The Fugitive

Well as the under-utilized naval ship sailed away from the harbor (whosever idea that was showed how tax payer dollars are abused that one was it) to the temporary closing (as in still set up but not being used) Javitz Center and the tents of the Salvation Army or whatever weird fucking religious crew run by homophobe Franklin Graham on public lands, which could have been used well for the public to go while being locked down, get folded up we are back to just the overworked and underprepared/supplied public hospitals, and those private ones stocked by Warren Buffet, to treat the  new/next/more Covid patients. The ones in the prisons or in Convents, nursing homes well you will be fine if no one notices you are dead.  And well even those on the Subway, again wondering how many hours those bodies were there shedding viruses or whatever caused them to die.  Remember if you are not tested POS for Covid and you die you die of that but still are likely counted as dead by Covid, maybe or maybe not. Who knows?  Does anyone care?  Well apparently law enforcement does.

I had read about arrests, chases and hunts of others in other less democratic countries who had escaped Covid treatment facilities; such as the woman in Chile, Russia, India , Africa and even Israel. 

When I read this article in the Tennessean about a homeless man who “escaped” the Covid facility from the fairgrounds (where I lived only about a mile away) and was set up exclusively for homeless it again made me wonder who was being treated at the varying satellite facilities in New York and New Jersey. Something tells me not the insured or the white but what do I know? Well nothing as they don’t tell you shit screaming HIPAA laws. Well wrong again.

Yes folks buried in the article was the policy regarding HIPAA and the ruling on public safety (of which there are many guidelines) .  Good times as this is what I had been looking for when I tried to explain to someone that HIPAA does not apply in the case of COVID as it is highly infectious and back in the day during the height of the AIDS crisis that debate raged as it was believed solely blood born and sexually transmitted.  Then came the Ryan White story and the affect on the blood supply and well game on and hence the law in New York that if you have had sex in the last 6 months you cannot donate blood despite that all blood regardless of donors sexual history is tested for any disease including AIDS.  That is called the work-around. And of course with Covid that is contagious via close contact,  the same way but without sex, meaning that coughing, sneezing, drooling, vomiting, diarrhea,  heavy sweat (as in a fever) makes this virus virulent and highly transmittable.  No it is not again in the air like measles, whooping cough or TB all by coming into contact via the air.  Covid is  flu like and that means close prolonged contact.  So keep moving and when out wash your hands immediately upon returning from those essential errands, then clean the surfaces that anything you brought in touched and dispose of those items, toss the gloves, the mask in the trash or in turn wash your mask after wearing and then finally clean your skin, such as a face or exposed areas again to eliminate any potential infection.  But no the virus is not floating in the air in the same way airborne diseases are unless again in a confined space.. you know the ones I keep mentioning.  But if you live in an apartment or home with others they have to follow the exact same protocol which means intense cleaning and agreement on that policy and good luck with that.  You might want to escape too.

I am all for my civil rights being ignored in a public health crisis and in a state of emergency, again 9/11 anyone. And that little office that housed ex-patriot Edward Snowden, is an example of what they did in the surveillance state. We have the capability and technology, Stingray’s anyone?  All available to monitor and track and trace people. So to have corporations such as Google and Apple come up with an App for that, I say no thanks.  Sorry but no. They are already underfire for either not providing or providing such information to law enforcement to use at their discretion and those cases of SWAT arriving at doors and taking down bad guys has worked out so well or not. What.ever. you decide.  And that is the problem, the lack of consistency, oversight, regulations and other issues that well ended up with stop and frisk, the drug wars and the new Jim Crow and the incarcerations of black men. It ends up with immigrants being detained for no actual crime and of course just innocent people getting caught in the crossfire.  So no thanks on that one.

I don’t take my phone anywhere.  I have a daily journal that I mark where I go and what I did that day and in turn most likely would provide that info if asked but most likely I would also tell the usual suspects whom I do contact regularly what my status is.  I also would do the testing at a private physician to speed up the results and also keep them private as unless I go to a hospital as it is a need to know basis and who needs to know?  I also know that as I am single, a woman and without an advocate I would be shoved onto a ventilator or put in some satellite facility as I don’t have health insurance.  So yes death panels do exist.   It is also why the journal along with all my directives, will and the like sits on my desk.  I have no ICE and there is no need as I am quite clear and there can be no confusion with it clearly marked and dated.  It is also notarized and updated annually.  So I have learned first hand how neglectful and abusive hospitals are.  Ask me about my experience at Harborview Medical Center in Seattle in 2012. They treated me like animal and I will never cheer medical personnel for as long as I live as a result.

