A community of 30,000 US Transcriptionist serving Medical Transcription Industry

Ethics Question about a life-threatening issue posed by teacher - longtail4711

Posted: May 26, 2011

Hello everyone! I'm an MT student who doing a bit of research for one of my classes, and I wanted to ask some real MT's about this one.

My teacher posed to us this question:

"What if you were privy to information in the same setting of transcribing 2 different clinics who apparently have a shared client, and you found out something about the patient that you perceived as seriously potentially life threatening? What if there was a medication prescribed in one context that was dramatically contraindicated in the other scenario? I’m not talking about situations that might impact anyone else other than this individual, but something about that WOULD create a potential-harm setting for this one person, who apparently is not fully “disclosive” (yes, made up word) with their physicians."

The obvious answer would be to go to my supervisor, but I'm interested what those of you who are independent contractors and owners of your own transcription businesses would do. Do you notify your clients about this? If so, how do you do it without getting in trouble with HIPAA?

Thank you, I appreciate your time!

*edited: The teacher says that you really think this IS a life-threatening issue and not just a potential one.

Ethics question - Old Pro

[ In Reply To ..]
Since I am neither an attorney nor a physician, but a medical transcriptionist, I would mind my own business and do my job within the constraints as prescribed by HIPAA. In American law, the attending physician is what is known in courts as "the Captain of the Ship." I would leave such discoveries (and liabilities) to him or her.

I agree.....sm - Tiny

[ In Reply To ..]
I agree with Old Pro 100%. I often catch mistakes within a report, such as the patient was prescribed aspirin, but then within the same dication the patient is allergic to aspirin. But, I don't know about carrying patient information from one provider to another based on typing the report. I would think that would be a major HIPPA no-no.

BTW...well said Old Pro!

That is a tough one... - stumped

[ In Reply To ..]
What if it is something life-threatening? Since I am a nurse transcriptionist and if I saw something like that, what would be expected of me?? Thanks for posting this.

stumped - Old Pro

[ In Reply To ..]
What would be expected of you is that you follow the HIPAA law, just like everybody else, including a doc I know who is now transcribing (he is disabled).

Thank you for replying - stumped

[ In Reply To ..]
Thank you for replying.

Theoretical question - Just an MT

[ In Reply To ..]
What are the chances of that happening, unless it's an extremely small town. It is not within the MTs realm to make judgments in regard to what is life threatening when it comes to treatment choices. I've had a lot of experience as an MT but honestly would not know if a medication were contraindicated in any given scenario, that's a pretty complex realm. Unless you knew your accounts really well, you might not pick up on something like that, as experienced MTs produce a high volume of work in a day. I don't pay much attention to who's who and probably wouldn't think twice about that unless it was something I had done back-to-back. Even then, I wouldn't try to second guess the physician. It's a confidentiality breach for anyone else to know that the clinics have a shared client, and going to your supervisor is not "the obvious answer."

Ethics question - MT

[ In Reply To ..]
You can take care of something like this without breaching HIPAA laws. If you, as an MT, know something that is potentially life threatening, as a medical worker, it is your duty to say something. You can go to your supervisor and tell your supervisor that you have a very good reason to believe that something life threatening is going on with this particular client. Relay that you are not able to disclose how you know this information, but that you highly recommend your supervisor speak with the doctor about making sure they review the chart carefully and quite possibly may need to ask the client for all their medical records in order to provide the best possible care. Your supervisor can tell the doctor that they got information that something could be potentially wrong and they need to double check the situation. I, as an MT, have had a similar experience. Not with two facilities, but with one patient receiving a medication that was contraindicated with the type of disorder she had. The doctor hadn't caught it, but I did because I typed this client's progress notes many times and was familiar with her background. I notified my supervisor who in turn did what she needed to do to try to contact the client, the client's workers, etc. Well from the time I learned of this contraindication to the time my supervisor tried to contact people that needed to know, the client had died from the contraindicated medication. I was able to have a clear conscience in knowing that I did what I needed to do in order to try to save this person's life, which unfortunately, wasn't caught in time. Doctors are not superior to errors. People believe that doctors should never be second guessed because somehow they are the almighty beings on this earth and can do no wrong. They see many, many patients a day and there is no way any doctor knows everything about everything and if you have experienced something that you know is life threatening, you should definitely call the doctor out on it. If you don't, you will feel guilty about it if something does happen, as well as the fact that the doctor could potentially lose his/her medical license because of one error that was caught by you but didn't have the gall to call the doctor out on it.

Not the Same Scenario - Another MT

[ In Reply To ..]
To MT: That's not the same scenario. We are talking about 2 different clinics, so even telling one physician about a patient to another physician is a breach, though I think one should read the small print in HIPAA to see if there's any type of "unless life-threatening..."

I, too, think this is an unlikely scenario. AND, you have to really know for sure this was the same patient before even considering doing anything. Same birth date, exact same medical, social history. That's the only way you'd even know. Born on blah, blah, medical history of blah, blah, drinks blah blah glasses of wine a day, smokes blah, blah cigarettes a day, etc.

That's the only way you'd know since it's 2 different clinics and you can't compare MR number type things.

MT - see message - Another MT

[ In Reply To ..]
I disagree with what you did but that's my opinion. The HIPAA confidentiality pledge that I signed at work states that I am not to access patient records unless it is required in the performance of my job. It is not my duty to tell a physician how to treat a patient, and "highly recommending" to my manager that they take action on a matter like this would not go over well. Doctors should not have to be told to do chart review, and asking the patient for all of their records would be the physician's prerogative, not yours or your manager's. I'm glad your conscience is clear but I think you stepped out of bounds. The physician signs off on those documents, he/she is responsible for the content, not you. If a health care provider makes life threatening errors, perhaps they deserve to lose their license, but it is not for you to say.

