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

[Anonymous]

I find this creepy. I also find the DCPS Volunteer background check creepy. I don't want child molesters volunteering, but I just gave away enough information in one form to make identity theft a cinch.

[Anonymous]

Anonymous wrote:

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.

Not PP, but having each of your children visiting the ER dozens of times is pretty unusual.

[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😊

Your child is more likely to share their medical info with everyone than the school nurse. This sounds like either a guilty conscience because you've violated HIPAA in your professional line of work.

[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😊

If you have concerns about this particular process, the avenue to take is not through a nurse director, it's to file a complaint with the Children's Patient Advocacy Dept. They can take it from there.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

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.

Not PP, but having each of your children visiting the ER dozens of times is pretty unusual.

Exactly. Big red flag for undiagnosed condition that requires more specialized support, abuse, or Munchausen's by-proxy.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

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.

Not PP, but having each of your children visiting the ER dozens of times is pretty unusual.

Exactly. Big red flag for undiagnosed condition that requires more specialized support, abuse, or Munchausen's by-proxy.

But OP is a WELL SEASONED HEALTHCARE PROFESSIONAL

[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.

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.

She's a contracted employee doing work for the school and creating school records. FERPA almost certainly applies in some way shape or form.

[Anonymous]

After reading the OPs incredibly LONG updated response to her own post:

1. OP for transparency your incredibly lengthy updated response should have started with "UPDATE: I WAS WRONG, I SIGNED A CONSENT FORM TO SHARE MY KIDS INFO. I DID NOT READ IT. MY MISTAKE." The accountability you seek of others should start with yourself.

2. OP, this entire thread is a prime example of why administrators and school staff are overwhelmed by parents with an emotional need for attention seeking, narcissistic power struggles, and validation.

3. The framing of your problem as a HIPPA violation was an ENTIRE waste of time for this school's principal, school nurse, and anyone else you looped into the drama with the nuanced half-informed baiting.

4. So much of your response reveals EXACTLY why hospitals follow up with schools. While you may want to cherry 🍒 pick the process TUITION FREE schools use to carry out care for kids, KIDS COME FIRST. If even one life is saved, or family is assisted by the policy to follow up AFTER consent is given, its worth it.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Don't take it personally.

DP. I take my child’s privacy very seriously. This would really bother me and unless they are considering their school nurses as part of Childrens, a likely privacy violation.

This exactly. I’d be speaking with an attorney.

[Anonymous]

Be VERY careful what you sign. At the very least ALWAYS snap a picture of everything you sign so you can read later and keep copies.

[Anonymous]

Anonymous wrote:After reading the OPs incredibly LONG updated response to her own post:

1. OP for transparency your incredibly lengthy updated response should have started with "UPDATE: I WAS WRONG, I SIGNED A CONSENT FORM TO SHARE MY KIDS INFO. I DID NOT READ IT. MY MISTAKE." The accountability you seek of others should start with yourself.

2. OP, this entire thread is a prime example of why administrators and school staff are overwhelmed by parents with an emotional need for attention seeking, narcissistic power struggles, and validation.

3. The framing of your problem as a HIPPA violation was an ENTIRE waste of time for this school's principal, school nurse, and anyone else you looped into the drama with the nuanced half-informed baiting.

4. So much of your response reveals EXACTLY why hospitals follow up with schools. While you may want to cherry 🍒 pick the process TUITION FREE schools use to carry out care for kids, KIDS COME FIRST. If even one life is saved, or family is assisted by the policy to follow up AFTER consent is given, its worth it.

I'm an administrator at a school. I'm grateful that the OP posted this thread as schools are often in the position of helping parents understand what is happening with their kids - even when those happenings are outside of education. I find the sharing of information with the nurse to be odd and am glad to be in a position (because of this thread) to let parents know that this is no lapse on the part of the school or the nurse but most likely related to forms that they signed giving permission for such.

[Anonymous]

Anonymous wrote:After reading the OPs incredibly LONG updated response to her own post:

1. OP for transparency your incredibly lengthy updated response should have started with "UPDATE: I WAS WRONG, I SIGNED A CONSENT FORM TO SHARE MY KIDS INFO. I DID NOT READ IT. MY MISTAKE." The accountability you seek of others should start with yourself.

2. OP, this entire thread is a prime example of why administrators and school staff are overwhelmed by parents with an emotional need for attention seeking, narcissistic power struggles, and validation.

3. The framing of your problem as a HIPPA violation was an ENTIRE waste of time for this school's principal, school nurse, and anyone else you looped into the drama with the nuanced half-informed baiting.

4. So much of your response reveals EXACTLY why hospitals follow up with schools. While you may want to cherry 🍒 pick the process TUITION FREE schools use to carry out care for kids, KIDS COME FIRST. If even one life is saved, or family is assisted by the policy to follow up AFTER consent is given, its worth it.

and absolutely zilch about what you just pontificated says anything at all about OP’s child’s rights under HIPAA and FERPA.

