Final Exam-Chapter 9 Confidentiality and Informed Consent

Name some federal laws that have to do with confidentiality:

1. Freedom of Information Act 2. Privacy Act 1974 3. Bankruptcy Abuse Prevention and Consumer Protection Act 2005

Name four sources of law that form the foundation for the rights to privacy.

1. constitutional provisions 2. statutory provisions 3. common law provisions 4. international provisions

What are 8 principles of the Nationwide Privacy and Security Framework?

1. individual access 2. correction 3. openness and transparency 4. individual choice 5. collection, use and disclosure limitation 6. data quality and integrity principle 7. safeguards 8. accountability

Types of Common Law protections of health info:

1. invasion of privacy 2. defamation 3. breach of contract

What are three state level confidentiality protections categories?

1. open record statutes 2. physician patient privileges statutes 3. privacy statues

IRB assessments for Privacy and Confidentiality Safeguards:

1. protect data collected 2. protect samples 3. identify who uses the data 4. de-identify or destroy data when needed

What does the California Consumer Privacy Act grant?

1. rights to be informed about any personal data companies have collected 2. why that data was collected 3. request deletion of the personal info 4. right to statutory damages even if no actual harm has occurred in the event of a data breach

Scope of informed consent can be measured by:

1. who may consent to treatment 2. how much information must the health-care provider disclose 3. what situations require informed consent

What professional organization determined that the privacy of the individual with HIV did not terminate upon death.

American Medical Association (AMA)

___ is embedded in the concept of informed consent.

Autonomy

What does BAPCPA stand for?

Bankruptcy Abuse Prevention and Consumer Protection Act

Compare and contrast open record statutes and privacy statutes.

Both are State level. Open record record statutes relates to the Freedom of Information Act.. The Privacy statues goes with the Privacy Act

Explain the interrelationship between confidentiality and privacy.

Confidentiality means the patient can trust his doctor to use patient information for diagnosis and treatment. Info stays with the facility. Privacy means not just anyone can be granted access to patient-specific health info

What does DHHS stand for?

Department of Health and Human Services

Estate of Behringer vs Medical Center at Princeton

Dr. Behringer went in for pneumonia. The whole staff found out about his AIDS and he ended up losing a lot of patients at his practice. He sued the hospital and won. He was a patient and should have been protected

What does EU stand for?

European Union

___ consent is verbal or written informed consent used during diagnostic or therapeutic procedures.

Express

21st Century Cures Act modifies the requirement of express consent for limited circumstances involving

FDA research

What privacy provisions cover educational records such as student health records?

Federal Educational Rights and Privacy Act (FERPA)

FOIA stands for

Freedom of Information Act

International Basis-What does GDPR stand for?

General Data Protection Regulation

Discuss the legal protections afforded to health care providers when treating patients in an emergency situation.

Good Samaritan laws serve to protect hc providers, rescuers, from liability for unauthorized treatment (doesn't include negligent or intentional misconduct); done at side of the road not in the emergency room

Explain Whalen vs Roe

New York State- collection of computer database regarding dangerous drugs likely to be abused. Decision- the public's need for the info outweighed the individual privacy

The Privacy Rule requires health care providers to issue a ___ to each patient.

Notice of Privacy Practice

What is PSDA?

Patient Self-Determination Act

What are two executive branch agencies the release information for purposes of research and statistical studies?

SSA and DHHS

What does SSA stand for?

Social Security Administration

What's the big deal about the case mentioned earlier: Whalen VS Roe?

The Supreme Court recognized that patients didn't want their personal info shared at all or without permission. Recognizes a right for informational privacy for the first time.

The Nationwide Privacy and Security Framework for Electronic Exchange of Individually Identifiable Health Information (Framework) was issued by ___.

The US. Department of Health and Human Services

Define confidentiality

The obligation of the hc provider to maintain patient information in a way that will not allow disclosure beyond the hc provider.

How can you distinguish between privacy and confidentiality?

Think of privacy has rights that belongs to the patient and confidentiality as a duty that belongs to the health care provider

There is nothing in the U.S. constitution that directly addresses the patient right to privacy. True or False?

True

Define the term advance directive.

WRITTEN instructions recognized under state law; living wills, durable power of attorney for health care; says what care they may or may not want if they become unable to speak for themselves

Define informed consent.

a legal doctrine that requires hc providers to disclose information to patients about treatment options and risks

How does GDPR define personal data?

any info that can identify a person; including physical, psychological, genetic, economic, or social identity

Explain the use and application of the physician-patient privilege.

applies to introduction of evidence at trial and used to prevent forced disclosure or testimony about info obtained by a healthcare provider during course of treatment.

Cruzan vs. Director, Missouri Department of Health

case dealing with the right to die issue; life support withdrawn from a patient in a vegetative state; there was evidence that Nancy's wishes were for life support to be withdrawn; lead to passage of PSDA

Who may consent to treatment?

competent adult patient; not emergency situation

The health care provider-patient relationship calls for

confidentiality and a mutual trust

Discuss the application of substituted consent to minor patients.

consent given by parent or legal guardian until minor becomes of age or becomes emancipated; exceptions are pregnancy, STDs, substance abuse; the kid can consent for himself

Information that has been stripped of all identifiers is called ___.

de-identified health information`1111111111111111111

The ___ health record poses new challenges to maintaining confidentiality and privacy of PHI.

electronic

Explain the Consumer Privacy Act of 2018 of California.

expands the definition of personal information to be protected, if not already accessible to the public; applies to everyone not just patients; follows the patient to other states too!

