Care manager at children’s shared details of child’s ER visit with school

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Children's ED has a way to flag patients that they believe may not provide appropriate follow up care in cases where they deem it necessary. In your case, you probably didn't leave a primary pediatrician's name, or they called that doctor and they said you were no longer a patient, or they couldn't reach that doctor; as a result, they used this alternate means of follow up. In this context, the school nurse is considered part of your care team. FWIW whether it's because you're a frequent flyer or because of your lack of a primary care doctor or something else, CNMC is concerned about your children and acted on that concern to avoid a child falling through the cracks. You may not like that this happened to you, but this kind of process saves kids lives. I will also say with your no diagnosis from one incident, etc comment that the hospital may have been concerned that you're in denial about your kid's medical condition, which would absolutely trigger this kind of follow up.

Disagree. The Childrens ER can do their own follow up. If there are actual concerns about abuse then call CFSA not school. The school is not part of my child’s medical team, period.

They are when you sign the form consenting to their notification like OP did.

well apparently there was no opt out on the form. and it goes against my settled expectations as a consumer so I would expect it to be more prominent a consent form.

You can cross out what you don’t agree with. Or are you expecting an opt out line after every sentence on a consent form?

I’m not a HIPAA lawyer but I think there’s likely a good chance that a specific disclosure like this needs to be opt-in not hidden. Plus we don’t know what the consent actually said. If it just vaguely said “any member of your child’s care team” that does NOT give consent to disclosure to any random medical professional who knows your child.

We know. OP said the disclosure referenced DCPS.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:OP, you realize you can leave this thread, right? It isn't giving you the answers/confirmation that you want.

Sorry you did not succeed in bullying OP. OP has done a useful service here and I may follow her lead by complaining to the Children’s omsbud.

seems like sockpuppetry.

+1 op is unhinged.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:OP, I have two children, ages 9 and 5. We have been to the ER literally never. Beyond annual checkups, we have called their pediatricians advice nurse countless times, had televisits if they need a prescription, gone to urgent care once in a case when my son would not stop vomiting and once when my other son had a bad cut. Urgent care is the place for MANY of the items on your list, others probably required a call to the doc.

The ER is for ACUTE emergencies: that means that they would lose their life or the use of some part of their body unless their was an intervention.

I agree that your family is on a CFSA list and you may suspect that and that's why you are freaking out.

My ped didn’t have a nurse line or telehealth. And urgent cares are not open at 1am. I am the PP who took my DS to the ER 9 times (but zero in the past 4 years). I never had anyone suggesting any of those visits were inappropriate. The one time I was able to get my ped on the phone (huge knot on head from falling down) she was able to counsel me to stay home. But in the middle of the night when kid cannot breathe? Yes, ER.

Not PP, but you described taking your child to the ER for stitches, and multiple seizures. Those are ER situations.

I just can’t wrap my head around OP thinking that “waking up on a Saturday with a 102 degree fever” is something where you would pack your kid in the car and go sit in the ER for 9 hours. Like…give them some Advil and tuck them into bed, ffs. Call the doctor if the fever isn’t gone in a few days. But the ER? That’s nuts.

OP here...and what if it was a preemie that had the 102 fever? Or a child that had a compromised immune system? Or a child that had recently gotten over a severe blood infection? Can you wrap your head around any of those scenarios? Probably not because (luckily for you) it sounds like you've never experienced any of them. Look...you handled you situation your way, and we handled ours our way. I wouldn't dare call you a slacker parent for giving your child a dose of motrin and sending him back to bed, so why do you feel the need to be so critical of us for doing what we felt was in the best interest of our child given the circumstances?

Does the kid with compromised immune system have a plan of care for fever? Is it to pack up and go to the ER? What about follow up instructions for the blood infection? It seems surprising to me that the plan of care would be step 1 - go to ER.

Sure, you don’t owe us all the medical history on your kids. But if they do have complex medical history your posts are so misleading it seems intentional (or trolling, maybe?). You didn’t say, I have a kid with a compromised immune system so we’ve been advised my medical team to go to ER if any sign of concern. You said kid woke up with a fever on the weekend so we went to the ER. Do you see how one of those things make you sound like a reasonable responsible parent and the other makes you sound bat shit crazy?

Do you see how it makes you look like you’re completely deflecting the actual issue by making up stories about OP? OP says her child is a patient of CP&A. That is no doubt in their electronic records and they are the appropriate medical provider to follow up with for continuity of care.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:OP, you realize you can leave this thread, right? It isn't giving you the answers/confirmation that you want.

Sorry you did not succeed in bullying OP. OP has done a useful service here and I may follow her lead by complaining to the Children’s omsbud.

seems like sockpuppetry.

+1 op is unhinged.

