![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 20 of 20. This is the beginning of the thread.
Posted by Voce on February 6, 2006, at 18:37:18
Can someone help me find where it says in HIPAA that an ex therapist cannot discuss their patient with anyone after termination with consent? I'll explain more later.
Posted by 10derHeart on February 6, 2006, at 19:16:06
In reply to I need some help fast, posted by Voce on February 6, 2006, at 18:37:18
This may be tough 'cause I don't think any of the HIPAA rules - it's the Privacy rule portion if I recall from my paralegal days... addresses things the way you've asked. BUT I may be making it too complicated...
I'm still looking.
But I've got to leave my PC for about 2 hours :-(
Tell me - was the ex-T in question a pdoc, psychologist, mental health counselor, social worker, trainee to be one of the above, etc? I believe it matters as each is covered by their own, separate and specific governing bodies' code of ethics - more sacred, understood, and (possibly?) helpful and on point than what's in the text of HIPAA.
Depending on what the problem may be, of course.
I'll keep trying to help any way I can when I return. (Maybe Babblemail gg, also?)
Sorry you're stressed. Take a deep breath.
Posted by fairywings on February 6, 2006, at 19:22:11
In reply to I need some help fast, posted by Voce on February 6, 2006, at 18:37:18
Looks like some of it depends on state law, but it appears if you put it in writing that you don't want her to have access to your records, she isn't allowed. I don't know, that's just what it seems. This is for the state of OR.fw
http://www.aracnet.com/~oahhs/issues/hipaa/special_records.htm
Posted by fairywings on February 6, 2006, at 19:28:47
In reply to I need some help fast, posted by Voce on February 6, 2006, at 18:37:18
http://aspe.hhs.gov/admnsimp/final/pvcfact2.htm
SPECIAL PROTECTION FOR PSYCHOTHERAPY NOTES
Psychotherapy notes (used only by a psychotherapist) are held to a higher standard of protection because they are not part of the medical record and are never intended to be shared with anyone else. All other personal health information is considered to be sensitive and protected consistently under this rule.
ESTABLISH ACCOUNTABILITY FOR MEDICAL RECORDS USE AND RELEASE
In HIPAA, Congress provided penalties for covered entities that misuse personal health information.
Civil penalties. Health plans, providers and clearinghouses that violate these standards will be subject to civil liability. Civil money penalties are $100 per violation, up to $25,000 per person, per year for each requirement or prohibition violated.Federal criminal penalties. Under HIPAA, Congress also established criminal penalties for knowingly violating patient privacy. Criminal penalties are up to $50,000 and one year in prison for obtaining or disclosing protected health information; up to $100,000 and up to five years in prison for obtaining protected health information under "false pretenses"; and up to $250,000 and up to 10 years in prison for obtaining or disclosing protected health information with the intent to sell, transfer or use it for commercial advantage, personal gain or malicious harm.
COMPLIANCE AND ENFORCEMENT
The final rule will be enforced by the HHS Office for Civil Rights (OCR). Before covered entities must comply with the rule, OCR will provide assistance to providers, plans and health clearinghouses in meeting the requirements of the regulation. A Web site on the new regulation is available at http://www.hhs.gov/ocr/hipaa/.
BALANCING PUBLIC RESPONSIBILITY WITH PRIVACY PROTECTIONS
In limited circumstances, the final rule permits - but does not require - covered entities to continue certain existing disclosures of health information without individual authorization for specific public responsibilities.These permitted disclosures include: emergency circumstances; identification of the body of a deceased person, or the cause of death; public health needs; research, generally limited to when a waiver of authorization is independently approved by a privacy board or Institutional Review Board; oversight of the health care system; judicial and administrative proceedings; limited law enforcement activities; and activities related to national defense and security.
All of these disclosures could occur today under existing laws and regulations, although the privacy rule generally establishes new safeguards and limits. If there is no other law requiring that information be disclosed, covered entities will use their professional judgments to decide whether to disclose any information, reflecting their own policies and ethical principles.
Hope some of this helps
fw
Posted by fairywings on February 6, 2006, at 19:36:07
In reply to Re: I need some help fast » Voce, posted by 10derHeart on February 6, 2006, at 19:16:06
I just read the fact sheets from the hippa site and it says you have to give written auth. to share private notes about your mental health counseling sessions, unless it's allowed by law. I remember GG saying something about if it's w/in an agency it might be allowed, but if not she could be in real hot water if she reads them.
