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

[Anonymous]

If you didn’t sign a HIPAA waiver then it’s a violation and should be reported. I’d start by asking the school and hospital, in writing, to see the waiver / consent form you signed allowing this contact to take place. If nobody can provide/produce that then I’d go to a kind but strongly worded letter to the school and hospital reporting the violation and ask that the HIPAA Privacy Officer, from school and hospital, contact you immediately. I’d also make it known that you are aware of the violation and this communication between the organizations needs to cease immediately. I’d also report the violation and steps you took to follow up to local and state reporting agencies- those numbers/addresses Can be obtained by the privacy officers or online.

This is a serious violation if you didn’t sign consent waiver for this.

[Anonymous]

Anonymous wrote:If you didn’t sign a HIPAA waiver then it’s a violation and should be reported. I’d start by asking the school and hospital, in writing, to see the waiver / consent form you signed allowing this contact to take place. If nobody can provide/produce that then I’d go to a kind but strongly worded letter to the school and hospital reporting the violation and ask that the HIPAA Privacy Officer, from school and hospital, contact you immediately. I’d also make it known that you are aware of the violation and this communication between the organizations needs to cease immediately. I’d also report the violation and steps you took to follow up to local and state reporting agencies- those numbers/addresses Can be obtained by the privacy officers or online.

This is a serious violation if you didn’t sign consent waiver for this.

Sockpuppetry. OP why are you responding to your own post like a new poster?

[Anonymous]

Please leave the school out of it and work with the nurse and hospital directly if you feel the need to discuss further. The school has nothing to do with it because nurses don’t work for DCPS. School staff have enough on their plate and won’t be able to provide you with any information or next steps about this.

[Anonymous]

Did they share “details” of the visit, or just that there was a visit?

There’s a difference between “Larlo was seen in the ER and follow up was recommended” and “Larlo was seen in the ER for severe abdominal pain and follow up was recommended.”

[Anonymous]

Anonymous wrote:

Anonymous wrote:If you didn’t sign a HIPAA waiver then it’s a violation and should be reported. I’d start by asking the school and hospital, in writing, to see the waiver / consent form you signed allowing this contact to take place. If nobody can provide/produce that then I’d go to a kind but strongly worded letter to the school and hospital reporting the violation and ask that the HIPAA Privacy Officer, from school and hospital, contact you immediately. I’d also make it known that you are aware of the violation and this communication between the organizations needs to cease immediately. I’d also report the violation and steps you took to follow up to local and state reporting agencies- those numbers/addresses Can be obtained by the privacy officers or online.

This is a serious violation if you didn’t sign consent waiver for this.

Sockpuppetry. OP why are you responding to your own post like a new poster?

Why would OP write a post like this when she already came back to say she had unknowingly signed a form at the ER allowing the disclosure

[Anonymous]

I'm a nurse case manager for an insurance company. If OP has been at the ER "dozens of times" for each kid, including for that laundry list of non-urgent concerns the she is a REAL OUTLIER. You don't do that kind of thing in a vacuum. I wouldn't be surprised if she trigged some sort of "frequent flyer" outreach from Childrens.

She's also the type of patient/parent who lands on my list for insurance-company based case management. You don't spend that type of money without the insurance company also saying "what is going on here?, this is not typical use. This person is inappropriately using the ER ---the diagnoses don't merit the level of care. We need to intervene in this to see if some education is needed'

[Anonymous]

Anonymous wrote:

Anonymous wrote:

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.

The patient. In the case of a minor, the parent or legal guardian.

I am sure, because it’s my livelihood.

No school staff (and a contract nurse is school staff) is in the audience, legally.



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.

I'm not sure who you think is looking at the dressing to see whether it is saturated or soiled, or to check if there is bleeding, or vomiting, or what have you, when the kid is at school. (?)

[Anonymous]

I don’t agree with you OP.

1. You signed the form.
2. This is, overall, a good thing for individuals and the community.
3. It’s essentially continuation of care. There is zero HIPAA violation here.