OP is being harassed by the usual DCUM suspects that get REALLY bent out of shape when people advocate for their kids in systems.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:OP, you realize you can leave this thread, right? It isn't giving you the answers/confirmation that you want.

Sorry you did not succeed in bullying OP. OP has done a useful service here and I may follow her lead by complaining to the Children’s omsbud.

seems like sockpuppetry.

+1 op is unhinged.

OP is being harassed by the usual DCUM suspects that get REALLY bent out of shape when people advocate for their kids in systems.

Hi, OP2! OP1 isn't being harassed. OP1 is participating voluntarily in a thread that s/he can easily walk away from, and no one would ever know who OP1 is. OP1 isn't actually walking away, weirdly, which suggests s/he is invested someone in this thread, despite it not going in the direction that s/he wants.

It is true that DCUM generally is going to find a way of being highly judgmental of anyone who posts anything here. I'm surprised OP1 doesn't know that.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:OP, I have two children, ages 9 and 5. We have been to the ER literally never. Beyond annual checkups, we have called their pediatricians advice nurse countless times, had televisits if they need a prescription, gone to urgent care once in a case when my son would not stop vomiting and once when my other son had a bad cut. Urgent care is the place for MANY of the items on your list, others probably required a call to the doc.

The ER is for ACUTE emergencies: that means that they would lose their life or the use of some part of their body unless their was an intervention.

I agree that your family is on a CFSA list and you may suspect that and that's why you are freaking out.

My ped didn’t have a nurse line or telehealth. And urgent cares are not open at 1am. I am the PP who took my DS to the ER 9 times (but zero in the past 4 years). I never had anyone suggesting any of those visits were inappropriate. The one time I was able to get my ped on the phone (huge knot on head from falling down) she was able to counsel me to stay home. But in the middle of the night when kid cannot breathe? Yes, ER.

Not PP, but you described taking your child to the ER for stitches, and multiple seizures. Those are ER situations.

I just can’t wrap my head around OP thinking that “waking up on a Saturday with a 102 degree fever” is something where you would pack your kid in the car and go sit in the ER for 9 hours. Like…give them some Advil and tuck them into bed, ffs. Call the doctor if the fever isn’t gone in a few days. But the ER? That’s nuts.

OP here...and what if it was a preemie that had the 102 fever? Or a child that had a compromised immune system? Or a child that had recently gotten over a severe blood infection? Can you wrap your head around any of those scenarios? Probably not because (luckily for you) it sounds like you've never experienced any of them. Look...you handled you situation your way, and we handled ours our way. I wouldn't dare call you a slacker parent for giving your child a dose of motrin and sending him back to bed, so why do you feel the need to be so critical of us for doing what we felt was in the best interest of our child given the circumstances?

Does the kid with compromised immune system have a plan of care for fever? Is it to pack up and go to the ER? What about follow up instructions for the blood infection? It seems surprising to me that the plan of care would be step 1 - go to ER.

Sure, you don’t owe us all the medical history on your kids. But if they do have complex medical history your posts are so misleading it seems intentional (or trolling, maybe?). You didn’t say, I have a kid with a compromised immune system so we’ve been advised my medical team to go to ER if any sign of concern. You said kid woke up with a fever on the weekend so we went to the ER. Do you see how one of those things make you sound like a reasonable responsible parent and the other makes you sound bat shit crazy?

Do you see how it makes you look like you’re completely deflecting the actual issue by making up stories about OP? OP says her child is a patient of CP&A. That is no doubt in their electronic records and they are the appropriate medical provider to follow up with for continuity of care.

What is PP making up about OP?

[Anonymous]

We have a kid w/ chronic medical problems, have been to the ER a bazillion times, and NEVER had the DCPS school nurse say a single word about any of it.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:OP, you realize you can leave this thread, right? It isn't giving you the answers/confirmation that you want.

Sorry you did not succeed in bullying OP. OP has done a useful service here and I may follow her lead by complaining to the Children’s omsbud.

seems like sockpuppetry.

+1 op is unhinged.

OP is being harassed by the usual DCUM suspects that get REALLY bent out of shape when people advocate for their kids in systems.

Hi, OP2! OP1 isn't being harassed. OP1 is participating voluntarily in a thread that s/he can easily walk away from, and no one would ever know who OP1 is. OP1 isn't actually walking away, weirdly, which suggests s/he is invested someone in this thread, despite it not going in the direction that s/he wants.

It is true that DCUM generally is going to find a way of being highly judgmental of anyone who posts anything here. I'm surprised OP1 doesn't know that.

why should OP walk away from their own thread? What do you think that proves?