Why this is so bad is  because right now no one is tracking, testing or tracing.  A woman here in Jersey City died from a heart attack brought on by an asthma attack; she originally was turned away from a hospital as she did not exhibit ALL of the symptoms(as if anyone does), got worse and by the time she returned to the same facility she was too ill and died.  Her death is listed as the result of a heart attack. Okay then, as she was never tested even in post mortem and yet since that time 9 others in her same building have all tested positive, a sort of mini hot zone if you will.  None of them knew about the other and there you go and the building was not cleaned or even touched to reduce the spread from day one.. at least in my building where we “know” of three units none of the staff knew until after and they are pissed, one quit.  So there you go. So much for public safety. Again the virus from symptoms to actual affects on the body varies and so if you are in at “at risk” group you should be tested immediately if one symptom is present, not because of a checklist, and in turn if you have other health issues immediately put on a 24-48 hour watch (many times it is week two when all hell breaks lose)  and that can be at a satellite facility with close contact upon release to ensure you are receiving appropriate, contactless care and in turn tested upon having no symptoms. That has not happened and again if it has what are the numbers for those cases and the results?

So why would you not escape as you aint’ getting shit. And neither are we.  And I would be happy to allow these facilities or organizations and hotels that are open of these kind of business to be available to treat all kinds of COVID patients and the like if they are just that, equipped, trained and able to do so.  Not so sure about that either as if you are short of PPE, etc then what do they have and are they able to do anything but handle the most minor of cases and if they do code then what?  So if this is about public safety and tax dollars we have the right to know and HIPAA has allowed us that much so cough it up… pun intended.

Tennessee, Nashville health officials provide names of those testing positive for coronavirus to police

Natalie Allison and Yihyun Jeong, Nashville
 Tennessean May 8, 2020

Gov. Bill Lee says the state’s release to police departments and sheriff’s offices the names and addresses of Tennesseans who have tested positive for the coronavirus is necessary to protect officers’ lives — information that is also being independently shared between city health officials and police in Nashville.

Lee told reporters at Second Harvest Food Bank in Nashville on Friday the details are only for those working “from a law enforcement standpoint” to know who has tested positive.

“We believe that that’s appropriate to protect the lives of law enforcement,” Lee said when asked why police need the information

The Tennessee Lookout, a new nonprofit news organization, first reported the agreement between local law enforcement agencies and the state Department of Health, which is releasing the information.

The agencies receiving lists from the state of individuals who have contracted the coronavirus include the Knoxville Police Department, the Nashville Airport Authority, the Montgomery County Sheriff’s Office and dozens more.
Nashville health officials share coronavirus patient data with police, fire officials

Separately, in Nashville, the Metro Health Department confirmed to The Tennessean Friday that officials have been providing to the Metro Nashville Police Department the addresses of people who have tested positive or are quarantined for COVID-19.

The data is inputted into the police department’s computer system so that any officer who has contact with an individual who has tested positive for the virus can take additional precautions, Metro Health spokesperson Brian Todd said.

Metro police spokesman Don Aaron said in a similar statement the department uses the information so officers can “take additional precautions.”

The information is also put into the Department of Emergency Communications dispatch system so that fire and EMS workers responding to an address can take steps to use increased personal protective equipment and distancing protocols.

“At no time is this data shared with the U.S. Immigration and Customs Enforcement (ICE) or the Davidson County Sheriff’s Office,” Todd said in a statement.

In a statement, Cooper spokesperson Chris Song reiterated Todd’s comments, and said the information is “safely kept” among Metro agencies.

“We are taking necessary precautions to protect both our first responders and our residents, including those who are part of Nashville’s diverse immigrant communities,” Song said, adding officials are communicating with community partners that the information will not be shared with federal immigration authorities.

“As Mayor Cooper has stated repeatedly, everyone deserves to feel safe in our community, including our front line personnel and the valued members of our immigrant communities,” he said in a statement.

Though the data isn’t not shared with the sheriff’s office, the health department said if a police officer arrests a person who has tested positive for COVID-19, they will inform sheriff’s personnel when releasing them into their custody.

All public safety personnel have been noticed that the information cannot be publicly released and is for “official use only,” Todd and Aaron said. Unauthorized use is a violation of Metro police policy.

The information is updated regularly, and once a person has recovered from COVID-19, they are removed from the list.

According to the Tennessee Department of Health, as of Friday 68 police chiefs and sheriffs have signed on to a memorandum of understanding that they will receive a running list of names and addresses of individuals in Tennessee “documented as having tested positive, or received treatment for COVID-19.”

The list is updated for law enforcement each day, the MOU states, and individuals’ names are removed from the list after 30 days.

Metro police and the Davidson County Sheriff’s Office have no plans to move into an agreement with the state, according to both Aaron and Todd.

Hedy Weinberg, executive director of the American Civil Liberties Union of Tennessee, criticized the policy’s impact on privacy and said it’s more important for law enforcement “Protecting the health of first responders is certainly an important priority. However, as public health experts have noted, disclosing names and addresses of positive cases does not protect first responders, as many people have not been tested and many people who do carry the virus are asymptomatic,” Weinberg said in a statement.

