nurse, an extensive investigation should be conducted.
