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:

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

that does NOT give blanket permission to disclose to the school nurse for any reason. the nurse has to be actually providing care to the student relevant to the records. Childrens deputizing the school for ER follow ups ain’t it.

How is ER follow-up assessment not care relevant to the ER records about the visit in questions? That's what follow-up by a trained professional is.

Because, once again, HIPAA does NOT allow disclosure to any medical professional they want. Just the care team. The school nurse is NOT by default a member of my child’s care team for all purposes. Otherwise the ER could send your records to any random healthcare professional.

Do you think it actually says "care team" in the HIPAA regulation? Go back and read what it actually says, not what you think it says.

I'm all for people changing HIPAA if they feel it is incorrect or insufficient, but you can't change it just by metaphorically stamping your foot.

And I am saying the school nurse meets none of those criteria for the purple of “follow up from ER”. It is *not enough* that the recipient just be a medical professional. Obviously. There would be no meaning to HIPAA. Childrens could send my kids records to any doctor they wanted for any reason. Also concerning is the loss of HIPAA status and the records becoming FERPA.

[Anonymous]

Anonymous wrote:PS: It allows communication without need for consent to other qualified personnel "for treatment purposes." Specifically, HIPAA "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."

The school nurse provides care to the student while the student is at school. If the student is nauseated again, or develops a rash, or gets dizzy, or has wound drainage leaking through the bandage, or whatever else is covered in the ED discharge plan as return precautions or things to look for, they will be taken to the school nurse.

That is how school nurses work.

That is what HIPAA allows in communication. if you don't like it, please, feel free to advocate to change the law. But you can't change it if you don't understand it.

That is only true if it’s something the kid is actually getting treatment in school from the school nurse for already. It is NOT a blanket exception. So many things a kid could be seen for at Childrens that are none of the school nurse’s business.

[Anonymous]

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.

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

that does NOT give blanket permission to disclose to the school nurse for any reason. the nurse has to be actually providing care to the student relevant to the records. Childrens deputizing the school for ER follow ups ain’t it.

The nurse stationed in DCPS schools is not a school employee, has direct access to the CNMC health records when needed, has a CNMC email addresses, and no access to school records. While I don't know the specifics in this situation, if OP situation required a follow up by a nurse, it could make sense that this be the nurse in the school. As others have mentioned, the nurse following up is not going to be the same exact person who you saw in the ER. Why couldn't it be someone employed by the same hospital, with the same credential? It's not like it was deputized to a classroom teacher.

Now the school nurse can share the medical record with a teacher if she deems it a “legitimate educational purpose.”

[Anonymous]

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.

I don't know what part you're disagreeing with. No Children's ED staff, which are already completely overwhelmed with wait times currently exceeding TWENTY HOURS, cannot follow up with you personally if their first efforts fail because you don't want your kid's school nurse to know whatever is going on. Everything else I typed above is factual and not something you can disagree with. Also, I did not accuse you of abuse... I said that CNMC staff may have been concerned that you would not follow up. Obviously it's appropriate for there to be a middle ground between doing nothing if they can't reach your pediatrician and reporting you to CPS.

None of that justifies the privacy breach.

[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.

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

that does NOT give blanket permission to disclose to the school nurse for any reason. the nurse has to be actually providing care to the student relevant to the records. Childrens deputizing the school for ER follow ups ain’t it.

The nurse stationed in DCPS schools is not a school employee, has direct access to the CNMC health records when needed, has a CNMC email addresses, and no access to school records. While I don't know the specifics in this situation, if OP situation required a follow up by a nurse, it could make sense that this be the nurse in the school. As others have mentioned, the nurse following up is not going to be the same exact person who you saw in the ER. Why couldn't it be someone employed by the same hospital, with the same credential? It's not like it was deputized to a classroom teacher.

Now the school nurse can share the medical record with a teacher if she deems it a “legitimate educational purpose.”

No, she can't. That's the point. She's not a school employee so FERPA does not apply to her.

[Anonymous]

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.