“Disclosing the personal information of individuals who will never have contact with law enforcement raises fundamental concerns about privacy without yielding a significant public health benefit. It is incumbent that any government policy implemented during the pandemic be grounded in science and public health and be no more intrusive on civil liberties than absolutely necessary.”

The Tennessee Immigration and Refugee Rights Coalition has worked during the pandemic to reduce barriers preventing immigrants statewide from getting care and have formally partnered with Metro Nashville and other organizations to increase more community outreach.

In a statement posted on Twitter Friday, TIRRC said the state’s policy to share information with law enforcement should be “rescinded immediately.”

“This completely undermines all of the work organizations like ours are doing to encourage people to go get tested. This will exacerbate the public health crisis,” TIRRC said.

The group did not immediately respond to a request for comment about Nashville’s policy.

Lee said Friday the state was providing this information to law enforcement agencies in compliance with guidelines put forth by the federal Department of Health and Human Services.

A document published by DHHS’ Office for Civil Rights states the HIPAA Privacy Rule permits an entity like a health department to release protected health information to first responders “to prevent or lessen a serious and imminent threat to the health and safety of a person or the public.”

Shelley Walker, spokesperson fro the Tennessee Department of Health, said in a statement the department “believes these disclosures are necessary to avert a serious threat to health or safety.”

More than 14,000 people in Tennessee have tested positive for the virus.

Lee defended the information only being made available to law enforcement and not other front-line workers, such as grocery store employees who also must interact with possible coronavirus patients, by saying that officers are “required to come into contact with these people.

“We know that first responders are required to and law enforcement are required to come into contact with these people as part of their job,” Lee said. “That’s why Health and Human Services gave that guidance to states and that’s why we’re implementing that.” to focus on offering officers proper protective gear as a way to keep them safe.

“Protecting the health of first responders is certainly an important priority. However, as public health experts have noted, disclosing names and addresses of positive cases does not protect first responders, as many people have not been tested and many people who do carry the virus are asymptomatic,” Weinberg said in a statement.

“Disclosing the personal information of individuals who will never have contact with law enforcement raises fundamental concerns about privacy without yielding a significant public health benefit. It is incumbent that any government policy implemented during the pandemic be grounded in science and public health and be no more intrusive on civil liberties than absolutely necessary.”

Dr. Facebook

The data mining crosses any boundaries and do so with or without your consent. This horror story of Target makes the Hunter fiasco this past weekend just a rain boot in the sand.    Irony that even if you are shopping for someone else or planning for the future,  buying for donation purposes, the algorithm has you pegged and noted regardless.

When I read this once again nothing surprises me when it concerns the medical industrial complex and the tech industry. These are the robber barons of the new age, they exploit and capitalize on fear and ignorance.  Just watching the Senate question his Majesty, Mark Zuckerberg, was enough to know that Congress is not in the know when it comes to technology.  Obama was a lover of this industry and gave them ample opportunity to educate and in turn regulate the industry through one who would have been favorable but at least realistic to what is actually going on when it comes to data mining.  Alas, poor Yorick, you died of a temporal lobe injury.

With the growth of online medical industry applications and insurance,  hello Kushner run Oscar health, the idea of Amazon and Warren Buffet with Chase attempting to develop an insurance company it is only a matter of time that you can get Amazon Prime insurance via Chase and get points all while Warren Buffet sits and does nothing but claim to give a folksy shit.  It is all great right?

You have no anonymity, no right to privacy, no right to be forgotten.  Every query, every mistake, every curiosity, inclination, dalliance or passing interest is duly noted and it comes back like a Boomerang just in case you need/want/care about it again.

Facebook is a succubus and it takes and takes and what do you get in return?  Farmville and an update on your high school friend’s marriage. Really that matters to you?  Get a book and read about others that are not about you.  

Facebook knows a ton about your health. Now they want to make money off it.
by Kirsten Ostherr The Washington Post April 18 2018

Let’s say you have had discussions on Facebook about your breast cancer diagnosis. It has been a useful forum for comparing treatment options with others who have dealt with similar health issues. There’s only one problem: Facebook has now categorized you as a patient, and you constantly receive precisely targeted ads about cancer services available near you. They are showing up on your computer screen at work, for all your co-workers to see, right when you’re up for a big promotion.

Many users experience a version of this scenario when they receive creepily personalized ads while browsing on Facebook. When those ads follow users onto sites outside Facebook, it feels like an invasion of privacy. But how do you regulate data privacy in an age of big-data black boxes?

Mark Zuckerberg’s testimony about the Facebook-Cambridge Analytica scandal alerted users about what personal data Facebook routinely collects and shares with third-party apps. But many questions were left unanswered. How many apps are collecting this data, and what are they doing with it? Are there more Cambridge Analyticas out there? It took a political scandal to get the attention of Congress this time. Where will it happen next, and how long will it be before the public finds out?

