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

[Anonymous]

Pretty sure I just filled out Virginia school entrance forms and there’s a box to check about allowing or not allowing whatever provider signs the form to share with the school and vice versa: this is why I make
Copies of all school forms.

[Anonymous]

Pp here,

School nurses in DC are required to document every child sent to the office and follow a notification protocol based on a battery of indicators. Its not willy nilly by any stretch and is googleable. Ever since Relisha Rudd and the pandemic , health and safety protocols for children have increased.

[Anonymous]

By the way here's a link where you can find out more about what school nurses actually do. They also work with the school social worker and parent liaison at times to coordinate care for families in need.

https://dchealth.dc.gov/service/school-health-services-program

Public schools = Public wraparound services.

[Anonymous]

Anonymous wrote:

Anonymous wrote:I think there is some confusion here about HIPAA. I'm pretty sure this type of use/disclosure (I'm not sure what the legal difference is) is allowed for "treatment". It's coordination of care.

https://www.hhs.gov/hipaa/for-professionals/privacy/guidance/disclosures-treatment-payment-health-care-operations/index.html

A covered entity may, without the individual’s authorization:

Use or disclose protected health information for its own treatment, payment, and health care operations activities.
For example: A hospital may use protected health information about an individual to provide health care to the individual and may consult with other health care providers about the individual’s treatment.

The facts as stated by OP do not fall under this provision that you cite.

I work in both the ambulatory setting (ie, your kid's pediatrician) and also in a local ICU.

Unless there's something the OP is intentionally failing to mention about the event that brought her kid to the ED, then the ED staff does not need to "coordinate care" with the CNMC-employed RN who is assigned to the kid's DCPS.

A possible hypothetical exception would be if, say, kid has severe asthma attack, is taken to ED, is given hospital-grade nebulizer in the ED, asthma flare is resolved, ED provider writes script for **never before used** asthma inhaler for home use. Communication is sent via internal health record from ED doctor to CNMC RN stationed at DCPS saying something to the effect of "please follow up with Timmy and confirm that new albuterol metered dose inhaler is therapeutic and no further flares have occurred since discharge. Confirm that student has medication available on site at DCPS during school day."

If something analogous to this ^^^ occurred , then OP has no leg to stand on. This shouldn't be "offensive" and it's not a violation of law. See also, concussion follow up, seizure follow up, and similar.

What is interesting to me is, what if CNMC DIDN'T contract to put its employees in DCPS? What if instead MedStar did, or Johns Hopkins? Then you wouldn't see the sort of hypothetical situation I used. Which is fine, just different.

I think you missed the HHS citation above where school nurses are specifically exempted. Continued care can be just following up on the return precautions, which as a nurse (I am guessing? or a tech?) you would be familiar with as a part of every ED discharge plan.

[Anonymous]

Anonymous wrote:

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[/b], physicians, or other health care providers [b]for treatment purposes, without the authorization of the student or student’s parent.

You are assuming, by citing this provision, that the school nurse is treating the kid for the same condition. You don't have any facts to support that. it may be the case that the school nurse is going to "treat" the kid on the school property -- or might be called upon to do so. Or not.

If the kid went to the ER to have a raisin removed from his nose, then you cannot make a credible claim that school nurse will continue the plan of care when school resumes on Monday and continue to "treat" the now-removed nose raisin. There's nothing to treat.

OP would have to be willing to divulge what the medical issue was that was treated in the ER to make a call on this.

Are you not familiar with what "return precautions" and a "discharge plan" are? Literally every ED discharge has them. It's standardized paperwork, usually. Sometimes modified but always present.

This is exactly why the DHHS made FAQ sheets.

[Anonymous]

Anonymous wrote:This seems to be a violation of HIPPA unless you signed a form that unknowingly allowed Children’s to share info with the school. Even if your school nurse is contracted to Children’s your child was not their patient at Children’s. Therefore they shouldn’t have had access to the info.

HIPAA.

[Anonymous]

OP here...I appreciate the different perspectives, but for us, this really did feel like an unnecessary invasion of our child's privacy, so I followed up with the hospital to get clarification.

The first person I spoke with was one of the directors of nursing and she was quite surprised when I explained what happened. I then spoke with someone in the ombudsman's office, and that person too was surprised. Both of those people agreed that what I was describing should not have happened and said they would follow up with the legal department and have them reach out to me.