I don't know what part you're disagreeing with. No Children's ED staff, which are already completely overwhelmed with wait times currently exceeding TWENTY HOURS, cannot follow up with you personally if their first efforts fail because you don't want your kid's school nurse to know whatever is going on. Everything else I typed above is factual and not something you can disagree with. Also, I did not accuse you of abuse... I said that CNMC staff may have been concerned that you would not follow up. Obviously it's appropriate for there to be a middle ground between doing nothing if they can't reach your pediatrician and reporting you to CPS.

None of that justifies the privacy breach.

What breach of privacy? OP consented to the release of information.

[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.

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

that does NOT give blanket permission to disclose to the school nurse for any reason. the nurse has to be actually providing care to the student relevant to the records. Childrens deputizing the school for ER follow ups ain’t it.

The nurse stationed in DCPS schools is not a school employee, has direct access to the CNMC health records when needed, has a CNMC email addresses, and no access to school records. While I don't know the specifics in this situation, if OP situation required a follow up by a nurse, it could make sense that this be the nurse in the school. As others have mentioned, the nurse following up is not going to be the same exact person who you saw in the ER. Why couldn't it be someone employed by the same hospital, with the same credential? It's not like it was deputized to a classroom teacher.

Now the school nurse can share the medical record with a teacher if she deems it a “legitimate educational purpose.”

And as a professional I'm sure they have guidelines and training on determining a legitimate educational purpose as it relates to student health privacy.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

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.

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

that does NOT give blanket permission to disclose to the school nurse for any reason. the nurse has to be actually providing care to the student relevant to the records. Childrens deputizing the school for ER follow ups ain’t it.

How is ER follow-up assessment not care relevant to the ER records about the visit in questions? That's what follow-up by a trained professional is.

Because, once again, HIPAA does NOT allow disclosure to any medical professional they want. Just the care team. The school nurse is NOT by default a member of my child’s care team for all purposes. Otherwise the ER could send your records to any random healthcare professional.

Do you think it actually says "care team" in the HIPAA regulation? Go back and read what it actually says, not what you think it says.

I'm all for people changing HIPAA if they feel it is incorrect or insufficient, but you can't change it just by metaphorically stamping your foot.

And I am saying the school nurse meets none of those criteria for the purple of “follow up from ER”. It is *not enough* that the recipient just be a medical professional. Obviously. There would be no meaning to HIPAA. Childrens could send my kids records to any doctor they wanted for any reason. Also concerning is the loss of HIPAA status and the records becoming FERPA.

They can, indeed, send the PHI to any doctor they want if that doctor is involved in the treatment of your child. That includes consulting another doctor about advice or suggestions on management, even if you never know about it.

If you don't like it, advocate to change HIPAA. But for treatment purposes medical information is NOT restricted to your waiver.

[Anonymous]

I’m the OP…I came back to check this thread and it seems to be more hostile than it was earlier today🙁

My original question was about whether anyone had a nurse from Children’s contact the nurse at their child’s (DC public or charter) school following an ER visit. I only asked because this is what happened to us following our child’s recent ER visit, and it was something that had never happened before.

Apparently, the director that I spoke to is relatively new to the position, and she wants to have a system in place where all DCPS kids who are seen in Children’s ER get follow-up, so that no DCPS kid gets missed. Her intentions in implementing (or reviving) this program were no doubt good, I just think more consideration should have been given to families who don’t need or want this type of intervention. After our conversation, she admitted that this is something they hadn’t really thought about, but that, based on our conversation, she would put it on the table for her team to discuss.

She was very apologetic for the ‘perceived’ breach of my child’s privacy and offered to remove our kids from their follow-up roster (or whatever its actually called). She also sent me a copy of the consent forms (which in all fairness, I signed) and highlighted the sentence that mentioned the sharing of information…it read in part, “I understand that if my child is a student in a local public or private school system, limited info about my child’s admissions can be shared with the local school nurse to ensure continuity of care for my child.” I’m guessing that without this blurb, sharing would be considered a hippa violation, but I’m not 100% sure.