How many kids do you have that you’ve been to the ER dozens of times? It sounds like given that # and your insistence that it’s a minor issue you’ve been potentially using the ER as urgent or primary care. Not a great idea when the ERs are overcrowded, or ever.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:
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.

This jumps out at me. If you've been at the ER dozens of times for multiple kids without diagnoses, then something is really wrong. I can totally see them calling in extra support.

Dozens of times to the ER with each kid is an awful lot.

This is the OP...nothing is wrong and dozens of times with each kid may seem like a lot to you, but that's you. For a family with asthmatic kids or kids who suffer from diabetes, seizure disorder or certain blood disorders, it's not a lot. We are not all the same, so please stop being judgemental and dramatic.

NP. Daughter of an ER nurse. You said you’ve taken your kid to ER for ingrown toenail. That is concerning. Rashes and strep throat also don’t call for ER visits. Your lack of judgment causes issues for when kids are really sick.

You're the daughter of an ER nurse, but do you have children? I would guess not.

Yes....you're right, the ingrown toenail was concerning...that's why we went to the ER. And in case you missed it, it took a SURGICAL procedure (DONE IN THE ER) to correct the problem. One of the rashes was suspected to be MRSA and the child was admitted, and for the instance of strep throat, the child woke up with a very high fever and we didn't know what was going on...so yes, out of concern, we went to the ER. And also...for all of you know-it-alls....urgent care is a relatively new healthcare option that wasn't available when our oldest kids were infants/toddlers.

[Anonymous]

Anonymous wrote:I'm a nurse case manager for an insurance company. If OP has been at the ER "dozens of times" for each kid, including for that laundry list of non-urgent concerns the she is a REAL OUTLIER. You don't do that kind of thing in a vacuum. I wouldn't be surprised if she trigged some sort of "frequent flyer" outreach from Childrens.

She's also the type of patient/parent who lands on my list for insurance-company based case management. You don't spend that type of money without the insurance company also saying "what is going on here?, this is not typical use. This person is inappropriately using the ER ---the diagnoses don't merit the level of care. We need to intervene in this to see if some education is needed'

Yes. This.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:
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.

This jumps out at me. If you've been at the ER dozens of times for multiple kids without diagnoses, then something is really wrong. I can totally see them calling in extra support.

This is the OP again....please don't be a jackass. Yes...we've been to the ER DOZENS of times...ear infections, asthma attacks, allergy flare ups, sprained ankles, strep throat, ingrown toenail, suspicious rashes, food poisoning, spider bites, covid testing, stomach viruses, respiratory viruses, concussions, chicken pox...and more. Anybody that judges a parent for getting the appropriate medical care for their child is a moron....

OP with all due respect, these are not ER-worthy visits. As a PP said, you do need education about this.

Asthma attacks, some severe respiratory issues, and perhaps a severe detectable (not potential) reaction to a spider bite or concussion is a reason to go to the ER.

An ingrown toenail isn’t an emergency. It happens over time. You can schedule a primary care appt or go to an urgent care (ask me how I know). Same for chicken pox and other illnesses. You went to the ER for COVID testing? You are absolutely triggering some alarms at the ERs you’re frequenting unnecessarily.

Unless your kids are 40, urgent cares are not new. Do you have insurance? Can we help you find better options? Do you have health anxiety? I get that, but it can be empowering to learn how to appropriately deal with these things. The ER ain’t it for 75% of your reasons.

[Anonymous]

Anonymous wrote:I think OP has exposed themselves as an attention seeker, is leaving out essential information, and the child has an open CFSA/Medical flag. From the details provided and reading between the lines, my gut is telling me that OP is leveraging a very stretched perception of what HIPAA is to mask the fact that the child has been flagged for possible need of extended support/care.

Using term "care manager" in the title of the post masks the fact that it was a Social Worker from the hospital that contacted the school nursing program to ensure follow up with the family, for whatever reasons/flag that may have been conveniently left out by the OP.

