HIPAA: How Corporations Over-react

(Here's a caveat: Ladera is owned by Genesis Health Care Corporation, and they are yuuuge. They own upwards of 500 nursing care/rehab facilities across the country. It's safe to say that whatever rules are being enforced at Ladera in Albuquerque are being enforced in every other Genesis site.)

I have been reading about HIPAA again because of the ways in which this law is being observed at this facility, ways that sometimes seem contrary to the interests of the patient. The gummint has an excellent set of information pages for both professional patient care practitioners and patients themselves. Beyond that, you can easily access the text of the law itself, text written in the arcane dialect known as legalese.

Andy Weir, author of Martian, calls it "ghetto" format -- white background and black default font from wall to wall. It wasn't too bad when screens were practically square and resolution was lower, but today it makes reading a challenge, especially when the text in question is legalese. Well, it's the government. If they were to actually format this stuff for readability, some demented cloud of dime squeezers would descend on the Government Printing Office and demand that they stop wasting ems.

But I digress.

Our corporate overlords do not want to be sued. Even baseless suits by opportunistic families cost money and time to defend, and the publicity can be bad. A patient complaint can possibly launch an investigation by the state health department, and, if they come in, they look at everything, disrupt the normal workflow, and generally fray the nerves of staff at all levels.

Some of the rules they make, however, would make Jonathan Swift rub his hands with malicious glee, like the one about Foley bag covers and the hanging of Foley bags themselves. (A Foley bag is the collector component of a Foley catheter. The catheter is inserted in the incontinent patient's "Trump"). For modesty's sake, the bags come with snug denim covers that snap on. The use of these covers is mandatory, as part of protecting the patient's privacy.

The problem is, no cover is mandated for the four feet of tube between the trump and the bag. Foley bags must not be left resting on the floor; they must be hung on something, usually the bed, which means there will inevitably be a loop of tube where urine will collect.

So why isn't there a cover for the tube? What's the point really? It's legal foolishness. Or maybe it's a company rule as opposed to a state mandate, but it's no less foolish for that.

Now let's consider things I have questioned, the answer to which questions has always been "HIPAA!"

After three days of orientation, which means following an experienced-at-Ladera CNA around, a newbie CNA is given responsibility for up to 12 patients on a portion of a hall. In long-term halls, the population is relatively static, but in the skilled unit, where patients come from the hospital for rehab, the population is in constant flux. In any case, the newbie is responsible for hands-on care for their section. They can either remember everything they were told, they can refer to the patient's chart, an often unwieldy tome which may not be removed from the nurses station, or they can ask another member of staff. A nurse tells me that every CNA has a sheet (another piece of paper!) with up-to-date information about the patients in their section. I presume this information is supplied by the outgoing shift. The thing is, it is absolutely forbidden to leave anything lying about in public view that in any way pertains to patient information. Even what size of brief a patient wears.

Does HIPAA really say you can't have any patient info in the room with that patient? Hell no!

According to the Department of Health and Human Services website, the facility can post signs that say things like "Diabetic" or "Do not put to bed until 8 p.m." as long as the patient or their POA* says it's okay to do so. This permission can be explained and sought at the time of admission, when the secretary is explaining all the other terms and conditions to the new admit and their family. All this stuff could be posted on the inside of the closet door, which would protect it from the casual passer-by.

What's it to me? I just refused a blood glucose test last week. I'm not diabetic, and I don't need to be tested. Thing is, this was the third time a nurse had attempted to perform the test since I moved to this hall; the list of who is to be tested is enumerated by room number, not patient name (HIPAA!). The resident who previously occupied this room got the glucose tests. The third nurse checked my MAR** and, having confirmed that I don't get tested, scratched my name off the other list. Now suppose this happens to a passive resident (which I totally am not), or one with cognitive difficulties. It's harmless, I guess, but it's bound to have an insurance code attached to it, which means that mistake costs somebody money.

But HIPAA!


*POA = Power of Attorney, frequently used as shorthand to refer to the person holding that power.
**MAR: Actually, I don't know exactly what this stands for, but it's the list/history of a patient's medications. Each patient has a MAR which the nurse refers to when dispensing meds.