While Zuckerberg claimed even he is not fully aware of everything that happens in the Facebook digital economy, the evidence suggests health-care information may lead to the next major data-related crisis.

In early April, MSNBC reported that Facebook recently launched a project based in its secretive “Building 8” group to get hospitals to share anonymized patient data with them. The project was reportedly put on hold in the wake of the current scandal, but the stated plan was to match hospitals’ patient data on diagnoses and prescription information with Facebook so the company could combine that data with its own to construct digital profiles of patients.

Even setting aside the voluminous evidence showing that true anonymization of data is virtually impossible, Facebook’s stated intent was never to leave the data anonymized. But requesting the hospitals’ data in that form would allow Facebook to sidestep the issue of obtaining patients’ consent, as required by federal law.

The company has reason to believe that, if asked, patients would not consent to this practice. In 2016, Facebook was sued by a metastatic cancer patient who accused the company of violating his privacy by collecting data about his participation on cancer websites outside of Facebook. The case was dismissed and is under appeal, but this clearly has not stopped the company from pursuing data initiatives in health care.

Indeed, Zuckerberg admitted in his congressional testimony last week that Facebook does collect some medical data from users. Considering the large number of patient support groups on Facebook that use the site for peer-to-peer health care and social support, there is plenty of medically relevant data to be mined. Membership in some patient groups numbers in the tens of thousands, with average daily posts of several hundred or more. A sampling of the types of data users post includes “tests, treatments, surgeries, sex drive, and relationships” on a breast cancer support site. Other data include location, personal profile information such as age, race, sex, educational background, employment, even cellphone numbers. In addition, many posts include photos that can be subjected to facial recognition software.

It is not surprising that Facebook wants to move into the digital health market: So does Amazon.com, Google, Apple, Uber and all of the other big tech companies. These businesses see an opportunity to profit from user’s personal health data because, unlike narrowly defined medical data, health and wellness data is not considered protected health information and therefore is not protected by privacy laws.

In contrast to the personal data users might post on Facebook, patient records at hospitals and other covered entities are protected by privacy laws such as the Health Insurance Portability and Accountability Act (HIPAA). Yet, for years, patient data has been sold to medical data miners and brokers in a multibillion-dollar global trade. The pharmaceutical industry is a major player in this marketplace, spending billions of dollars annually on direct-to-consumer advertising aimed at influencing physicians’ prescribing practices and patients’ requests for brand-name drugs. But social media companies such as Facebook struggled to attract this lucrative advertising market.

In June 2017, Facebook addressed this challenge by convening drug marketers at the inaugural Facebook Health Summit, an event where the company wooed the pharmaceutical industry with new features designed to address their specific needs. Danielle Salowski, Facebook’s industry manager for health, said the company re-engineered its advertising features so pharmaceutical advertisers could turn off comments on their Facebook brand pages and on their ads, to help them avoid the negative publicity associated with the legal requirement of reporting adverse reactions to drugs.

This activity could simply be understood as advertising in the age of big data, a practice our society has so far agreed to accept. But the unique risks from health- and medical-data mining and digital profiling of patients suggests greater stakes worthy of regulatory attention. Congress accused Facebook of illegal marketing of opioids and noted that many other types of drugs are also sold on the platform. Patients with life-threatening conditions or limited means to pay for health care are at greater risk of harm from targeted advertising of products or services by unscrupulous vendors.

In addition, the lack of transparency, increasing interconnection of health and technology, and growing reliance on risk modeling in health care means that combining health- and medical-data sources to target patients could harm anyone who has a serious illness or the risk of developing one. The insurance industry uses social media intelligence and profiling to inform algorithms that automate pricing, claims handling and fraud detection. When health risks are understood as financial risks, contextual information from users’ digital profiles can be used against them to raise premiums or deny claims. That means everyone is at risk.

Members of Congress were criticized for displaying through misguided questions their lack of understanding about how Facebook works. But in the current data economy, Facebook and other big tech companies operate as black boxes that are impossible for outside users to fully understand. We really don’t know most of the time what is being done with the data we post online, except when housing discrimination, exploitative advertising practices or foreign interference in elections is exposed. The Cambridge Analytica scandal revealed at least 87 million of us are at risk of being exploited or discriminated against.

And really, why should we trust Facebook and third-party app developers to respect users’ privacy when their business model depends on doing the opposite? Facebook clearly recognizes the enhanced value of its user data when combined with medical data. That should tell lawmakers the definition of “protected health information” needs an update. If we can still think of big data as something that could be harnessed for social benefit, we need to create regulations that allow users to consent to participate, like they do in clinical trials. We don’t need to lock down all the data; we just need to distribute the power to access and share it so patients and future patients receive benefits, rather than harms, from sharing their experiences online.

