Second-guess reporters to protect celebrities
Patient record is reporter’s gold mine
Protecting a patient’s privacy always is important, but a high-profile case may up the ante. Rather than guarding against inadvertent slips that compromise privacy, you may have to parry attempts to buy or steal the information.
The scenario is familiar to Joan Hajny-Leeds, RN, BSN, FASHRM, director of risk management at Cedars-Sinai Medical Center. As a major hospital in trendy Los Angeles, Cedars-Sinai admits many celebrities for treatment. In addition, the hospital often treats victims of sensational crimes or the ever-present California disasters.
Use consistent risk management policies
Whether reporters are showing up to cover a movie star, a princess, or a crime victim, many of the risk management issues will be the same. Protecting patients’ privacy is always a primary concern, and Hajny-Leeds knows that it sometimes requires innovation and creativity.
"These are cases where there is a very high risk of breach of confidentiality," she says. "It doesn’t matter why they’re here or who they are, we treat them the same way if the media is after them. If a rape victim wants the same arrangements we can make for a big Hollywood actor, we do that."
Past events at Cedars-Sinai have shown that one of the weakest links in the confidentiality chain can be the paper record kept at the nurses’ station. Typically, a hospital keeps the patient’s record at the nurses’ station so the doctors can find them easily. And in most cases, that poses little security risk.
Keep patient chart locked up
But when reporters are looking for a story, that chart is a gold mine. And there it sits, just waiting for someone in a white coat to pick it up and take it away.
The solution at Cedars-Sinai is a formal policy allowing nurse managers to take any patient’s chart out of circulation. The policy states that "any nurse can administratively withdraw a medical record from the normal chart file," if he or she feels the usual location does not offer enough security. The chart is locked away in the nurse manager’s office or in any other secure location, and a note is left in the chart file indicating who to see for access.
The policy specifically allows any nurse to make that decision at any time and to keep the chart sequestered for any length of time. To encourage the nurse to take that initiative, the hospital places a reminder label prominently on each chart. This is what the label says:
"This medical record, and all related material, are property of Cedars-Sinai Medical Center and may be withdrawn from the record rack at any time and sequestered by nursing in order to maintain the integrity of the record, and the confidentiality of the patient-related information."
Hajny-Leeds had the labels affixed to each patient chart binder when she heard that nurse managers felt assertive enough to secure patient records, but many other nurses were intimidated by people demanding to see the records. She points out that the policy is intended to thwart not only reporters, but also attorneys and even family members who should not have access to the records. Too often, people assume that they have a right to see the record, especially if they are relatives of the patient.
"It has been our experience that those who would remove a record from the nursing rack to read also have been seen to remove documents from the record. Either they don’t realize the importance of those documents or they want to remove something they don’t like," she notes. "Now the nurse can point to the label and say, See what this says? Now, zip, I’m going to make this record disappear.’"
Others options are available for protecting the confidentiality of a high-profile patient. Listing the patient under another name is a popular method, known as "going AKA." Celebrities are routinely offered this option, and Hajny-Leeds suggests extending it to other patients pursued by the media. When a patient is AKA, the entire medical record is listed under a pseudonym. At Cedars-Sinai, the patient’s real name is mentioned only in a cross-reference file in the medical records department.
At Georgia Baptist Hospital in Atlanta, Director of Corporate Risk Services Deana Allen encourages crime and disaster victims to be admitted under an AKA if they are intent on keeping their names out of the press. Even if the patient’s true name is somehow obtained, the AKA will make it very difficult for a reporter or attorney to ferret out further information.
Computers can enhance privacy
Allen says Georgia Baptist offers "more than an AKA" that involves a secretive way of listing people in the computer system. Even before the Olympic bombing, the hospital had prepared the system to handle the admission of Olympic officials, entertainers, and heads of state who might be admitted during the games. She does not want to spill the beans on how the hospital’s system works, but she suggests she would be willing to discuss it individually with other risk managers.
Another weak link in the chain of confidentiality can be the hospital workers who have incidental contact with the patient. The clinicians treating the patient are unlikely to speak to reporters, but lower-level workers may be willing to talk for a price. When Cedars-Sinai admits a Hollywood star or a princess from a foreign land, reporters start targeting these weak links.
Employees sign confidentiality pledge
All employees are required to sign a confidentiality form upon hiring that explains the prohibition against talking about patients. Ongoing education in inservices and posted reminders continue to make the point.
If an employee does cooperate with a reporter or attorney seeking information, the hospital is likely to fire him or her if the case is strong enough.
When confidential information does somehow get into the press, that does not necessarily mean you should give in. In many cases, Hajny-Leeds will deny that the information came from the hospital unless there is proof. If the media outlet insists that the hospital is the source, she may issue a challenge to name the source and what inducement was provided. Since that information will not be forthcoming, the dispute ends in a stalemate.
A breach in confidentiality should be discussed with the patient, even if you do not know how it happened. Tell the patient that the information is out and clarify what has been made public and what has not. Then ask how to proceed.
The patient may wish to make no change and provide no information at all, provide some information or correct published mistakes, or go public. The hospital’s risk management and media relations officials should provide advice.
The hospital also should consider whether any increase in security is warranted. During the patient’s admission, the hospital should evaluate whether normal security arrangements are sufficient. If not, the hospital is obligated to bring in additional staff and make other needed changes.
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