No HIPAA for us in healthcare

We guard the privacy of patients in my hospital zealously—we take care of a lot of celebrities since we’re right in the shadow of Beverly Hills.  And of course we live in terror of HIPAA violations, those federally mandated HHS rules that protect individually identifiable healthcare information and could bring down “civil money penalties” upon us if we don’t keep our patients’ medical records strictly confidential.

But for healthcare workers—physicians, nurses, technicians, even medical supply vendors—in LA County, the usual privacy rules don’t apply any more.  Now everybody gets to know at least some of our medical history:  whether or not we’ve been vaccinated against influenza.

How will anyone know whether or not I’ve had this year’s flu vaccine?  Because policy dictates that I must publicly say so, whether I want to “out” that information or not.

As of October 2013, all healthcare workers in Los Angeles County must be vaccinated against influenza or wear a protective mask any time they might have contact with patients or stray into patient care areas.  This is an order that came down by fiat from Dr. Jonathan Fielding, the Director of the LA County Department of Public Health, and now applies in LA County to every hospital and care facility.

You might think that sounds like a reasonable idea.  After all, the flu is a dangerous disease that may even lead to death.  My personal choice is to take the flu vaccine every year, in the hope that I’ll make it through another winter without the high fever, bone-rattling chills, racking cough, and other miserable symptoms that characterize classic flu.

But I choose to take the flu vaccine realizing that the vaccine won’t necessarily protect me against all the different strains of the flu virus, and knowing too that I could suffer severe side effects.  Those side effects can range from mild fever and chills to a potentially devastating condition called Guillain-Barré syndrome, which causes muscle weakness and even paralysis, and may leave its victims with permanent nerve damage.

I’ve always agreed with the general recommendation that people who work in healthcare should be vaccinated against the flu, but that still needs to be a personal decision, not a government mandate.  Each person has individual responsibility to make decisions about safety issues of all kinds–whether or not to smoke, to eat that second piece of cake, to get the tires checked on the car before the road trip.  While we acknowledge that bad decisions may put others at risk to a greater or lesser degree, in America we still believe that personal decisions are just that:  personal.

Not in LA County, however.  In other southern California counties, healthcare personnel may still decide whether the risks of the flu vaccine outweigh the potential benefits, and keep that decision to themselves with the same right to medical privacy that everyone else has.  But in LA County, you either get the vaccine or wear a mask, even if you’re perfectly healthy and haven’t got the slightest symptom of the flu.  Because that’s what Dr. Fielding has ordered.

In fairness, many hospitals across the country already have the same policy in place:  get the flu vaccine or wear a mask in patient care areas.  One hospital in New York City puts a small red sticker on the badges of healthcare workers who’ve been vaccinated.  USC University Hospital uses a little yellow dot.  Other hospitals simply use an honor system, with random checks for compliance.  My hospital handed out new badges for everyone to wear along with their ID badges:  either a green badge or an orange one.  Green means that the wearer has been vaccinated for flu; orange means the wearer has declined the vaccine for whatever reason, and must wear a mask. The individual may even be barred from receiving this year’s flu vaccine because of a previous severe reaction—such as Guillain-Barré syndrome—but he or she still gets the orange badge.

Let me point out the obvious flaws in this system.  If I should become ill with a strain of influenza that hasn’t been covered by this year’s vaccine, since I’ve been vaccinated I don’t have to wear a mask though I could be quite contagious for at least a day before I develop overt symptoms.  No hospital (to my knowledge) is requiring patients’ visitors and families to provide evidence of flu vaccination or wear masks, though they go in and out of patient care areas at will. If we are really to be logical and scientific about flu transmission, either we all should wear masks or none of us should bother.

Many of us in clinical healthcare have good reason to resent the obvious HIPAA violation that is taking place when healthcare workers are required to divulge whether or not they’ve been vaccinated against this year’s most likely influenza strains.  Apparently, HIPAA only applies to some patients, not to all.  Patient privacy, it seems, only matters when the government wants it to, and confidentiality doesn’t extend to those of us who come to work every day to take care of our patients.

I’ll carry my green badge in my pocket, thanks.

27 COMMENTS

Neal Koss

I agree!! However, I do believe that Pasadena and Long Beach are also in LA County, so it is unclear why they don’t have to follow the same rule. At our hospitals, we get a little sticky to go on the badge if we get the shot ( I did!).

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karen

Right as usual, Dr. Koss! Shame on me for not double-checking the source that mentioned Pasadena and Long Beach. Revision made, and thank you–

Karen Sibert

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Cheryl F

I resent the government telling me who am an epileptic controlled on Dilantin, that I have to get a flu shot. If I acquire Gilliam Barry’s the government going to pay my. BIlls?
The last time I checked in the US we are free and we as patients also have the right to refuse and hippa gives us the right to not difficult urge our medical info.

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Yeah, it’s true. My anesthesia department aimed for “100% compliance!” with flu vaccination. Last time I checked it was MY arm getting stuck with needles.

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christine

I live in New York and work at a state hospital and I am forced to wear a mask, I am now developing redness at the bridge of my nose and sores on top of my ears, I am so frustrated by this outrageous mandate,and how my rights are being violated,I read your story and it was refreshing,and I am so happy to see that others feel the same way thank you for time

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yvonne c

Hopefully, anyone developing rashes and other problems from wearing masks will report these problems as a worker’s comp claim.

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Tricia Baldwin

Thank you for your sane opinion regarding the privacy of healthcare workers. I have been a critical care RN for over 20 years and cannot (not will not) get the flu vaccine due to 3 systemic reactions from each of the last 3 flu vaccines I received. Despite a medical waiver signed by my MD, I must wear a mask on the chance that I might have been exposed to the flu yet not have symptoms and then might transmit that flu to someone else. Each day I reveal my health history and reaction history to patients and families who then express confusion when I tell them I cannot remove my mask even though they have been vaccinated. Exactly when did my health and vaccination history cease being private?