[Anonymous]

Anonymous wrote:After reading the OPs incredibly LONG updated response to her own post:

1. OP for transparency your incredibly lengthy updated response should have started with "UPDATE: I WAS WRONG, I SIGNED A CONSENT FORM TO SHARE MY KIDS INFO. I DID NOT READ IT. MY MISTAKE." The accountability you seek of others should start with yourself.

2. OP, this entire thread is a prime example of why administrators and school staff are overwhelmed by parents with an emotional need for attention seeking, narcissistic power struggles, and validation.

3. The framing of your problem as a HIPPA violation was an ENTIRE waste of time for this school's principal, school nurse, and anyone else you looped into the drama with the nuanced half-informed baiting.

4. So much of your response reveals EXACTLY why hospitals follow up with schools. While you may want to cherry 🍒 pick the process TUITION FREE schools use to carry out care for kids, KIDS COME FIRST. If even one life is saved, or family is assisted by the policy to follow up AFTER consent is given, its worth it.

OP here...I admit that the post was rather lengthy, but only because I wanted to address the uninformed, closed-minded, arrogant, antagonistic and baseless attacks that were made against our family. Your post fits more than one of those categories.

In one of the earlier post, I believe I did mention that I may have unknowingly signed a consent allowing the hospital to share the information. That was clearly a mistake on my part, but when you're a parent in the ER with a sick child, your attention is primarily focused on said sick child. Reading through every line of the standard "consent to treat" forms that we've filled out many times before, was not our highest priority...our child was. But again, you don't have kids, so you wouldn't know that. In any case, it seems like both of us could benefit from reading things a bit more carefully.

If you ever have kids of your own, I hope you don't view defending their privacy rights as attention seeking or narcissistic...that would be tragic for them.

OP, this entire thread is a prime example of why administrators and school staff are overwhelmed by parents with an emotional need for attention seeking, narcissistic power struggles, and validation.

Are you a school administrator? Are you speaking from experience in this role? I'd love to hear more about your perspective so I can further juxtapose it to the perspective of the other school administrator who posted on this thread. That administrator was appreciative of my post, was glad to have been made aware of the practice I described, and didn't share any of your concerns at all.

Lastly, I'm sure you missed it in my earlier post, but I never mentioned reaching out to the school principal. I did however, speak to THREE executive level, hospital administrators (including one in the ombudsman's office), and two of them had NO IDEA that the practice of sharing ER visit info with DCPS school nurses even existed...they were just as surprised as I was. The third was someone who was directly involved with the Children's/DCPS school nurse partnership and it was this person who explained the practice to me.

I'm so sorry that my post didn't meet your standards, but if you provide an email address, I'll be sure to run my next post by you for approval. #NOT..lol. Seriously, this is like your 3rd or 4th snarky comment on this thread...what's with all the passive aggression? And why are you so worked up about this? You realize that you don't have to respond right?

[Anonymous]

Anonymous wrote:

Anonymous wrote:After reading the OPs incredibly LONG updated response to her own post:

1. OP for transparency your incredibly lengthy updated response should have started with "UPDATE: I WAS WRONG, I SIGNED A CONSENT FORM TO SHARE MY KIDS INFO. I DID NOT READ IT. MY MISTAKE." The accountability you seek of others should start with yourself.

2. OP, this entire thread is a prime example of why administrators and school staff are overwhelmed by parents with an emotional need for attention seeking, narcissistic power struggles, and validation.

3. The framing of your problem as a HIPPA violation was an ENTIRE waste of time for this school's principal, school nurse, and anyone else you looped into the drama with the nuanced half-informed baiting.

4. So much of your response reveals EXACTLY why hospitals follow up with schools. While you may want to cherry 🍒 pick the process TUITION FREE schools use to carry out care for kids, KIDS COME FIRST. If even one life is saved, or family is assisted by the policy to follow up AFTER consent is given, its worth it.

I'm an administrator at a school. I'm grateful that the OP posted this thread as schools are often in the position of helping parents understand what is happening with their kids - even when those happenings are outside of education. I find the sharing of information with the nurse to be odd and am glad to be in a position (because of this thread) to let parents know that this is no lapse on the part of the school or the nurse but most likely related to forms that they signed giving permission for such.

This is the OP....thank you for your thoughtful, insight. I'm glad the post was helpful to you.

[Anonymous]

Anonymous wrote:I don't necessarily think this is a bad thing. There are a lot of of families without regular doctors for whom this would be helpful follow up and might put them in touch with resources they could use to manage care.

Don't be offended OP. Don't look for things to be angry about or offended by....you're lucky you can manage the post ER visit care on your own, many cannot and this is likely helping them.

It is outrageous and it IS A BIG THING. Your assertion that most people can't manage the post ER visit is ridiculous