Good luck,
fw
Posted by Racer on February 6, 2006, at 19:41:46
In reply to I need some help fast, posted by Voce on February 6, 2006, at 18:37:18
I'm not sure of the answer, but I *am* certain that you can put in writing that any authorization of release of records is rescinded as of this date. There are probably circumstances under which that won't help -- such as when they're in the same agency, for instance -- but it's still worth doing if you don't want her to have any input, or to learn more about what's happening with you now.
I hope this situation settles for you. I know I'd be LIVID if an ex-T of mine were still communicating about me with anyone.
Good luck.
Posted by Voce on February 7, 2006, at 0:37:41
In reply to I need some help fast, posted by Voce on February 6, 2006, at 18:37:18
My situation is too murky to benefit from HIPAA!! Basically, I made a request for my records to be released to me, which I posted about earlier. I am meeting tremendous resistance now from the director of the health center which holds my records. I am tired of getting the run-around when I had been told previously that it wouldn't be a problem.
My problem is that T2 not only discussed my desire with T1, who subsequently talked her out of the idea, but probably contacted the director of the health center about this as well, which would explain why the director conviently doesn't know anything now, when she supposedly was informed that I would be picking up my own records. T2 has been talking about me to at least one other colleague!! It's about stuff that has happened post-treatment though, not about actual treatment, so chances are I'm not protected under HIPAA.
But I just feel like my trust has been shattered with both T's, and that honestly I don't even want the freaking records anymore. Not when I have to get dragged over the coals to get them.
Posted by B2chica on February 7, 2006, at 8:58:44
In reply to It doesn't matter..., posted by Voce on February 7, 2006, at 0:37:41
Voce, i'm so sorry you are dealing with this. and it DOES matter. this is your innermost thoughts worries and concerns. you trusted T1 AND T2 with their descretion.
i'm having a similar issue right now. my old T just left and told him specifically i wanted my file archived, that i under any circumstances did NOT want this other t to have them. i wanted to 'start fresh'. well, when after my T left and i went to new T (whom i've made no committment too) right in her office was my file...
i did call her and asked her to give me her word that she wouldn't read it till we have a chance to talk next week, she said she woudn't. but chances are she's already read at least part of it.
my trust is already shattered.
i was trying to find hipaa stuff too and i think that since mine is intraagency that i don't have a chance, but that doenst' mean i won;t fight to the end.
hang in there.
b2c.
Posted by Emily Elizabeth on February 7, 2006, at 9:43:33
In reply to It doesn't matter..., posted by Voce on February 7, 2006, at 0:37:41
Have you considered writing a letter to T1 and T2 about this issue? You could use the letter more as a way to address your own feelings abt things rather than as a form of formal, legal action. In a letter you could describe your thoughts clearly and have control over how emotional you get. I'm not saying that there is a proper level of emotion here, but I know that I personally always do better in letters b/c I don't start crying when I want to appear tough or start yelling when I want to be calm.
A letter might prompt them to explain themselves, clarify things, and (hopefully) appologize. It might even make them think twice before doing something like this again.
If things played out like you think that they did, I do not mean to excuse their misbehavior. Their actions were unethical. Period. However, it sounds like you had a positive relationship with both T's. I imagine that they still care very much about you and may have been trying to help you (although you didn't find their "help" helpful). It sounds like they may have been very sloppy with the laws, but not malicious.
I want to be very clear that I am suggesting this possibility not to let them off the hook, but because I want you to know that this isn't because they don't care about, don't like you, etc. Those would be awful feelings to be left with.
Please take care of yourself and keep us posted.
Best,
EEP.S. Today might be a good day to treat yourself to something special--ice cream, a new shirt, a bubble bath?
Posted by gardenergirl on February 7, 2006, at 10:00:15
In reply to It doesn't matter..., posted by Voce on February 7, 2006, at 0:37:41
It may not be covered under HIPAA if it's not protected health information (since it's post-treatment). But it may be covered under state law or the code of ethics.
You might try calling your state licensing board and explain the situation. They should be able to tell you how to proceed with a complaint if you wish, and also what your rights are.