Right to Privacy

As I wrote in the last blog post about your Medical Records you need to understand that while you have a hard time getting accurate copies, there are those who have no problem doing so and using them to assess your job prospects, your credit and your monetary information.

Your health records are supposed to be private. They aren’t.
The federal law that protects health information is violated often and easily, and it’s hardly ever enforced.

By Charles Ornstein
The Washington Post
December 30, 2015
 

Charles Ornstein is a senior reporter at ProPublica, a nonprofit investigative news organization based in New York.

Seven years ago, I sat across from Farrah Fawcett in the living room of her Los Angeles condo. In what would be her last media interview before she died in 2009, the actress described her suspicion that an employee at UCLA Medical Center had shared details of her cancer treatment — and the setbacks along the way — with the National Enquirer.

Whenever she sought treatment there, the tabloids were quick with a story, even if it wasn’t right. “I actually kept saying for months and months and months, ‘This is coming from here,’ ” Fawcett told me. “I was never more sure of anything in my life.”

To prove her theory, Fawcett had set up a sting: In May 2007, she withheld news of her cancer’s return from nearly all of her relatives and friends. Within days, the story was in the Enquirer. “I couldn’t believe how fast it came out,” Fawcett said. A UCLA employee was caught and charged with selling information to the tabloid. She pleaded guilty but died before she was sentenced.

In 2008, prompted by Fawcett’s experience and those of other celebrities, California passed a law authorizing fines on hospitals that fail to protect patient privacy. Gov. Arnold Schwarzenegger signed it; his then-wife, Maria Shriver, was one of those whose records had been accessed inappropriately at UCLA.

At the time, I thought that this was a problem largely confined to the People magazine world of celebrities and that this law would quash the prurient interest in their medical records.

I was wrong.

After spending the past year reporting on loopholes and lax enforcement of the Health Insurance Portability and Accountability Act, the federal patient-privacy law known as HIPAA, I’ve come to realize that it’s not just celebrity patients who are at risk. We all are.

Over the course of my reporting, I’ve talked to hundreds of people who say their medical records were hacked, snooped in, shared or stolen. Some were worried about potential consequences for themselves and their families. For others, the impact has been real and devastating, requiring therapy and medication. It has destroyed their faith in the medical establishment.

I spoke to Jacqueline Stokes, a cybersecurity consultant whose story I wrote about in The Washington Post. When she went to what was supposed to be a secure website to check the results of a paternity test she’d purchased at a local pharmacy, she stumbled upon 6,000 other people’s test results. She complained to the federal regulator that enforces HIPAA, but she was told that the lab wasn’t covered by the law — when it was drafted in 1996, its authors probably hadn’t imagined such things as over-the-counter paternity tests. Stokes gave up when she was told to contact a different agency.

I met Kenneth Chanko, whose dad, Mark, was rushed to NewYork-Presbyterian Hospital/Weill Cornell Medical Center in 2011 after being struck by a sanitation truck. Unbeknownst to his family, a real-life medical show, “NY Med,” was filming in the hospital at the time. The following year, Mark Chanko’s widow was watching the show on ABC and realized that the blurred-out man dying on the TV screen in her living room was her husband. No one had told the family — or asked for permission. The Chankos filed a lawsuit against the hospital and the TV network, as well as a complaint with the Department of Health and Human Services’ office for civil rights, which enforces HIPAA. The lawsuit was dismissed and is being appealed to New York’s top court. The complaint with the civil rights office, filed in January 2013, is pending. In the meantime, New York City’s hospitals voluntarily agreed this summer not to allow commercial filming of patients without their permission.

I talked to Edie McGee, a lawyer for a federal agency who lives in Maryland and whose name was leaked to the press in 2003. She had just returned from China after adopting her daughter when she came down with an upper respiratory infection. Doctors suspected she had the SARS virus. Before the lab results even came back, a Washington Post reporter showed up at her door, and other media outlets wanted interviews, too.

And I spoke with a woman named Frances whose diagnosis with a sexually transmitted disease was plastered on Facebook by a former friend who worked at the Indiana hospital where she received treatment. “PLZ HELP EXPOSE THIS HOE!” the public post said. The hospital apologized, but Frances now drives miles out of her way to go grocery shopping so she can avoid people in her town. I was surprised by just how many health workers have leaked details about acquaintances who have STDs.

I’ve written about nursing-home workers who posted dehumanizing, explicit photos of residents on Snapchat and about a New Jersey psychology practice that didn’t redact patients’ mental health diagnoses or treatments as part of legal actions to secure payment of unpaid bills. Even the names and diagnoses of minors were included.

In each story, a common theme emerged: HIPAA wasn’t working the way we expect. And the agency charged with enforcing it, the HHS office for civil rights, wasn’t taking aggressive action against those who violated the law.