[Anonymous]

Anonymous wrote:

Anonymous wrote:The health care providers, the ER case managers and the school nurses, see themselves as part of the same team, both are part of managing the care - they just work in different physical locations. One who works in a location where there is easier access to follow up with the child. It isn't really any different from a follow up from the ER to see how the child is doing. There is sharing of information within a healthcare team but you can't share that outside the health care team. The school nurse can't share anything with anyone else at the school and likely all health information is in an electronic documentation system that is the same system being accessed in the ER or remotely from whereever the health care teams work.

There would be a major privacy issue if the school nurse shared any information with the school or anyone outside of the health care team. The fact she is physically located inside the school is typically about ease of access to the children - it makes no difference in terms of what information she has access to or who she can share it with. It would be the same if she was physically located in a community health center or at a hospital or anywhere else.

Healthcare legislation and policy also has implied consent built in - that anyone who needs the information within the team to provide care can access it. For example, at the ER, you don't have to give express consent to each health care provider and they can share information and read the EHR if they are providing care.

The only real potential issue here is the blanket policy. The nurse located at the school has been given the role and responsibility to assess all the files and determine who needs follow up. However if not that nurse, then another nurse would be taking on that same role of assessing files of children who came to the ER to determine if follow up is needed. Neither would have been people actively providing care in the ER. Blanket policies however can be an issue at times and they should revisit the roles and responsibilities of each on the team.

Disagree. The school nurse is not in every instance a “member of the care team.” There absolutely is no implied consent that every medical/psychiatric visit my child makes results in implied consent to share the health record with the school. And once it goes to the school is is covered by FERPA not HIPAA, which means that some random school nurse could decide that my child’s medical records could be shared with teachers without my consent.

The Children’s ER is outsourcing its followup to the school nurses who are working for the school. Not OK.

It's not being shared with the school which includes admin and teachers it's being shared with the nurse who is covered under HIPAA law. Nurse still has to maintain medical records and privacy laws even when working in a school based location. They did their job making sure your child is okay and you're mad about it, so get over it.

[Anonymous]

OP, do you tell your pediatrician whenever you have an ER visit? Have you gotten their thoughts on whatever issues that are bringing you to the ER? Your Ped will be more helpful than us about your child's health care (and as goes without saying, should be the first point of contact on their care and should know about all ER visits).

[Anonymous]

Anonymous wrote:OP, do you tell your pediatrician whenever you have an ER visit? Have you gotten their thoughts on whatever issues that are bringing you to the ER? Your Ped will be more helpful than us about your child's health care (and as goes without saying, should be the first point of contact on their care and should know about all ER visits).

What? OP has not asked for help about their child’s health care. She had a specific question about school notifications. That’s it. There’s no need for you to dive into the health conditions of her children or think you need to provide advice about the medical conditions.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:The health care providers, the ER case managers and the school nurses, see themselves as part of the same team, both are part of managing the care - they just work in different physical locations. One who works in a location where there is easier access to follow up with the child. It isn't really any different from a follow up from the ER to see how the child is doing. There is sharing of information within a healthcare team but you can't share that outside the health care team. The school nurse can't share anything with anyone else at the school and likely all health information is in an electronic documentation system that is the same system being accessed in the ER or remotely from whereever the health care teams work.

There would be a major privacy issue if the school nurse shared any information with the school or anyone outside of the health care team. The fact she is physically located inside the school is typically about ease of access to the children - it makes no difference in terms of what information she has access to or who she can share it with. It would be the same if she was physically located in a community health center or at a hospital or anywhere else.

Healthcare legislation and policy also has implied consent built in - that anyone who needs the information within the team to provide care can access it. For example, at the ER, you don't have to give express consent to each health care provider and they can share information and read the EHR if they are providing care.

The only real potential issue here is the blanket policy. The nurse located at the school has been given the role and responsibility to assess all the files and determine who needs follow up. However if not that nurse, then another nurse would be taking on that same role of assessing files of children who came to the ER to determine if follow up is needed. Neither would have been people actively providing care in the ER. Blanket policies however can be an issue at times and they should revisit the roles and responsibilities of each on the team.

Disagree. The school nurse is not in every instance a “member of the care team.” There absolutely is no implied consent that every medical/psychiatric visit my child makes results in implied consent to share the health record with the school. And once it goes to the school is is covered by FERPA not HIPAA, which means that some random school nurse could decide that my child’s medical records could be shared with teachers without my consent.

The Children’s ER is outsourcing its followup to the school nurses who are working for the school. Not OK.

It's not being shared with the school which includes admin and teachers it's being shared with the nurse who is covered under HIPAA law. Nurse still has to maintain medical records and privacy laws even when working in a school based location. They did their job making sure your child is okay and you're mad about it, so get over it.

wrong. when it goes to the school it becomes a FERPA record and can be disclosed to anyone with a “legitimate educational interest.”

