Objectives

1
Objectives

• Discuss the ethical appeals that ground a right
  to confidentiality
• Discuss the ethical guidelines for disclosing
  confidential information
• Name the federal and state confidentiality laws
  that are relevant to pharmacy practice
• List the four exceptions to confidentiality under
  HIPAA
• Identify actions that breach confidentiality in
  pharmacy practice

2
Overview

• Ethical and legal consensus on confidentiality
• Inappropriate disclosures and inappropriate
  access
• Case discussion

3
Ethical Grounding of Confidentiality

• Appeal to trust
• Without trust that health care professionals will
  maintain confidentiality, patients may be less
  willing to
• Seek help
• Share relevant information
• Comply with a treatment plan
• Appeal to respect for autonomy
• Patients have a right to decide with whom to
  share personal information

4
Ethical Grounding of Confidentiality

• Appeal to fidelity
• Implicit or explicit promises of confidentiality
• Appeal to respect
• Recognizing and being sensitive to patient
  vulnerability
• Preserving patient dignity

5
Codes of Ethics

• A pharmacist promotes the good of every patient
  in a caring, compassionate, and confidential
  manner.
• A pharmacy technician respects and supports the
  patients individuality, dignity, and
  confidentiality.
• From the APhA Code of Ethics and the AAPT Code of
  Ethics for Pharmacy Technicians

6
Ethical Guidelines for Disclosure

• The communication should be necessary and
  effective for good patient care
• The risks of breaching confidentiality are
  proportional to the potential benefits
• The alternatives for communicating the
  information are impractical
• The communication practice should be transparent
  (in the sunshine)

7
HIPAA

• Federal law that provides a minimum standard for
  privacy by restricting the use and disclosure of
  protected health information (PHI)
• One of the motivations for passing HIPAA was
  targeted marketing by pharmaceutical companies

8
PHI Disclosures Under HIPAA

• Permitted disclosures
• Those required for treatment, payment, health
  care operations
• Disclosures authorized by the patient
• There are numerous gaps in the regulations that
  are appropriately filled by professional judgment
  and ethical guidelines

9
Texas Confidentiality Laws

• Texas law has explicit laws regarding
  physician-patient communications but defers to
  HIPAA and other general medical record privacy
  laws in the case of pharmacists and pharmacy
  technicians

10
Exceptions to Confidentiality

• Required Disclosures
• Abuse (child, elderly)
• Injuries such as gunshot wounds
• Reportable communicable
• diseases
• Permitted Disclosures
• Patient consent
• Surrogate decision maker when patient is
  incapacitated (includes minors)
• May warn police in case of imminent physical
  threat to self or others
• Legal proceedings
• Others involved in patients care

11
Reportable Communicable Diseases

• Includes STDs (especially including HIV)
• A health professional (which includes pharmacists
  and pharmacy technicians) shall report to the
  local health authority a suspected case of a
  reportable disease and all information known
  about a person who has or is suspected of having
  the disease if the persons physician, lab
  director, etc. has not already done so.

12
Inappropriate Disclosure

• You are working on a prescription for a patient
  who has an embarrassing bowel condition and the
  patients name sounds familiar. You realize that
  the patient is a co-workers ex-boyfriend. They
  didnt part on good terms and so she laughs when
  you tell her about his plight.

13
Ask yourself

• Is sharing the PHI necessary for the patients
  treatment, billing or hospital operations, or has
  the patient authorized the disclosure?
• Is sharing the PHI a required or permitted
  disclosure?

14
Cousin Billy

• Your cousin Billy, who is a close friend of
  yours, is in the hospital and, purely by chance,
  you find yourself filling his prescription. The
  prescription is for AZT, an antiretroviral drug
  for treatment of HIV. You did not know that
  Billy is HIV and you are concerned for his
  girlfriend, Tracy. You visit Billy later and ask
  him if Tracy knows. Billy is adamant that Tracy
  not know his HIV status and insists that he is
  careful.

15
Handling Cousin Billy

• Texas law allows a persons HIV status to be
  disclosed to his or her spouse, but not a girl-
  or boyfriend
• Are there hospital resources such as chaplains,
  social workers or others who might also talk to
  Billy?
• Texas Partner Notification Program

16
Accessing Records

• When anyone not involved in a patients care,
  billing or hospital operations accesses the
  patients medical record, confidentiality has
  been breached
• This includes hospital employees, physicians and
  others who have wide-ranging access to patient
  records
• This is true even if the person does not share
  the information in the chart with others

17
Inappropriate Access

• You have learned that one of your co-workers fell
  ill over the weekend and was admitted to the
  hospital. Curious about his ailment, you check
  his record to see what hes taking.

18
Ask Yourself

• Do I need this information for the patients
  care?
• Is this information I would legitimately have
  access to anyway?
• Your minor childs record
• Your own record

19
Princess Magdalena Vanessa

• You are shocked to hear that Princess Magdalena
  Vanessa of Elvefal is a patient in the hospital.
  Your parents immigrated from Elvefal and you have
  grown up hearing about its royal family. Your
  whole family celebrated the Princesss marriage
  to Prince Nicolas Magnus last year. You are
  deeply concerned about the Princess, especially
  since there have been rumors that she is
  expecting. You want to check her chart to see if
  she is OK.

20
The Princesss Records

• If you do not need access to a patients record
  for treatment, billing or hospital operations, it
  is inappropriate to access the patients record
  without the patients authorization.
• This is true even if you want to access the
  record out of concern and not out of curiosity.