Again…for families who need/want this service…I think they should have it, but for those that don’t…I think there should be a clear and easy way to opt-out. There was one PP who suggested an “opt-in” to this type of sharing, and I thought that was a great idea and will mention it as a suggestion.

Although she didn’t initially understand my privacy concerns, I think she was able to appreciate them after our conversation. As I explained to her, a school nurse….just like a pilot, doctor, coach, teacher or mechanic, is fallible. And in the frenzy of her job, she could inadvertently leave a document with a student’s private health information lying around her office….or she could be having a conversation about a student not realizing another student was in earshot.

Even though our particular health issue during the ER visit wasn’t a sensitive one, it very well could have been. It didn’t help that during the same week that the school nurse contacted me about the ER visit, she also contacted me to insist that my child get vaccines that were already (years ago) received. She then emailed later to ask that I resend a copy of the full shot record. I wasn’t mad about it because accidents happen, but that was my very point. The misplaced shot record could’ve just as easily been a misplaced mental health or reproductive health record…then my child (or anyone’s child) has to suffer because of this person’s mistake. IMO, it just seems easier to not share as much info in the first place.

For the record….

—I/we were not looking for, nor do we need parenting advice.

—We do not need help finding a pediatrician (we’ve been at the same practice for over 20 years and all of our kids have been seen there since infancy).

—Said practice became affiliated with CNMC many years ago so medical info about our kids is easily accessible by our peds practice as well as the specialty providers at Children’s main hospital (including their ER).

—I/we are not at all unhinged.

—We do not need any wrap around services.

—How many kids we have is none of anyone’s business.

—The medical issues our kids have is none of anyones business.

—We don’t abuse our kids and we have never abused our kids.

—There aren’t any cps flags attached to our family.

—We do not need education on when/how to use the ER.

—We DO NOT overuse or misuse the ER…as a matter of fact, there have been times when the ER doctor has asked why we didn’t bring a child in sooner.

—I am a well-seasoned health care professional, so when I took my kids to the ER, you better believe they needed to be there. In many (but definitely not all) cases I treated them at home first, but when they didn’t respond as expected, I took them to the ER, because that is what responsible parents do.

—Trust me when I say this….my life is (and has been for years) way too busy to give up hours of it by sitting in the ER “just because” or for whatever other stupid reason posters on this thread suggested. I have lots of "mom" friends, and sitting in the ER for hours is not on any of their "preferred activities" lists...dinner, concert, spa, beach...yes, but ER...not so much.

—My child(ren) being seen in the ER is not the reason why your friend’s child had to wait 7 hours to be seen. Your friend’s child had to wait 7 hours to be seen because healthcare in this country is a train wreck. Hospitals have been critically understaffed for years and the problem continues to worsen. There are fewer doctors, nurses, techs and aides to provide efficient care, which is one of the reasons for the long ER wait times. And also….shame on anyone for condemning a parent for taking their child to get the medical treatment they deem necessary.

—If we are overusing the ER, how is it also that we have been flagged as a family that needs more services? Seems like if we need more services, there would have been PLENTY of chances to get them to us…seeing as how we’re in the ER so much right?

—The school nurse was not going to be treating, observing or medicating my child for anything. Nothing. So there was no need for the ER care mgrs to reach out to school nurse to have her follow up with us, when our pediatrician is in the same network as the school nurse.

—Also, because I work in healthcare, I know how easily PHI can be accidentally shared. But the how/when/why doesn’t usually matter too much to the person whose privacy has been invaded and violated….their primary concern is usually that their private medical info is no longer private. So for that reason I feel like its best to minimize the likelihood that a breach could happen, but that’s just me.

Anyway, thanks again to everyone who offered supportive, positive, constructive, insightful and/or rational feedback…it was definitely appreciated😊

[Anonymous]

Anonymous wrote:I’m the OP…I came back to check this thread and it seems to be more hostile than it was earlier today🙁

My original question was about whether anyone had a nurse from Children’s contact the nurse at their child’s (DC public or charter) school following an ER visit. I only asked because this is what happened to us following our child’s recent ER visit, and it was something that had never happened before.