We all know HIPAA, whether we recognize the acronym or not. It’s what requires us to stand behind a line, away from other customers, at the pharmacy counter or when checking in at the doctor’s office. It is the reason we get privacy declaration forms to sign whenever we visit a new medical provider. It is used to scare health-care workers, telling them that if they improperly disclose others’ information, they could pay a steep fine or even go to jail.

But in reality, it is a toothless tiger. Unless you’re famous, most hospitals and clinics don’t keep tabs on who looks at your records if you don’t complain. And even though the civil rights office can impose large fines, it rarely does: It received nearly 18,000 complaints in 2014 but took only six formal actions that year. A recent report from the HHS inspector general said the office wasn’t keeping track of repeat offenders, much less doing anything about them.

[Who is protected by patient privacy laws? Hint: not patients.]

Making matters worse, HIPAA does not allow patients to sue health providers for damages if they violate the law. So if the federal government doesn’t enforce the law, there are often no consequences for breaking it, though some patients have found grounds to sue under some states’ laws.

What can be done? For one, the HHS civil rights office could use tools already at its disposal: When the office imposes fines for HIPAA violations, it gets tokeep the money for its own enforcement efforts, rather than hand it over to the treasury. Experts I interviewed said the agency needs to use its authority more and demonstrate that it’s serious about violations, particularly repeat ones. ProPublica recently analyzed data requested under the Freedom of Information Act and found that hundreds of health providers have been cited for violations multiple times. The top offender was the U.S. Department of Veterans Affairs, followed by CVS Health.

Moreover, the government needs to write regulations to implement provisions of a 2009 law that would give patients whose privacy has been violated a share of the money HHS recovers. Finally, the government has yet to submit to Congress a report due in 2010 with recommendations for how to deal with the privacy of health information not covered by HIPAA.

For our part, we as patients — and loved ones of patients — need to stay vigilant. We need to ask for and keep copies of our medical records. We should look for errors and ask for corrections. Beyond that, we can request a list of who has accessed our records. And we can ask health facilities to restrict who can access them (although a provider is not required to agree). You can speak to your hospital’s or clinic’s privacy or compliance officer with these requests.

After my mom died in 2013, I worried that her death might have been caused by a medical error. In the course of trying to investigate, I asked for a listing of everyone who had looked at her records. It was dozens of pages, and even though I’d been writing about health care for more than 15 years at that point, I couldn’t make much sense of it. I didn’t know who the people were or why they had looked at her records. I’m sure many, if not all, of them had legitimate reasons to do so — to take her blood, process her prescriptions, adjust the settings on her ventilator, etc. That said, now that I know about the steps I can take to protect myself, I’m pretty sure I will take them going forward.

Ultimately, though, privacy boils down to trust. It has to. If we need medical care, we seek it — and whether our records will be kept secure is generally not foremost in our minds.

I’ve thought often this year about how what Fawcett told me years ago foreshadowed a much bigger problem. “I’m a private person,” she said. “I’m shy about people knowing things. And I’m really shy about my medical” care.

“It seems that there are areas that should be off-limits.”

In Confidence

As this is a case in my backyard I am not surprised that I read about in the New York Times.  A couple of years ago a young man in the hipster area of town had a meltdown and it led to Police called and ultimately his death.   Not the first in many cities as we know the Santa Barbara area mass shooter had been visited by the Police at the request of his parents concerned he was a danger to himself and possibly others.

The law enables any Physician or Therapist/Licensed to Professional  to contact law enforcement if they believe that their patient is capable of such.  It is called “Duty to Warn” or “Duty to Protect”  This law differs in many states but in this case and in this State it is mandated by law.

We already have States adding to this, drug use and positive drug or alcohol tests to law enforcement for varying reasons, often leading to children being removed from the home or being arrested for another warrant unrelated to the cause or reason for treatment.  The Police already have a reciprocal if not co-dependant relationship with Doctors and Nurses to be complicit in warrant-less blood/urine draws so having access to mental health diagnosis or treatment plans just seems another idea bad to to the bone.

What is not a bad idea is to have members of the force designated mental health evaluators to better handle calls that are about individuals who have demonstrated mental health problems as noted by the callers and in turn that may prevent these individuals from being shot by the Police or in turn place themselves or others in situations where they could in fact do harm with others.

The idea of guns and possession is the other elephant in the room. The right to bear arms is not the right to wreak havoc with said guns. And if the Police believe or are aware that a gun might be in the possession of said individual then no one would complain if with or without warrant they entered the premise with appropriate SWAT, etc to retrieve the weapons. Funny they do that over drugs but not when it is about potential accelerated violence.  So is it the Doctor and his/her lack of information or the fact that Police have no interest in actually doing the job they were hired to do?