Multiple visits to the ER for certain reasons can definitely trigger a CFSA investigation without your knowledge, depending upon how a medical provider writes the evaluation or if the child has been flagged for possible medical neglect by Children's National. They can contact whomever they want to ensure the child's safety.

OP, your entitlement oozes through every inch of every response in this post. The energy you've exerted and time spent pestering the ED at your school about your child's health being followed up on, I hope you spend this much time actually addressing the underlying issues that would cause you to undermine a system put in place to protect children.

OP here....lol. If you have kids, just pay close attention to the consent forms if you ever take them to the ER at Children's. You'll see that it says they share health information with the local public and private school nurses to ensure continuity of care. So this is not something that they did specifically for our child...its their policy. Maybe you should have checked into that before tossing out baseless accusation against a parent who was only trying to get insight on an issue of concern.

Honestly, some people are so dramatic...there is no sinister reason that we've been to the ER several times...if there were, our kids would have been taken from us by now (and none of them ever have been). And again, not one time has any ER doctor or nurse said that we could have or should have gone to see our pediatrician instead of coming to the ER, not ONE...so there goes your "undermining the system" theory...lol.

[Anonymous]

Anonymous wrote:I don’t agree with you OP.

1. You signed the form.
2. This is, overall, a good thing for individuals and the community.
3. It’s essentially continuation of care. There is zero HIPAA violation here.

How many kids do you have that you’ve been to the ER dozens of times? It sounds like given that # and your insistence that it’s a minor issue you’ve been potentially using the ER as urgent or primary care. Not a great idea when the ERs are overcrowded, or ever.

How many kids do you have? This is the OP asking...

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:
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.

This jumps out at me. If you've been at the ER dozens of times for multiple kids without diagnoses, then something is really wrong. I can totally see them calling in extra support.

This is the OP again....please don't be a jackass. Yes...we've been to the ER DOZENS of times...ear infections, asthma attacks, allergy flare ups, sprained ankles, strep throat, ingrown toenail, suspicious rashes, food poisoning, spider bites, covid testing, stomach viruses, respiratory viruses, concussions, chicken pox...and more. Anybody that judges a parent for getting the appropriate medical care for their child is a moron....

OP with all due respect, these are not ER-worthy visits. As a PP said, you do need education about this.

Asthma attacks, some severe respiratory issues, and perhaps a severe detectable (not potential) reaction to a spider bite or concussion is a reason to go to the ER.


Thank you for your opinion Dr., but again....no one in the ER has EVER redirected us or said we made a bad call by bringing our kids to the ER. Sorry, you're wrong.

An ingrown toenail isn’t an emergency. It happens over time. You can schedule a primary care appt or go to an urgent care (ask me how I know). Same for chicken pox and other illnesses. You went to the ER for COVID testing? You are absolutely triggering some alarms at the ERs you’re frequenting unnecessarily.

Unless your kids are 40, urgent cares are not new. Do you have insurance? Can we help you find better options? Do you have health anxiety? I get that, but it can be empowering to learn how to appropriately deal with these things. The ER ain’t it for 75% of your reasons.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:
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.

This jumps out at me. If you've been at the ER dozens of times for multiple kids without diagnoses, then something is really wrong. I can totally see them calling in extra support.

Dozens of times to the ER with each kid is an awful lot.

This is the OP...nothing is wrong and dozens of times with each kid may seem like a lot to you, but that's you. For a family with asthmatic kids or kids who suffer from diabetes, seizure disorder or certain blood disorders, it's not a lot. We are not all the same, so please stop being judgemental and dramatic.

NP. Daughter of an ER nurse. You said you’ve taken your kid to ER for ingrown toenail. That is concerning. Rashes and strep throat also don’t call for ER visits. Your lack of judgment causes issues for when kids are really sick.

This! You took your kid for an INGROWN TONAIL? The problem here is OP, not the ER contacting the school nurse. They should have contacted social services as well.