Apparently, the director that I spoke to is relatively new to the position, and she wants to have a system in place where all DCPS kids who are seen in Children’s ER get follow-up, so that no DCPS kid gets missed. Her intentions in implementing (or reviving) this program were no doubt good, I just think more consideration should have been given to families who don’t need or want this type of intervention. After our conversation, she admitted that this is something they hadn’t really thought about, but that, based on our conversation, she would put it on the table for her team to discuss.

She was very apologetic for the ‘perceived’ breach of my child’s privacy and offered to remove our kids from their follow-up roster (or whatever its actually called). She also sent me a copy of the consent forms (which in all fairness, I signed) and highlighted the sentence that mentioned the sharing of information…it read in part, “I understand that if my child is a student in a local public or private school system, limited info about my child’s admissions can be shared with the local school nurse to ensure continuity of care for my child.” I’m guessing that without this blurb, sharing would be considered a hippa violation, but I’m not 100% sure.

Again…for families who need/want this service…I think they should have it, but for those that don’t…I think there should be a clear and easy way to opt-out. There was one PP who suggested an “opt-in” to this type of sharing, and I thought that was a great idea and will mention it as a suggestion.

Although she didn’t initially understand my privacy concerns, I think she was able to appreciate them after our conversation. As I explained to her, a school nurse….just like a pilot, doctor, coach, teacher or mechanic, is fallible. And in the frenzy of her job, she could inadvertently leave a document with a student’s private health information lying around her office….or she could be having a conversation about a student not realizing another student was in earshot.

Even though our particular health issue during the ER visit wasn’t a sensitive one, it very well could have been. It didn’t help that during the same week that the school nurse contacted me about the ER visit, she also contacted me to insist that my child get vaccines that were already (years ago) received. She then emailed later to ask that I resend a copy of the full shot record. I wasn’t mad about it because accidents happen, but that was my very point. The misplaced shot record could’ve just as easily been a misplaced mental health or reproductive health record…then my child (or anyone’s child) has to suffer because of this person’s mistake. IMO, it just seems easier to not share as much info in the first place.

For the record….

—I/we were not looking for, nor do we need parenting advice.

—We do not need help finding a pediatrician (we’ve been at the same practice for over 20 years and all of our kids have been seen there since infancy).

—Said practice became affiliated with CNMC many years ago so medical info about our kids is easily accessible by our peds practice as well as the specialty providers at Children’s main hospital (including their ER).

—I/we are not at all unhinged.

—We do not need any wrap around services.

—How many kids we have is none of anyone’s business.

—The medical issues our kids have is none of anyones business.

—We don’t abuse our kids and we have never abused our kids.

—There aren’t any cps flags attached to our family.

—We do not need education on when/how to use the ER.

—We DO NOT overuse or misuse the ER…as a matter of fact, there have been times when the ER doctor has asked why we didn’t bring a child in sooner.

—I am a well-seasoned health care professional, so when I took my kids to the ER, you better believe they needed to be there. In many (but definitely not all) cases I treated them at home first, but when they didn’t respond as expected, I took them to the ER, because that is what responsible parents do.

—Trust me when I say this….my life is (and has been for years) way too busy to give up hours of it by sitting in the ER “just because” or for whatever other stupid reason posters on this thread suggested. I have lots of "mom" friends, and sitting in the ER for hours is not on any of their "preferred activities" lists...dinner, concert, spa, beach...yes, but ER...not so much.

—My child(ren) being seen in the ER is not the reason why your friend’s child had to wait 7 hours to be seen. Your friend’s child had to wait 7 hours to be seen because healthcare in this country is a train wreck. Hospitals have been critically understaffed for years and the problem continues to worsen. There are fewer doctors, nurses, techs and aides to provide efficient care, which is one of the reasons for the long ER wait times. And also….shame on anyone for condemning a parent for taking their child to get the medical treatment they deem necessary.