[Anonymous]

Anonymous wrote:

Anonymous wrote:Children's ED has a way to flag patients that they believe may not provide appropriate follow up care in cases where they deem it necessary. In your case, you probably didn't leave a primary pediatrician's name, or they called that doctor and they said you were no longer a patient, or they couldn't reach that doctor; as a result, they used this alternate means of follow up. In this context, the school nurse is considered part of your care team. FWIW whether it's because you're a frequent flyer or because of your lack of a primary care doctor or something else, CNMC is concerned about your children and acted on that concern to avoid a child falling through the cracks. You may not like that this happened to you, but this kind of process saves kids lives. I will also say with your no diagnosis from one incident, etc comment that the hospital may have been concerned that you're in denial about your kid's medical condition, which would absolutely trigger this kind of follow up.

Disagree. The Childrens ER can do their own follow up. If there are actual concerns about abuse then call CFSA not school. The school is not part of my child’s medical team, period.

Does the HIPAA Privacy Rule allow a health care provider to disclose protected health information (PHI) about a student to a school nurse or physician?
Yes. The HIPAA Privacy Rule allows covered health care providers to disclose PHI about students to school nurses, physicians, or other health care providers for treatment purposes, without the authorization of the student or student’s parent. For example, a student’s primary care physician may discuss the student’s medication and other health care needs with a school nurse who will administer the student’s medication and provide care to the student while the student is at school. In addition, a covered health care provider may disclose proof of a student's immunizations directly to a school nurse or other person designated by the school to receive immunization records if the school is required by State or other law to have such proof prior to admitting the student, and a parent, guardian, or other person acting in loco parentis has agreed to the disclosure. See 45 CFR 164.512(b)(1)(vi).- source HHS.gov

https://www.hhs.gov/hipaa/for-professionals/faq/517/does-hipaa-allow-a-health-care-provider-to-disclose-information-to-a-school-nurse/index.html

[Anonymous]

Anonymous wrote:

Anonymous wrote:OP, do you tell your pediatrician whenever you have an ER visit? Have you gotten their thoughts on whatever issues that are bringing you to the ER? Your Ped will be more helpful than us about your child's health care (and as goes without saying, should be the first point of contact on their care and should know about all ER visits).

What? OP has not asked for help about their child’s health care. She had a specific question about school notifications. That’s it. There’s no need for you to dive into the health conditions of her children or think you need to provide advice about the medical conditions.

Well, it seems like for some reason, Children's National/the nurse has flagged this family as somehow needing more care beyond ER visits. That's why the nurse is calling.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:The health care providers, the ER case managers and the school nurses, see themselves as part of the same team, both are part of managing the care - they just work in different physical locations. One who works in a location where there is easier access to follow up with the child. It isn't really any different from a follow up from the ER to see how the child is doing. There is sharing of information within a healthcare team but you can't share that outside the health care team. The school nurse can't share anything with anyone else at the school and likely all health information is in an electronic documentation system that is the same system being accessed in the ER or remotely from whereever the health care teams work.

There would be a major privacy issue if the school nurse shared any information with the school or anyone outside of the health care team. The fact she is physically located inside the school is typically about ease of access to the children - it makes no difference in terms of what information she has access to or who she can share it with. It would be the same if she was physically located in a community health center or at a hospital or anywhere else.

Healthcare legislation and policy also has implied consent built in - that anyone who needs the information within the team to provide care can access it. For example, at the ER, you don't have to give express consent to each health care provider and they can share information and read the EHR if they are providing care.

The only real potential issue here is the blanket policy. The nurse located at the school has been given the role and responsibility to assess all the files and determine who needs follow up. However if not that nurse, then another nurse would be taking on that same role of assessing files of children who came to the ER to determine if follow up is needed. Neither would have been people actively providing care in the ER. Blanket policies however can be an issue at times and they should revisit the roles and responsibilities of each on the team.

Disagree. The school nurse is not in every instance a “member of the care team.” There absolutely is no implied consent that every medical/psychiatric visit my child makes results in implied consent to share the health record with the school. And once it goes to the school is is covered by FERPA not HIPAA, which means that some random school nurse could decide that my child’s medical records could be shared with teachers without my consent.

The Children’s ER is outsourcing its followup to the school nurses who are working for the school. Not OK.

Why do you think one excludes the other? HIPAA excludes "education records," but it does not become purely an education record just because it is physically located in a school.

The point is that is is also a FERPA record which means it can be further disclosed within the school at the discretion of random busybody nurse. It compounds the invasion of privacy.

why is the school nurse a random busybody but not ER nurses?????? They have the same/equivalent credentials in providing care to your child, so why the disrespect?