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Train employees on how to use PHI to protect individuals' safety and health

Nurse Manager Weekly, February 21, 2003

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From time to time, health care providers must consider whether to disclose PHI without a patient's permission in order to protect the health or safety of an individual. HIPAA permits them to do so under certain circumstances-and you should make sure your staff knows when such disclosures are appropriate.

General rule: Serious threat to health or safety

The HIPAA privacy regulations permit a covered entity to disclose PHI if it believes in good faith that doing so is necessary for either of the following reasons:

• To prevent a serious and imminent threat to the health or safety of an individual or the public
• For law enforcement officials to identify or apprehend an individual

Health or safety-The threat that gives rise to the disclosure must be likely to cause serious harm and suggest that the harmful conduct will occur in the very near future. Whether these two circumstances exist requires a judgment call. Your facilities' policies should therefore specify who in your organization is qualified to make the judgment, and how those people should be notified of the possible need for disclosure.

Law enforcement-A covered entity may disclose PHI to law enforcement officials if either of the following conditions exist:

• An individual admits to participating in a violent crime that the covered entity reasonably believes may have caused serious physical harm to a victim
• The circumstances suggest that an individual may have escaped from "custody"

HIPAA places the following limitations on a covered entity's disclosure to law enforcement authorities:

• If an individual makes the admission described above during the course of treatment, counseling, or therapy related to his or her violent propensities, providers may not disclose the individual's PHI. HHS wants to encourage individuals to seek such care by protecting statements they make during treatment.
• If an individual makes such an admission while requesting such treatment, counseling, or therapy, a covered entity may not disclose it. This restriction applies once the individual has made a request or has been referred for such care. For example, if an employee in the hospital's waiting room overhears a person admit a violent crime after requesting treatment for his behavior, the hospital cannot disclose that information.

Adapted from: Briefings on HIPAA, www.hcmarketplace.com/Prod.cfm?id=162&S=ENMW.

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