When you are in the room and you are ranting, mentally ill, simply volatile or emotional many things are often said in that state. That is the time for the said professional to asses if the patient is in fact simply venting or are actually providing a manifesto or plan of action. Again that is where professional and failure to do one’s job is the issue.  I know of a professional “therapist” who complained about his last patient who killed herself immediately after her confirmation that she had no intent of doing so.  Her death was not as import apparently is what I inferred from that, her death was not the problem.  I have little respect for those in mental health gigs as they are often the ones more in need. 

I see nothing good from ringing alarm bells when any patient talks smack. This will not end well regardless.
 
Protect Doctor-Patient Confidentiality

NOV. 19, 2015
The New York Times
Opinion Page
Sandeep Jauhar

WHEN should a doctor betray a patient’s confidence? This week the Supreme Court of the State of Washington heard arguments on this question in a case that has profound implications for the doctor-patient relationship.

In the case, Volk v. DeMeerleer, a psychiatrist, Howard Ashby, was sued after a patient of his, Jan DeMeerleer, shot and killed an ex-girlfriend and her 9-year-old son before killing himself. (Mr. DeMeerleer also stabbed another son, who survived.) The estate of the victims, Rebecca and Phillip Schiering, took legal action, arguing that Dr. Ashby was liable because he had not warned the Schierings. A lower court ruled in Dr. Ashby’s favor on the grounds that Mr. DeMeerleer, who had occasionally voiced homicidal fantasies, had made no specific threats toward the Schierings during his treatment.

But last November an appeals court reversed that judgment, asserting that doctors could be required to warn “all foreseeable victims” of potentially dangerous patients in their care. Whether the attack on the Schierings was foreseeable, the court said, should be decided by a jury..

Though the murder of innocents is obviously a tragedy, the Washington State Supreme Court should overturn the appeals court’s decision. Not only does that judgment greatly expand the circumstances in which psychiatrists would be required to violate patients’ confidentiality; those violations in the end would also not serve the purpose for which they were intended.

Throughout history, doctor-patient confidentiality has been a cornerstone of Western medical practice. The duty to keep patients’ information private is written into the codes of ethics of medical organizations, and is even in the Hippocratic oath: “What I may see or hear in the course of treatment,” it says, “I will keep to myself.”

Patients allow physicians into their private lives on the condition that the information we learn will not be used against them. I once took care of a business executive in the emergency room who had hired call girls during a weekend drug binge. When he saw a police officer outside his room, he quietly handed me an envelope containing a large amount of white powder. I wasn’t sure what to do with it, so I discarded it. For the next several hours the patient eyed me suspiciously, probably wondering whether I had ratted him out. But it never occurred to me to do so.

Of course, like all ethical imperatives, doctor-patient confidentiality is not absolute. Doctors have to disclose private information when it is clearly in the patient’s interest (documenting a drug allergy in the medical record, for example) or when it comes to complying with a court order (as in cases of child abuse). We must also betray confidentiality when it is in the “public interest” (reporting infectious diseases, for example).

The duty to warn third parties in danger is also an important exception to confidentiality. We publicly disclose the identities of sex offenders. We alert family members when hereditary diseases in our patients come to light. A colleague of mine once took care of a patient, a school bus driver, who received an implantable defibrillator after suffering cardiac arrhythmias. When my colleague advised the man to quit his job because of the potential risk to young children, the man refused, so my colleague reported him to the Department of Motor Vehicles. It was an action that my colleague felt very comfortable taking, even though it created an irreparable rift in that relationship.

In the same vein, doctors have a duty to warn individuals who are threatened by their patients with bodily harm. This obligation was largely shaped by the seminal 1976 case of Tarasoff v. Regents of the University of California, in which the Supreme Court of California ruled that mental health professionals had a responsibility to protect the intended victims of their violent patients through direct warning or by notifying the police. As Justice Matthew Tobriner famously wrote in the majority opinion, “The protective privilege ends where the public peril begins.” The case has served as a basis for law in 33 states obligating physicians to warn or protect third parties.

However, the Tarasoff case has generally been interpreted to confer an obligation to warn individuals who are specifically targeted by psychiatric patients. The lower court in Washington observed that Jan DeMeerleer communicated no threats toward the Schierings during his treatment. Predicting when violence will occur or where it will be directed is difficult under the most straightforward of circumstances. When the threat is not articulated, it is next to impossible.

The World Medical Association states that confidentiality may be breached when the expected harm of maintaining privacy is believed to be “imminent, serious” and “unavoidable.” This standard does not appear to have been met in the case before the Washington Supreme Court.

Breaching doctor-patient confidentiality in such situations will likely be self-defeating. Mentally ill patients may not seek treatment, and psychiatrists, saddled with new legal liabilities, may decline to treat them. We are more likely to minimize harm if the confidence of patients at the greatest risk for violence is maintained.