Last week someone contacted me. She wasn't from the legal department though...she said she asked the legal department to hold off in contacting me because she wanted to speak to me first as her department was directly involved with the nature of my concern. The school nurses in DC Public/Charter Schools are employed by Children's...that I was aware of, but there is another team of nurses (I think they're called care managers, community nurse managers, or something) that work to make sure kids who are seen in the ER get the follow-up care they need. Apparently, this team of nurses gets a list of all DCPS kids who were seen in the ER the previous day and reaches out to the nurses at their respective schools to give them info on the child's ER visit and any other relevant details on observation, follow-up, etc.

I asked her who the gatekeeper was to this process...like, who was responsible for reviewing and taking in to consideration the necessity or appropriateness of sharing the reason for a child's condition/ER visit with a school nurse, but she said there wasn't anyone to do that. So its a blanket policy, but I asked...what if its a sensitive medical condition that the child or the parents don't want to share...cancer, reproductive health issues, medically necessary cosmetic surgery, etc, and she couldn't see that there was a difference between the ER/care mgr nurses having access to that info and the school nurse having access to that info. She said it wasnt like anyone else at the school would see the info...it would only be available to the school nurse...not other students, not teachers or counselors...just the school nurse. I did explain it to her from a parental perspective...that with the info being there on the school premises there would always be a possibility that it could be accessed by someone other than the nurse, but the fact that I had to explain this (for me at least), was an issue in itself.

I guess I was so caught off guard because we've been to the ER dozens of times with each of our kids and were never contacted by the school nurse after a visit until now. I was also concerned because neither myself nor my husband gave consent or had knowledge that any information about our child would be shared, so when I got the phone call it felt very intrusive. On that note, this person said that there's a line in the ER reg/consent forms that mentions this, but I didn't recall seeing it (not disputing it was there, I just don't recall seeing it). She assured me it was there, but that there was no "opt out" box for parents who weren't in favor of the sharing option....which is something she agreed they may need to fix. However, she also said that I was the first parent to take issue with this policy..I was surprised by this..and actually thought it was a bit unbelievable, so I just wanted to get input from other parents.

It didn't help that the school nurse was adamant that she was entitled to the information and said it was necessary that she had it in case she ever needed to treat our child for the same issue (very unlikely that this would ever happen with the issue we had). It also bothered me that she conflated an instance of something with an actual diagnosis of something...for example, because I have 1 elevated blood pressure at a drs appt, it doesn't mean that I get a diagnosis of high blood pressure. She kept going on and on about my child's "new diagnosis" when no new diagnosis existed.

[Anonymous]

I hope you get some closure on this and feel your concerns were heard and understood, OP.

[Anonymous]

Anonymous wrote:OP here...I appreciate the different perspectives, but for us, this really did feel like an unnecessary invasion of our child's privacy, so I followed up with the hospital to get clarification.

The first person I spoke with was one of the directors of nursing and she was quite surprised when I explained what happened. I then spoke with someone in the ombudsman's office, and that person too was surprised. Both of those people agreed that what I was describing should not have happened and said they would follow up with the legal department and have them reach out to me.

Last week someone contacted me. She wasn't from the legal department though...she said she asked the legal department to hold off in contacting me because she wanted to speak to me first as her department was directly involved with the nature of my concern. The school nurses in DC Public/Charter Schools are employed by Children's...that I was aware of, but there is another team of nurses (I think they're called care managers, community nurse managers, or something) that work to make sure kids who are seen in the ER get the follow-up care they need. Apparently, this team of nurses gets a list of all DCPS kids who were seen in the ER the previous day and reaches out to the nurses at their respective schools to give them info on the child's ER visit and any other relevant details on observation, follow-up, etc.

I asked her who the gatekeeper was to this process...like, who was responsible for reviewing and taking in to consideration the necessity or appropriateness of sharing the reason for a child's condition/ER visit with a school nurse, but she said there wasn't anyone to do that. So its a blanket policy, but I asked...what if its a sensitive medical condition that the child or the parents don't want to share...cancer, reproductive health issues, medically necessary cosmetic surgery, etc, and she couldn't see that there was a difference between the ER/care mgr nurses having access to that info and the school nurse having access to that info. She said it wasnt like anyone else at the school would see the info...it would only be available to the school nurse...not other students, not teachers or counselors...just the school nurse. I did explain it to her from a parental perspective...that with the info being there on the school premises there would always be a possibility that it could be accessed by someone other than the nurse, but the fact that I had to explain this (for me at least), was an issue in itself.