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Jennifer Power

“…and families who then express confusion when I tell them I cannot remove my mask even though they have been vaccinated.”

In this one sentence, the entire premise of vaccination against infectious disease falls apart. No wonder the public is questioning the need for ANY vaccines at all. What a ludicrous situation.

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aussie

Well its hit australian shores as largest health provider in victoria introduces mandatory mask wearing for unvaccinated flu workers. I wholeheartly agree on the discrimination and violation of privacy.i have certainly felt harrassed, reported on and singled out.

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Cheryl F

Discrimination by employers for whatever reason is against the law!

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Conqueringfools

Ha!!!! This isn’t only a healthcare/employee issue this is an American taxpayer issue!!! As an RN I can’t wait to leave the pathetic punching bag profession. Moreover, as an American it’s disgusting how much control government is now exerting into our lives and livelihoods. Obama and Obamacare is an utter failure! All I could do was shake my head a few years ago when all my fellow nurses had support Obamacare stickers on their bumpers. Nurses have no voice in their profession. They are or should I say WE are slaves to an absolute disgusting corrupt healthcare system.

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At UVA medical center in charlottesville va most boosters and flu shots were mandatory. When you got your flu shot you received a color dated sticker on your name bag. Total violation of HIPPA. No sticker no work !

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Jnelson

I work in Virginia as a phone triage nurse.
My office is about a mile from the hospital.
Its locked to the public and one needs a passkey to get in.
I am in a cube
Alone
And because I declined getting a flu shot I am required to wear a mask.
A patient couldnt get to me if they tried.
But wait…..it gets better.
Last yr 2 people in my office who got the flu vaccine got the flu anyway. One was tested and found to be positive for flu by her doctor. The other was in direct contact with someone who tested positive for flu and she had classic symptoms ( she was also a nurse and seemed to be very proud to have gotten the flu despite being vaccinated!). Even though policy dictates that anyone with flulike symptoms ALSO wear a mask, in fact the only one who is constantly badgered to wear a mask is me. These 2 were allowed to come to work and cough, hack,and drown in their own secretions without a word being said to them. I never got sick.
The hypocrisy, the lack of common sense and the harrassment is crazy. The government wants all hospitals to have a 90 % compliance rate or they are threatened with having their medicare reimbursement cut. Ahhhhh yes now it all makes sense…….why else would a hospital care if sick people come?

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Jnelson

Almost forgot….
ANYONE who doesnt get a flu shot MUST wear a snowflake on their badge to identify them. The head of the dept in charge of inforcing this was proud to call herself the flu nazi.

Also last year I was required to take a CEU about flu vaccines in the elderly. I was surprised to learn that the older we get the less vaccines work on our failing immune systems. This CEU only bolstered my resolve not to get a flu shot. Let me say i am NOT anti-vaccine. What I am is PRO- I get to decide what goes into my own body.

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James L

I personally know of five people who have gotten a neurological complication from the flu vaccine, and I live in a community of 60,000 people. We have three in our operating room alone who gotten Guillan-Barre from a vaccination. The vaccine companies have figured out how to suppress this information and have brokered immunity for themselves, leaving hospitals holding the liability bag for such not so infrequent injuries. Of all the ObamaCare provisions out there, this is one that needs to be repealed first.

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I spent 22 years as an RN and could speak endlessly on the issues of our absurd healthcare system, but now as a HIPAA consultant, I advocate the importance of security awareness training and there’s really no excuse for this. There are actually hundreds of free and cost-effective solutions online, but time and time again, I see Covered Entities and Business Associates failing to implement basic training. As a HIPAA security specialist, it’s somewhat upsetting to see this because something that’s so vital to an organization and that is so easy and cost-effective to obtain is many times never done. C’mon folks, train your employees about ensuring the safety and security of PHI, it’s not that difficult. Think about it, healthcare companies spend massive amounts of money on new hardware and software products for security, but the true front line for defense for protecting PHI is well-trained and educated employees, something that’s so easy to do!

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Alicia

I work for a health care facility in Yuba County, Northern California. Even though my department is outside of the main hospital, all office staff are required to get the flu vaccine, even though we have absolutely no patient contact. The nurses and other staff do get a little dot sticker to put on their badge showing they received the vaccine. I do not get the vaccine due to an allergy to formaldehyde, therefore, I am required to wear a mask when entering the main hospital. I very rarely go to main hospital, but when I do my badge goes in my pocket. It’s no one’s business if I have the vaccine or not.

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Laur

You all have it lucky with a small sticker or a snowflake, my hospital requires me not only to wear a mask but to wear an additional red badgesaying INFLUENZA. They treat us as though we are already infected, meanwhile, people come in sick sneaking and coughing all over and exposing us all to illness and no one bats an eye.

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Amelia

I have been working in a medical office for 5 years now and our office offers free flu vaccines to employees. I’ve never done it, but I’ve also never needed it. Then a big hospital buys our independent practice and suddenly I receive an email stating I now need a flu vaccine in order to keep my job when we transition to the hospital. I state I do not believe in getting a flu shot and I decline. I get an email back basically saying the state I work in is an at-will state and if I do not get the vaccine, I may be terminated. So for 5 years it didn’t matter that I wasn’t vaccinated and now all of a sudden a huge hospital(aka corporation) takes over and it’s mandatory. What about all our patients who cough on me without covering their mouths? Shouldn’t they now be required to get flu shots to be seen at our practice?

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