—If we are overusing the ER, how is it also that we have been flagged as a family that needs more services? Seems like if we need more services, there would have been PLENTY of chances to get them to us…seeing as how we’re in the ER so much right?

—The school nurse was not going to be treating, observing or medicating my child for anything. Nothing. So there was no need for the ER care mgrs to reach out to school nurse to have her follow up with us, when our pediatrician is in the same network as the school nurse.

—Also, because I work in healthcare, I know how easily PHI can be accidentally shared. But the how/when/why doesn’t usually matter too much to the person whose privacy has been invaded and violated….their primary concern is usually that their private medical info is no longer private. So for that reason I feel like its best to minimize the likelihood that a breach could happen, but that’s just me.

Anyway, thanks again to everyone who offered supportive, positive, constructive, insightful and/or rational feedback…it was definitely appreciated😊

TL;DR.

[Anonymous]

Anonymous wrote:

Anonymous wrote:I’m the OP…I came back to check this thread and it seems to be more hostile than it was earlier today🙁

My original question was about whether anyone had a nurse from Children’s contact the nurse at their child’s (DC public or charter) school following an ER visit. I only asked because this is what happened to us following our child’s recent ER visit, and it was something that had never happened before.

Apparently, the director that I spoke to is relatively new to the position, and she wants to have a system in place where all DCPS kids who are seen in Children’s ER get follow-up, so that no DCPS kid gets missed. Her intentions in implementing (or reviving) this program were no doubt good, I just think more consideration should have been given to families who don’t need or want this type of intervention. After our conversation, she admitted that this is something they hadn’t really thought about, but that, based on our conversation, she would put it on the table for her team to discuss.

She was very apologetic for the ‘perceived’ breach of my child’s privacy and offered to remove our kids from their follow-up roster (or whatever its actually called). She also sent me a copy of the consent forms (which in all fairness, I signed) and highlighted the sentence that mentioned the sharing of information…it read in part, “I understand that if my child is a student in a local public or private school system, limited info about my child’s admissions can be shared with the local school nurse to ensure continuity of care for my child.” I’m guessing that without this blurb, sharing would be considered a hippa violation, but I’m not 100% sure.

Again…for families who need/want this service…I think they should have it, but for those that don’t…I think there should be a clear and easy way to opt-out. There was one PP who suggested an “opt-in” to this type of sharing, and I thought that was a great idea and will mention it as a suggestion.

Although she didn’t initially understand my privacy concerns, I think she was able to appreciate them after our conversation. As I explained to her, a school nurse….just like a pilot, doctor, coach, teacher or mechanic, is fallible. And in the frenzy of her job, she could inadvertently leave a document with a student’s private health information lying around her office….or she could be having a conversation about a student not realizing another student was in earshot.

Even though our particular health issue during the ER visit wasn’t a sensitive one, it very well could have been. It didn’t help that during the same week that the school nurse contacted me about the ER visit, she also contacted me to insist that my child get vaccines that were already (years ago) received. She then emailed later to ask that I resend a copy of the full shot record. I wasn’t mad about it because accidents happen, but that was my very point. The misplaced shot record could’ve just as easily been a misplaced mental health or reproductive health record…then my child (or anyone’s child) has to suffer because of this person’s mistake. IMO, it just seems easier to not share as much info in the first place.

For the record….

—I/we were not looking for, nor do we need parenting advice.

—We do not need help finding a pediatrician (we’ve been at the same practice for over 20 years and all of our kids have been seen there since infancy).

—Said practice became affiliated with CNMC many years ago so medical info about our kids is easily accessible by our peds practice as well as the specialty providers at Children’s main hospital (including their ER).

—I/we are not at all unhinged.

—We do not need any wrap around services.

—How many kids we have is none of anyone’s business.

—The medical issues our kids have is none of anyones business.

—We don’t abuse our kids and we have never abused our kids.

—There aren’t any cps flags attached to our family.

—We do not need education on when/how to use the ER.

—We DO NOT overuse or misuse the ER…as a matter of fact, there have been times when the ER doctor has asked why we didn’t bring a child in sooner.

