Anonymous
11/07/2022 02:46
Subject: Care manager at children’s shared details of child’s ER visit with school
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.
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.
Anonymous
11/07/2022 02:10
Subject: Re: Care manager at children’s shared details of child’s ER visit with school
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....
None of these seem worthy of an ER visit. Are you sure you mean ER?
Anonymous
11/07/2022 02:05
Subject: Care manager at children’s shared details of child’s ER visit with school
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.
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.
Anonymous
11/07/2022 01:22
Subject: Re: Care manager at children’s shared details of child’s ER visit with school
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.
Anonymous
11/07/2022 00:20
Subject: Re: Care manager at children’s shared details of child’s ER visit with school
Anonymous wrote: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.
Of course. But you have said your kid doesn't have a diagnosis. If your kid has diabetes, asthma severe enough to need multiple ER trips, a seizure disorder, or a blood disorder then of course the school nurse is part of the health care team.
And also, when I mentioned multiple ER visits....I was referring to ER visits during the entire course of their lives...not a single school year
I said there was no "NEW" diagnosis....
Anonymous
11/07/2022 00:17
Subject: Re: Care manager at children’s shared details of child’s ER visit with school
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.
Of course. But you have said your kid doesn't have a diagnosis. If your kid has diabetes, asthma severe enough to need multiple ER trips, a seizure disorder, or a blood disorder then of course the school nurse is part of the health care team.
I said there was no "NEW" diagnosis....
Anonymous
11/07/2022 00:13
Subject: Re: Care manager at children’s shared details of child’s ER visit with school
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....
You have said your kid has no diagnosis. Now you're saying they have asthma and allergies.
That many ER visits, especially for things that are usually prevented by vaccines, or medical care, or handled by urgent care or a primary care provider is a red flag that, at a bare minimum, your kid isn't connected with routine health care.
I think you misunderstood...there was no new diagnosis made at this particular ER visit. And this particular child does not have asthma or allergies. But please tell me which of the things I mentioned are prevented by vaccines (with the exception of chicken pox, which one child got a few days after getting the varicella vaccine)? And which are prevented by medical care? And doubt that you're a parent, but if you were...would you take your child to a drs office or an urgent care clinic if said child was having trouble breathing? Covered in a strange rash? Had been bitten by a spider that caused an entire limb to swell? Had hit their head so hard during PE that their vision was blurry and he was throwing up (by the way the school was going to call the emt to take him to the ER, but I got to him first)? Had irretractable vomitting? Has their foot swell so much that they couldn't get on a shoe...this was the ingrown toenail case by the way, and they had to do surgery...yes SURGERY on my kid to resolve this issue. No PCP or urgent care clinic would have been able to do that...you know what they would have done? Told me to take him to the ER!!! How about if you had a kid that woke up and out of the blue had a 102 degree fever on a saturday...would you wait until monday to see the PCP? Maybe you would...but I didn't and I never had an ER dr or nurse tell me that I made a bad call...never, not one time.
Anonymous
11/06/2022 23:52
Subject: Re: Care manager at children’s shared details of child’s ER visit with school
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.
Of course. But you have said your kid doesn't have a diagnosis. If your kid has diabetes, asthma severe enough to need multiple ER trips, a seizure disorder, or a blood disorder then of course the school nurse is part of the health care team.
Anonymous
11/06/2022 23:50
Subject: Re: Care manager at children’s shared details of child’s ER visit with school
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.
Anonymous
11/06/2022 23:48
Subject: Re: Care manager at children’s shared details of child’s ER visit with school
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....
I hope you're just exaggerating for effect and didn't actually go to an ER for all, actually no.. most of the things on that list. Because that's a real misuse of the resource.
Anonymous
11/06/2022 23:48
Subject: Re: Care manager at children’s shared details of child’s ER visit with school
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....
You have said your kid has no diagnosis. Now you're saying they have asthma and allergies.
That many ER visits, especially for things that are usually prevented by vaccines, or medical care, or handled by urgent care or a primary care provider is a red flag that, at a bare minimum, your kid isn't connected with routine health care.
Anonymous
11/06/2022 23:44
Subject: Re: Care manager at children’s shared details of child’s ER visit with school
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....
Anonymous
11/06/2022 23:27
Subject: Re: Care manager at children’s shared details of child’s ER visit with school
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.
Anonymous
11/06/2022 23:25
Subject: Re: Care manager at children’s shared details of child’s ER visit with school
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 also mentioned to her that while there is a blurb about sharing info with the school nurse on the consent forms, there is absolutely NOTHING in the discharge paperwork that mentions that. As a matter of fact, our discharge paperwork explicitly says that parents are to follow up...if child doesn't have a PCP then parents should find one as soon as possible, etc. Nowhere does it mention that the school nurse will follow up or will act as a resource for the child/family after discharge...the school nurse isn't mentioned at all in our d/c paperwork.
I was also very concerned that they didn't see an issue with this being a blanket policy, and that they didn't have anyone in place to review the ER visits before calling school nurses and sharing what could be sensitive information about a child's health status. I asked if they had ever considered having the care managers call parents first (before calling the school nurse) just to confirm that they were ok with the school nurse being given the ER visit info, and she said they had not....but it's something she'd be willing to discuss with her team.
The proof of the pudding is in the eating. I suppose it can be reassuring that they are being conciliatory, but will that actually happen? Not "talking with her team," but changing practice. It would be interesting to hear the update.
Anonymous
11/06/2022 23:23
Subject: Re: Care manager at children’s shared details of child’s ER visit with school
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.