Good luck and keep us posted.
If you want to babblemail with what states are involved, I can try to find state laws which might be applicable.
gg
Posted by Daisym on February 7, 2006, at 12:11:44
In reply to Re: It doesn't matter... » Voce, posted by gardenergirl on February 7, 2006, at 10:00:15
Voce,
Did you ever give T2 permission to talk with T1? Especially written permission? Even post treatment, she can't do this if you didn't. She isn't even supposed to have identified you as a patient. We run into this all the time as kids age out of our program and we see them in classrooms. I have a teacher right now whose own child is in a K-classroom with a former agency client. She greeted the child and the K-teacher said something like, "oh, did this child receive services?" and my teacher had to essentially take the fifth. I think she said, "she wasn't ever my client and even if she was I wouldn't be able to share that with you." That is why we have so many things posted about patient confidentiality.
I like the idea of a letter to both Ts. I'd send one more to the health center asking for your file to be sent to you or your GP. If they deny this, I'd want the reason in writing. The minute you start asking people to put things in writing, they get a lot more cooperative.I'm sorry this has reopened old wounds. You have better things to focus on.
Hugs,
Daisy
Posted by Voce on February 7, 2006, at 14:04:22
In reply to Re: It doesn't matter... » Voce, posted by B2chica on February 7, 2006, at 8:58:44
B2, I'm so sorry that is happening to you. It's a much clearer violation of your rights than my situation, but that doesn't make it better. I don't blame you for having your trust in this new T shattered. Are you able to give old T a piece of your mind through e-mail, etc? If he didn't properly protect your records, than she is doing something she shouldn't. I don't know where that sense of entitlement comes from...
Posted by 64bowtie on February 7, 2006, at 16:09:27
In reply to Re: It doesn't matter... » Voce, posted by gardenergirl on February 7, 2006, at 10:00:15
GG,
So good to see you here with your clear thinking and "steady hand"....
Rod
Posted by madeline on February 7, 2006, at 18:18:12
In reply to It doesn't matter..., posted by Voce on February 7, 2006, at 0:37:41
It maybe time to file a complaint... from privacyrights.org....
"We advise that you make your request in writing. If you are denied access, you can file a complaint with the U.S. Department of Health and Human Service's Office of Civil Rights. (Contact information is provided at the end of this guide). Your state's medical privacy law might also enable you to file a complaint with state regulators."
U.S. Department of Health and Human Services
Office of Civil Rights
200 Independence Avenue, S.W.
Washington, D.C., 20201
Phone: (866) 627-7748
Web: www.hhs.govRead PRC Fact Sheet 8a, "HIPAA Basics: Medical Privacy in the Electronic Age," www.privacyrights.org/fs/fs8a-hipaa.htm.
Posted by Voce on February 7, 2006, at 20:42:19
In reply to Re: It doesn't matter... » Voce, posted by Emily Elizabeth on February 7, 2006, at 9:43:33
Thank you for your post, EE. I think you really hit on some true things.
<Have you considered writing a letter to T1 and T2 about this issue? You could use the letter more as a way to address your own feelings abt things rather than as a form of formal, legal action.>
I've started 3 different letters to T2 today, some angry, some calm. I think I'm starting to find a happy medium between unhappy and reasonable. In the end she's going to want to meet with me in person and discuss this, but I don't want to. I don't want her to explain her actions. I just want this to all go away.
<However, it sounds like you had a positive relationship with both T's.>
I did. Still do, I guess.
<It sounds like they may have been very sloppy with the laws, but not malicious.>
That sounds exactly right. Sloppy is an excellent word.<I want to be very clear that I am suggesting this possibility not to let them off the hook, but because I want you to know that this isn't because they don't care about, don't like you, etc. Those would be awful feelings to be left with.>
Thanks. It IS a feeling I have been fighting all day. I just feel like I can't trust anyone. I also feel like things are going on over my head like I'm some little kid or something who's not big enough to join the discussion.
<P.S. Today might be a good day to treat yourself to something special--ice cream, a new shirt, a bubble bath?>
Already done. A nice big brownie with lunch.