—I am a well-seasoned health care professional, so when I took my kids to the ER, you better believe they needed to be there. In many (but definitely not all) cases I treated them at home first, but when they didn’t respond as expected, I took them to the ER, because that is what responsible parents do.

—Trust me when I say this….my life is (and has been for years) way too busy to give up hours of it by sitting in the ER “just because” or for whatever other stupid reason posters on this thread suggested. I have lots of "mom" friends, and sitting in the ER for hours is not on any of their "preferred activities" lists...dinner, concert, spa, beach...yes, but ER...not so much.

—My child(ren) being seen in the ER is not the reason why your friend’s child had to wait 7 hours to be seen. Your friend’s child had to wait 7 hours to be seen because healthcare in this country is a train wreck. Hospitals have been critically understaffed for years and the problem continues to worsen. There are fewer doctors, nurses, techs and aides to provide efficient care, which is one of the reasons for the long ER wait times. And also….shame on anyone for condemning a parent for taking their child to get the medical treatment they deem necessary.

—If we are overusing the ER, how is it also that we have been flagged as a family that needs more services? Seems like if we need more services, there would have been PLENTY of chances to get them to us…seeing as how we’re in the ER so much right?

—The school nurse was not going to be treating, observing or medicating my child for anything. Nothing. So there was no need for the ER care mgrs to reach out to school nurse to have her follow up with us, when our pediatrician is in the same network as the school nurse.

—Also, because I work in healthcare, I know how easily PHI can be accidentally shared. But the how/when/why doesn’t usually matter too much to the person whose privacy has been invaded and violated….their primary concern is usually that their private medical info is no longer private. So for that reason I feel like its best to minimize the likelihood that a breach could happen, but that’s just me.

Anyway, thanks again to everyone who offered supportive, positive, constructive, insightful and/or rational feedback…it was definitely appreciated😊

TL;DR.

Longest I have ever seen on dcurbanmom

[Anonymous]

Anonymous wrote:I’m the OP…I came back to check this thread and it seems to be more hostile than it was earlier today🙁

My original question was about whether anyone had a nurse from Children’s contact the nurse at their child’s (DC public or charter) school following an ER visit. I only asked because this is what happened to us following our child’s recent ER visit, and it was something that had never happened before.

Apparently, the director that I spoke to is relatively new to the position, and she wants to have a system in place where all DCPS kids who are seen in Children’s ER get follow-up, so that no DCPS kid gets missed. Her intentions in implementing (or reviving) this program were no doubt good, I just think more consideration should have been given to families who don’t need or want this type of intervention. After our conversation, she admitted that this is something they hadn’t really thought about, but that, based on our conversation, she would put it on the table for her team to discuss.

She was very apologetic for the ‘perceived’ breach of my child’s privacy and offered to remove our kids from their follow-up roster (or whatever its actually called). She also sent me a copy of the consent forms (which in all fairness, I signed) and highlighted the sentence that mentioned the sharing of information…it read in part, “I understand that if my child is a student in a local public or private school system, limited info about my child’s admissions can be shared with the local school nurse to ensure continuity of care for my child.” I’m guessing that without this blurb, sharing would be considered a hippa violation, but I’m not 100% sure.

Again…for families who need/want this service…I think they should have it, but for those that don’t…I think there should be a clear and easy way to opt-out. There was one PP who suggested an “opt-in” to this type of sharing, and I thought that was a great idea and will mention it as a suggestion.

Although she didn’t initially understand my privacy concerns, I think she was able to appreciate them after our conversation. As I explained to her, a school nurse….just like a pilot, doctor, coach, teacher or mechanic, is fallible. And in the frenzy of her job, she could inadvertently leave a document with a student’s private health information lying around her office….or she could be having a conversation about a student not realizing another student was in earshot.