International Basis-What does the GDPR do?

expands the definition of what constitutes personal data that must be protected

Negligence refers to

failure to do or not do something that a reasonable person would do or not do

Trace the historical development of the informed consent doctrine.

informed consent began in 1900s by applying battery theory to lawsuits against hc providers; touching a patient without consent was considered battery, later on it focused on whether or not the patient understood what she was agreeing to (pros and cons of treatment); autonomy became important explaining to patients in a manner that they could understand and could choose to be treated or not; power rests with the patient; leading to possibility of negligence on the part of the doctor; leading to separate legal theory called doctrine of informed consent; it is the doctor's duty to explain treatment, risks, alternatives, benefits or else he can get sued for negligence instead of battery like the olden times

Privacy can be viewed as the patient looking ___. Protecting info that belongs to her.

inward

Emancipation

legal ability of a minor to act as an adult when he or she has moved away from home and receives no support from his or her parents

Explain the concept of substituted consent.

legal doctrine that allows authorized person to consent to or refuse treatment on behalf of a patient when the patient is unable to

Distinguish between living wills and durable powers of attorney for health care.

living will is written doc while patient is competent that gives instructions about medical care in the event of incapacitation (physical or mental); durable power of attorney is written doc allowing a competent patient to name someone else to make hc decisions in the event he becomes incapacitated; state law addresses patient rights; federal law addresses procedures for exercising those rights

Protection of health information applies to the ___ or ___ individual.

living; deceased

FOIA encourages access to government records and ___ disclosure upon request, without exceptions.

mandates

In express consent risk is considered to be

more than silght

What are some identifiers by which an individual can be recognized?

name address DOB tele health record #

An EU citizen who sees a provider in the US has provisions through GDPR. If there is a breach he

needs to be notified within 72 hours

Does HIPAA cover employment records and school records?

no it does not

If the doctor is the one who has HIV the legal restrictions on access to HIV info are ___ as clear.

not

BAPCPA deals with the bankruptcy of health care businesses. A patient care ___ is appointed to maintain confidential patient information.

ombudsman

Confidentiality can be viewed as the ___ looking activity. Health care provider not sharing info that belongs to another.

outward

John Roe vs Jane Doe

patient informed doctor he was HIV positive. Dr. released this info during a subpoena from the patient's employer. New York law says- the subpoena should have specified that it needed HIV info (which it didn't) Standard release of information may be insufficient to authorize release of HIV info depending on the state.

Privacy Act also allows access to government records, but ___ that certain info is confidential and may not be disclosed unless there is written consent of the individual.

presumes

Compare and contrast the professional disclosure standard and the reasonable patient standard.

prof. disclosure stand. measures what a reasonable hc provider under the same situation would disclose. Need expert testimony; reasonable pat. stand. measure what material information is necessary for an average, reasonable patient to reach a decision to consent or forgo treatment; no expert witness necessary

Information containing identifiers by which an individual can be recognized is considered ___.

protected health informaton

Describe the types of restrictions that confidentiality statutes and ethical guidelines place on HIV/AIDS information.

protects against identifying the patient test and test results; the only ones who can see it are the individual, legally authorized rep., person listed on release of info, health care providers directly involved with patient; unless it is court ordered and specifies an individual; ethically revealing cause of death of a patient to can be damaging to the deceased's reputation. so watch out doctors

What does PAD stand for?

psychiatric advance directive;

right to die

refuse treatment with the result that the patient may die

In re: Milton Hershey Medical Center

resident cut his hand and got HIV; the Pennsylvania court was asked to release this info to patients who make have been affected. Permission was granted. Public health won over the individual's privacy. They did not use his real name and only shared the info with a very limited audience; also offered counseling and free testing

What are some other names for right to privacy?

right to be left alone or right to control personal info

In implied consent risk is considered to be

slight or not apparent

Each state possesses the authority to create or modify ___ legal rights concerning advance directivies.

substantive

___ consent allows a health care provider to provide treatment to the patient when he cannot consent to treatment.

substituted

Implied consent can also be called ___.

tacit consent

What is the foundation of the current medical professions' guidelines on confidentiality of health info?

the Hippocratic Oath

The relationship between law and medicine has developed

the doctrine of informed consent

Who is in charge of making sure protected health information remains confidential in the context of Research?

the research team and the Institutional Review Board (IRB)

Who is demanding patient information?

third-party payers, government entities, patients themselves

What is the goal of PSDA?

to ensure patient's rights to make their own health care decisions be communicated and protected; all depends on the state laws

State laws in regards to privacy focuses on the ___ of records involved.

type

Define reasonable patient standard

used in negligence context to determine liability; what would a reasonably prudent person do in that same situation