HIPAA Rules

A patient whom I’d been treating with opioids for chronic back pain the family claimed they tried to call me to tell me about my patient’s drug addiction but that I’d refused to talk with them.

The fact is, I did decline to take the phone call, and it was because the patient hadn’t given me written permission to do so. I didn’t want to violate HIPAA rules. What could I have done differently?

The U.S. Department of Health and Human Services issued the Privacy Rule to implement the related requirement of the Health Insurance Portability and Accountability Act of 1996 (HIPAA).1There is a wide misconception about this aspect of HIPAA. The law states that without a patient’s express permission, health care providers cannot provide information to his or her family members; but the law does not prevent you from listening. You can say to the caller, “I can’t tell you anything, but I am very willing to hear what you want to tell me.”

Family members can be a very useful source of information, and sometimes they will provide important information that will significantly impact your prescribing decisions. Once you have this information, you need to document it in the chart and attempt to assess its validity. You might suggest that the family member come in with the patient on the next visit to discuss the situation.

If the family member insists that you not reveal the source of this information, you will have to question the patient in detail and try to assess the reliability of the information and your patient’s credibility. Unless you conclude that the caller was just a disgruntled friend or relative, you may decide to stop prescribing opioids to this patient, refer him for addiction treatment, and/or discharge him from your practice.
The bottom line is, you need to be willing to accept such phone calls and listen.