Even though our particular health issue during the ER visit wasn’t a sensitive one, it very well could have been. It didn’t help that during the same week that the school nurse contacted me about the ER visit, she also contacted me to insist that my child get vaccines that were already (years ago) received. She then emailed later to ask that I resend a copy of the full shot record. I wasn’t mad about it because accidents happen, but that was my very point. The misplaced shot record could’ve just as easily been a misplaced mental health or reproductive health record…then my child (or anyone’s child) has to suffer because of this person’s mistake. IMO, it just seems easier to not share as much info in the first place.

For the record….

—I/we were not looking for, nor do we need parenting advice.

—We do not need help finding a pediatrician (we’ve been at the same practice for over 20 years and all of our kids have been seen there since infancy).

—Said practice became affiliated with CNMC many years ago so medical info about our kids is easily accessible by our peds practice as well as the specialty providers at Children’s main hospital (including their ER).

—I/we are not at all unhinged.

—We do not need any wrap around services.

—How many kids we have is none of anyone’s business.

—The medical issues our kids have is none of anyones business.

—We don’t abuse our kids and we have never abused our kids.

—There aren’t any cps flags attached to our family.

—We do not need education on when/how to use the ER.

—We DO NOT overuse or misuse the ER…as a matter of fact, there have been times when the ER doctor has asked why we didn’t bring a child in sooner.

—I am a well-seasoned health care professional, so when I took my kids to the ER, you better believe they needed to be there. In many (but definitely not all) cases I treated them at home first, but when they didn’t respond as expected, I took them to the ER, because that is what responsible parents do.

—Trust me when I say this….my life is (and has been for years) way too busy to give up hours of it by sitting in the ER “just because” or for whatever other stupid reason posters on this thread suggested. I have lots of "mom" friends, and sitting in the ER for hours is not on any of their "preferred activities" lists...dinner, concert, spa, beach...yes, but ER...not so much.

—My child(ren) being seen in the ER is not the reason why your friend’s child had to wait 7 hours to be seen. Your friend’s child had to wait 7 hours to be seen because healthcare in this country is a train wreck. Hospitals have been critically understaffed for years and the problem continues to worsen. There are fewer doctors, nurses, techs and aides to provide efficient care, which is one of the reasons for the long ER wait times. And also….shame on anyone for condemning a parent for taking their child to get the medical treatment they deem necessary.

—If we are overusing the ER, how is it also that we have been flagged as a family that needs more services? Seems like if we need more services, there would have been PLENTY of chances to get them to us…seeing as how we’re in the ER so much right?

—The school nurse was not going to be treating, observing or medicating my child for anything. Nothing. So there was no need for the ER care mgrs to reach out to school nurse to have her follow up with us, when our pediatrician is in the same network as the school nurse.

—Also, because I work in healthcare, I know how easily PHI can be accidentally shared. But the how/when/why doesn’t usually matter too much to the person whose privacy has been invaded and violated….their primary concern is usually that their private medical info is no longer private. So for that reason I feel like its best to minimize the likelihood that a breach could happen, but that’s just me.

Anyway, thanks again to everyone who offered supportive, positive, constructive, insightful and/or rational feedback…it was definitely appreciated😊

Are you at a title 1 school? I can see these processes in place so these kids, who usually don’t get regular care or follow up, can fall thru the cracks.

The nurse did nothing wrong because you signed the form allowing sharing of info with the school. Sure they can set up an opt out. An opt in is not going to be a feasible option.

[Anonymous]

This program does not follow up with all DCPS patients. Your file was flagged for some reason. It may be as simple as your pediatrician’s phone line being down, but the explanation you’re being given about this happening to everyone is patently false. (You should also probably be able to tell that because no one in this thread has ever had it happen to them and it has never previously happened to you.)

[Anonymous]

CNMC did the right thing here. Hopefully this flag in the child's file keeps extra eyes on their situation.

[Anonymous]

Anonymous wrote:CNMC did the right thing here. Hopefully this flag in the child's file keeps extra eyes on their situation.

Actually it shows the opposite. Medical information needs to be kept private so officious people like you who decide a parent is acting in a way you don't like cannot use the information improperly. There's absolutely nothing here to flag.