The only trapped miner to survive last week’s explosion in West Virginia developed a slight fever on Monday, according to his doctors. Randal McCloy Jr. remains in critical condition, and he’s still connected to a ventilator even though he is now breathing on his own. Is there any private information the hospital can’t give to the press?
Yes. Under federal privacy rules, doctors can give the press (and the public at large) only the most general information about a patient, called “directory information.” They can confirm that a specific patient has been admitted to the hospital, and they can give a short assessment of his overall condition. (Most assessments are just one word—good, fair, serious, or critical.) If a patient is conscious and alert when he comes into the hospital, he’s given the option to keep even this general information under wraps.
A patient can also forgo his privacy protections. He can give the hospital free rein to discuss the details of his case by preparing a formal authorization letter that includes explicit directions as to which information will be disclosed and for what purpose and who will disclose it to whom. Authorization letters must also have an expiration date. If a patient is incapacitated—like McCloy—and can’t make decisions about his own privacy, those decisions fall to his next of kin. McCloy’s doctors began discussing his case with the media only after they received written permission from his wife.
The federal privacy rules first went into effect two and a half years ago, under the mandate of the Health Insurance Portability and Accountability Act of 1996. In addition to providing a minimum degree of privacy protection—which can be extended by individual state laws—the federal rules also set up a system for enforcement. Anyone whose medical information has been disclosed inappropriately can file a complaint with the Office of Civil Rights in the Department of Health and Human Services. A health-care provider that fails to uphold the privacy rights of its patients can be cited for civil or criminal penalties, depending on the nature of the violation. (Such penalties are rare: By the end of October, the office had received more than 16,000 complaints since 2003, but not a single civil fine had been imposed.)
Bonus Explainer: What do the one-word condition assessments actually mean? Each hospital comes up with its own rules, but most are derived from the standards published by the American Hospital Association. Patients in good condition should be “conscious and comfortable”; patients in fair condition are “conscious, but may be uncomfortable.” A case is considered serious if the patient is “acutely ill,” and critical if her “vital signs are unstable and not within normal limits” and if “indicators are unfavorable.” A final note on death: Hospitals may disclose a patient’s death as a general condition assessment, but they may not give out the date, time, or cause of death without permission.
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Explainer thanks William Case of Ruby Memorial Hospital and Janlori Goldman of the Health Privacy Project.