Another MT - Old Pro

[ In Reply To ..]
What she did is clearly out of bounds, and if she worked for me she would be fired immediately. She is not a physician and this is not her place. Too many MTs know neither the law nor boundaries.

Two Another MTs - First Another MTs

[ In Reply To ..]
I'm the first Another MT, someone else posted under the same alias as me.

I forgot who I was! - Just an MT

[ In Reply To ..]
I had posted as Just an MT the first time, sorry for the confusion.

I would choose saving someones life over a job. - stumped

[ In Reply To ..]
I think you did the right thing.

Ethics question - MT

[ In Reply To ..]
Thank you. I think someone's life is more important than my job, but regardless of that, I know I did the correct thing because I know what HIPAA laws are all about and I wouldn't have lost my job.

The following is right out of the HIPAA laws and regulations so before any of you sit on your high horse telling me what the HIPAA regulations require and how you'd fire me if I worked for you, maybe you should read up on them.

"Serious Threat to Health or Safety. Covered entities may disclose protected health information that they believe is necessary to prevent or lessen a serious and imminent threat to a person or the public, when such disclosure is made to someone they believe can prevent or lessen the threat (including the target of the threat). Covered entities may also disclose to law enforcement if the information is needed to identify or apprehend an escapee or violent criminal."

I would say that a life threatening situation would fall under this guideline, even if it is the patient themselves and the person who could lessen the threat is the doctor. If any of you feel that your job is more valuable than a person's life, you have no business being in the medical field, regardless if you are just typing reports. As well, if you just assume that HIPAA means revealing no information regardless of the situation, you have no business being in the medical field either. A person who is expected to follow HIPAA laws, needs to know exactly what that means, including when you can make exceptions.

MT - Old Pro

[ In Reply To ..]
It would be interested to see how an attorney (which I assume you are not) would interpret this. I would hope that anyone transcribing (not "typing," please) for our organization would have the good sense to mind her own business and know about BOUNDARIES.

Ethics - Just an MT

[ In Reply To ..]
You are the one on their high horse, judging who belongs in the medical fields and who does not. If you were busy worrying about this physician's conduct in the treatment of a patient, you were performing outside the realm of medical transcription because you were reading information that you were never privy to, I'm sure you must have had to research this situation before taking it to your manager. I was never trained to make the kind of judgment call you made. The error would have to be extremely blatant for me to catch something like that in the first place. You're obviously an exceptional person to be able to do your MT job and to also make sure the doctors do theirs.

Ethics question - MT

[ In Reply To ..]
Reading information that I'm not privy to? Really? What exactly is it that you "transcribe," because I transcribe medical reports meaning that I have that information at my fingertips, not searching where I shouldn't and as a medical professional I KNOW my stuff. I don't just transcribe what I hear, I know what is being said and I know a clear contraindication when I hear one. With that knowledge, it's not only my duty as a medical professional, but as a HUMAN BEING to save someone else if that opportunity arises, which it did, even though unfortunately it wasn't caught in time. However, I can sleep at night knowing I did what I could.

MT - Old Pro

[ In Reply To ..]
A "medical professional?--? I am sorry, I apologize, I did not realize you had been to medical school. My bad.

Just an MT - Old Pro

[ In Reply To ..]
Oh, but I am not the one making calls and trying to contact physicians. I know the correct boundaries and I observe them. As to this hang-up you have about "judging"--following the rules it not judging. I refuse to reply to your further comments, as you intend to turn this into a personal battle. Sorry, no.

You couldn't be more out of line and wrong in your actions - if you tried. You are a dangerous busybody. (nm)

[ In Reply To ..]
nm

no such thing as duty to inform for an MT - mt2

[ In Reply To ..]
If this were one facility, if you worked for a service, you'd flag the note with a SUGGESTION for the physician to review and send it to QA.

If you worked directly for ONE clinic, you'd flag the report and SUGGEST the physician review.

However, you work for TWO clinics and you cannot share information from one clinic with the other clinic. That most assuredly IS a HIPAA violation. Heck, I work as a clinician and I can't talk about this with anyone else in our facility UNLESS the physician has SPECIFICALLY given me permission to do so.

An MT has no duty to warn. We have only one little piece of the pie. We have no clue if one clinic has chosen NOT to document something in a transcribed record (again, as a clinician, I sometimes choose to refrain from putting some information in the record and have "private" notes that don't necessarily get shared with insurance companies and potentially employers.)

So bottom line, since you can't warn one clinic w/o breaching your confidentiality with the other clinic, you'd do nothing beyond requesting a physician review - but you can't say why :)

Ethics question - MT

[ In Reply To ..]
If you would have read all of my posts, you would see that that is what I suggested to the OP. I'm getting slammed for saving someone's life that was a patient of one facility that I worked in, not as an IC, as an employee. I told the OP that she should notify her supervisor that she had reason to believe something life threatening may be going on with this person and to request that the physician take another look or speak with the patient without giving any information about the other facility or even suggesting that there is another facility. However, no one here can seem to get the information right. I'm sure as a clinician it would be within your bounds to talk with a physician in a facility you work for about a potential imminent harm to the client if you have reason to believe there is such.

ethics question - nina

[ In Reply To ..]
What ever happened to leaving a blank/flagging the report? I've had numerous reports where the physician says a patient is on a medication that is also listed as an allergy. So, I leave a blank in both spots. It's not up to us to decide what to put in the report and what to leave out. It is up to the dictator to verify it. They are supposed to sign off on reports and it is their responsibility to fill in the blanks that we leave.

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