I guess I was so caught off guard because we've been to the ER dozens of times with each of our kids and were never contacted by the school nurse after a visit until now. I was also concerned because neither myself nor my husband gave consent or had knowledge that any information about our child would be shared, so when I got the phone call it felt very intrusive. On that note, this person said that there's a line in the ER reg/consent forms that mentions this, but I didn't recall seeing it (not disputing it was there, I just don't recall seeing it). She assured me it was there, but that there was no "opt out" box for parents who weren't in favor of the sharing option....which is something she agreed they may need to fix. However, she also said that I was the first parent to take issue with this policy..I was surprised by this..and actually thought it was a bit unbelievable, so I just wanted to get input from other parents.

It didn't help that the school nurse was adamant that she was entitled to the information and said it was necessary that she had it in case she ever needed to treat our child for the same issue (very unlikely that this would ever happen with the issue we had). It also bothered me that she conflated an instance of something with an actual diagnosis of something...for example, because I have 1 elevated blood pressure at a drs appt, it doesn't mean that I get a diagnosis of high blood pressure. She kept going on and on about my child's "new diagnosis" when no new diagnosis existed.

Glad you posted the full story. As many suggested, there was a notification in the consent paperwork you signed.

This was important to include in your OP as you real concern appears to be if, even with the notification in the consent paperwork, are parents ok with this information sharing.

[Anonymous]

Anonymous wrote:Let's imagine a different story -
A 16 YO has a miscarriage and goes to the ER. The school nurse calls 2 weeks later asking if you followed up.

Would you still think it is OK for the school nurse to call home?

+100. I’m with OP on this. It’s a total violation of privacy. I do see the value of having school nurse being able to coordinate after care post-ER but that consent should be explicit. I personally would not want to deal with school nurse calling me when I have a peds practice. I don’t need more middle men in my life and am a private person generally.

[Anonymous]

HIPAA violation. File a complaint.

[Anonymous]

Anonymous wrote:

Anonymous wrote:This seems to be a violation of HIPPA unless you signed a form that unknowingly allowed Children’s to share info with the school. Even if your school nurse is contracted to Children’s your child was not their patient at Children’s. Therefore they shouldn’t have had access to the info.

On the contrary, HIPAA specifically excludes exchange of information between health care providers in the course of ongoing care for the same patient. This never requires a waiver. I can find the citation, if you would like.

But I don’t consent to “ongoing care” by the school nurse.

[Anonymous]

Anonymous wrote:

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.

Yes the school system contracts it’s school nurse program to children’s.

I still think that’s fishy. I seriously doubt they create a records firewall between the school nurse and the school.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

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[/b], physicians, or other health care providers [b]for treatment purposes, without the authorization of the student or student’s parent.

You are assuming, by citing this provision, that the school nurse is treating the kid for the same condition. You don't have any facts to support that. it may be the case that the school nurse is going to "treat" the kid on the school property -- or might be called upon to do so. Or not.

If the kid went to the ER to have a raisin removed from his nose, then you cannot make a credible claim that school nurse will continue the plan of care when school resumes on Monday and continue to "treat" the now-removed nose raisin. There's nothing to treat.

OP would have to be willing to divulge what the medical issue was that was treated in the ER to make a call on this.

Are you not familiar with what "return precautions" and a "discharge plan" are? Literally every ED discharge has them. It's standardized paperwork, usually. Sometimes modified but always present.

This is exactly why the DHHS made FAQ sheets.

I can assure you, the discharge plan never includes the school nurse in its to-do list.

Take medication as directed. Report to the lab in one week. Change dressing when it is saturated or soiled.

Follow up with your provider who is not the school nurse in 3 days.

Report any continued bleeding / dizziness / vomiting etc etc to your provider who is not the school nurse.

I write discharge plans. The contract DCPS school nurse is not implicated, implicitly or explicitly, in discharge planning.

[Anonymous]

Anonymous wrote:HIPAA violation. File a complaint.

Read her update. She consented to the disclosure and didn’t realize it.