Posted by Voce on February 7, 2006, at 20:48:16
In reply to Re: It doesn't matter..., posted by Daisym on February 7, 2006, at 12:11:44
<Did you ever give T2 permission to talk with T1? Especially written permission?>
Yes, I did at one point. I think it was in October of 2004. The release I signed was only good for one year, though. It's long expired by now.
<The minute you start asking people to put things in writing, they get a lot more cooperative.>
Good point. If I decide to pursue this then that's not a bad idea. I'm just so tired, Daisy. I'm tired of having to defend myself about this, and I'm tired of feeling as though I'm all by myself with no advocate. No one is on my side, so it seems. Everyone's goal is to keep me away from my records. I almost don't want them anymore.
<I'm sorry this has reopened old wounds. You have better things to focus on.>
Thanks. You are right, and I really wish I could close this chapter in my life, because there are so many things that are already sapping my energy. Maybe I don't need to hurt myself over this anymore.
Posted by Voce on February 7, 2006, at 20:52:46
In reply to Re: It doesn't matter... » Voce, posted by gardenergirl on February 7, 2006, at 10:00:15
<You might try calling your state licensing board and explain the situation. They should be able to tell you how to proceed with a complaint if you wish, and also what your rights are.>
I *could* do this. I just don't have the heart.
At what point do I try to mend the relationships, and at what point do I complain? It would tear me up to file a complaint against my two Ts. Even if what they did was wrong. I hate that I'm still loyal to them.<If you want to babblemail with what states are involved, I can try to find state laws which might be applicable.>
I'm in CA. I'm just so confused by all the ethics, codes, guidelines, blah blah. It's a jungle. You probably know your way around this stuff better. But even if they WERE breaking a state law, I don't think I'd find it in myself to use it against them.
I'm going to crawl into my cave for awhile. Why does this hurt so much?
Posted by B2chica on February 8, 2006, at 9:08:19
In reply to Re: It doesn't matter... » B2chica, posted by Voce on February 7, 2006, at 14:04:22
i don't think my situation is worse just different.. either way were talking about confidentiality and our rights being violated. and common respect for our wishes is not being shown. they preach about trust, well how the f@ck can we trust someone who wont respect our wishes!!!!!
i hope your situation gets better
hugs.
b2c.
Posted by Voce on February 9, 2006, at 1:04:34
In reply to Re: It doesn't matter... » Voce, posted by B2chica on February 8, 2006, at 9:08:19
And I didn't mince words. I told her how upset I was that she had been discussing me without my consent, and I told her how frustrating it has been trying to get my records, and feeling like I don't have any rights.
She can be kind of slow with responding to e-mails, sometimes more than a week. I honestly don't know what I expect her to say in response since I told her I didn't want to come in to see her and discuss it. I feel better having sent it now. But I am still left with the feeling that I just can't trust either of them, which reall hurts because of how much I went through with them, especially T1.
The saga of pre-marital counseling continues. It has been okay so far, just some personality tests. But tonight we talked about our "families of origin." It wasn't as bad as I thought it would be because the counselor did a lot of the talking (he talks too much, actually). But it kept us from having to do a lot of talking. I didn't really want to talk about anything at all...I am meeting individually with this guy in 2 weeks, which is part of the program. I have no idea what we will talk about. I don't know him well enough to open up. And I don't feel like re-hashing what I did in therapy. It's been hashed enough.
I'm PMSing and everything makes me cry right now. Someone tell me that it will get better. You're not supposed to cry this much when you're planning a wedding.
Posted by pegasus on February 9, 2006, at 10:01:42
In reply to I wrote T2 an e-mail, posted by Voce on February 9, 2006, at 1:04:34
Oh, I don't know about that. Weddings bring up a lot of emotional material - and not always positive stuff. I cried quite a bit in the months before my wedding, too. It's such a big life event, and we wanted to be *sure* and prepare well for the marriage. For us, that meant talking about some painful family stuff, and airing some scary doubts. Doing that at the same time as planning a major social event involving a bunch of opinionated people was a lot to handle. And you've got this therapy stress on top of it, and it sounds like some PMS getting tangled up in there. That's a lot on your plate. So I think it's totally understandable that you'd be crying now. You have every right. It will definitely get better.
(((voce)))
peg
This is the end of the thread.
Psycho-Babble Psychology | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.