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

[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.

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.

He he he…the OP calling other people dramatic

[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.

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.

Thank you for your offer, but I've probably been raising kids for longer than you've been alive. There is no knowledge deficit on our end honey so we don't need to be educated by you or any of the other #PseudoDoctors out there

[Anonymous]

OP, I guarantee you landed yourself on a special call list for "frequent flyers" of the Children's ER.

Children's is not tracking down the school nurse for every DCPS student who goes to their ER.
They have a threshold for outreach and you crossed it with your ER utilization.

These protocols are there to protect kids who:
--are using the ER instead of primary care
--may need school support of the chronic health concerns that are causing this level of acute care utilization

[Anonymous]

Gotta agree that many of these ER visits sound unnecessary. A 102 degree fever is barely worthy of a regular doctor visit, let alone the ER.

[Anonymous]

Anonymous wrote:OP again...so I did mention to the director person that 1) consent for sharing information with the school nurse should be more pronounced (instead of being co-mingled with all the other general consent info and 2) there should be an "opt out" option for any parent that doesn't want to use that service (as it stands now, there is not...unless you just cross out whatever section you object to).
.

I want to pull this out, and explain why it is a bad idea. Allowing a parent to opt out removes a critical early warning system for identifying child abuse. Schools are the most consistent places where children are seen outside their family unit, which makes them the most logical place for information and patterns to emerge.

So, if I am abusing my child but always have a plausibly deniable excuse, then all I have to do is keep the ERs rotating. Fractured skull goes to Children's. Broken arm goes to Sibley. Informing the schools about "ER frequent fliers" gives someone the opportunity to identify patterns of abuse. We don't want to remove that, for the good of the children in our community.

[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.

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.

Thank you for your offer, but I've probably been raising kids for longer than you've been alive. There is no knowledge deficit on our end honey so we don't need to be educated by you or any of the other #PseudoDoctors out there

Omg this post totally changed my mind. You’re not an a$$hole like I first thought!

[Anonymous]

Anonymous wrote:

Anonymous wrote:OP again...so I did mention to the director person that 1) consent for sharing information with the school nurse should be more pronounced (instead of being co-mingled with all the other general consent info and 2) there should be an "opt out" option for any parent that doesn't want to use that service (as it stands now, there is not...unless you just cross out whatever section you object to).
.

I want to pull this out, and explain why it is a bad idea. Allowing a parent to opt out removes a critical early warning system for identifying child abuse. Schools are the most consistent places where children are seen outside their family unit, which makes them the most logical place for information and patterns to emerge.

So, if I am abusing my child but always have a plausibly deniable excuse, then all I have to do is keep the ERs rotating. Fractured skull goes to Children's. Broken arm goes to Sibley. Informing the schools about "ER frequent fliers" gives someone the opportunity to identify patterns of abuse. We don't want to remove that, for the good of the children in our community.

I get the goal, but do realize this is an example of why privacy no longer exists.

[Anonymous]

Im not the op, but i did take my 5 year old dd to the ER when she woke up and her ear piercing had gotten badly infected. The lobe had swallowed up the earring and my daughter was in such pain. They needed to give anesthesia to remove it.

Overall i agree op overused the ER.

Something about this post makes me wonder why she’s so defensive….

[Anonymous]

I have nothing against you OP. Honestly. I’m not attacking you. I say this with kindness. Many of the issues you describe are better handled by a regular pediatrician. Mine has office hours on weekends too. And if the things you describe happened at night when the ped isn’t open, there is pediatric urgent care. The ER should have told you this. I don’t know how you’re expected to know if you don’t know. They should be providing education at each visit, and that’s on them, not on you. But starting today, are you able yo establish care at a pediatrician’s office that has weekend hours? That would be a good way to avoid many future ER visits.

[Anonymous]

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

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

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

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

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

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

[Anonymous]

Anonymous wrote: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.

False. The records may have become school records covered by FERPA when they were transmitted to the school. OP has every reason to contact the school, particularly if the nurse has been pushy and inappropriate about it.

[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.

That’s a nice bit of fan fic there. Next time attempt to stay rooted in reality.

But yes, self-righteous fabulators like you are *precisely* why I keep
my kid’s records locked down.

[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'

none of which justifies a HIPAA breach, of course.

[Anonymous]

Anonymous wrote:

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

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

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

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

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

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

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

[Anonymous]

Anonymous wrote:

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.

That’s a nice bit of fan fic there. Next time attempt to stay rooted in reality.

But yes, self-righteous fabulators like you are *precisely* why I keep
my kid’s records locked down.

At least there are no red flags anywhere at all in this thread.