Doctor Doctor Give Me the News

This morning was an editorial from a Doctor and Professor at Yale regarding the rise and use of Electronic Medical Records as a part of the Affordable Care Act aka “Obamacare.”  Part of the funding included the requirement that Hospitals and Physicians use EMT to facilitate transfer of records and in turn reduce costs associated with duplication, misinformation and miscommunication as a presumptive reason for why costs are rising.  Well that may be one thing but as we recently found out that in fact that has enabled by far more duplicity and corruption than led to believe. And of course the Medical profession denies culpability blaming the Government for instituting the change without guidance.  They did that with regards to HIPAA too.  Considering how little regulation and intervention the Medical Industrial Complex has nationally let alone locally, its amusing that the most minimal of change that benefits of all things patients is seen as challenging.  And you thought Cancer was a bitch!

I think that EMT records are the new Titanic frankly. I have the evidence in my own 200 pages of farce that document my recent stay at Horrorview, clearly showing how little communication,  coordination and actual medicine takes place.  What does take place is extrapolation of data and phrases that others use to diagnose or dismiss their actual need to diagnose or do something.  To prove this I gave these records to two different Attorneys who did exactly the same thing. Well to be honest they make Doctors seem benevolent.   And recently I went to a Speech Therapist who chose to read and interpret my records in a non-sensical fashion – neither sequential nor chronological which in my case are the same, but instead she chose to isolate and in turn mis-sequence the order of issues I have faced as the result of my injuries.  Point-proven.

So when others say this matters because it happened to you, my response is yes but if it happened to me its happening to others. I am not that big of a narcissist to think I am that special and exclusive. I am afraid this incompetence and inaccuracy is more the rule than the exception.

Without appropriate guidelines, rules and in turn firewalls to protect one’s personal medical history and records expect further issues and problems to arise.  HIPAA frankly needs strengthening and tightening as it has more holes than the safety nets,  and the Medical matrix needs to be more accountable for their greed, laziness and ineptitude.  And not via the courts and malpractice but by regulation and supervision.  Consistency and mandatory expectations works so why not just do it. And no that doesn’t mean more paperwork or documentation what it means is simply better streamlined care and in turn substantiation of it.  Doctors are quick to criticize and condemn but be different, be brave and instead of acting like a member of dysfunction junction be different and do something. Work with Legislators, the DSHS, Attorney Generals and other groups to find ways to make the process easier for both patients and Doctors.  If you are so smart then prove it.

A Shortcut to Wasted Time

By LEORA HORWITZ

A FEW years ago, we doctors kept handwritten charts about patients. Back then, it sometimes seemed like we spent half our time walking around looking for misplaced charts, and the other half trying to decipher the handwriting when we found them. The upside was that if I did have the chart in front of me, and I saw that someone had taken the trouble to write something down, I believed it. 

Unfortunately, this is no longer the case. The advent of electronic medical records has been a boon to patient safety and physician efficiency in many ways. But it has also brought with it a slew of “timesaving” tricks that have had some unintended consequences. These tricks make it so easy for doctors to document the results of standard exams and conversations with patients that it appears more and more of them are being documented without ever having happened in the first place. 

For instance, doctors used to have to fill out a checklist for every step in a physical exam. Now, they can click one button that automatically places a comprehensive normal physical exam in the record. Another click brings up a normal review of systems — the series of screening questions we ask patients about anything from nasal congestion to constipation. 

Of course, you shouldn’t click those buttons unless you have done the work. And I have many compulsively honest colleagues who wouldn’t dream of doing so. But physicians are not saints.

Hospitals received $1 billion more from Medicare in 2010 than they did in 2005. They say this is largely because electronic medical records have made it easier for doctors to document and be reimbursed for the real work that they do. That’s probably true to an extent. But I bet a lot of doctors have succumbed to the temptation of the click. Medicare thinks so too. This fall, the attorney general and secretary of health and human services warned the five major hospital associations that this kind of abuse would not be tolerated. 

And then there are the evil twins, copy and paste. I’ve seen “patient is on day two of antibiotics” appear for five days in a row on one chart. Worse, I’ve seen my own assessments of a patient’s health appear in another doctor’s notes. A 2009 study found that 90 percent of physicians reported copying and pasting when writing daily notes. 

In short, reading the electronic chart has become a game of looking for a small needle of new information in a haystack of falsely comprehensive documentation and outdated, copied text. Why do we doctors do this to ourselves? Largely, it turns out, for the same reason most people do most things: money. 

Doctors are paid not by how much time they spend with patients, how well they listen or how hard they think about what could be wrong, but by how much they write down. And the rules for what we have to write are Byzantine: Medicare’s explanation takes 87 pages. To receive the highest level of payment for an office visit, I have to document several aspects of the main problem, screening questions about at least 10 organ systems, something about the patient’s family and/or social history, and/or a lengthy physical exam. In addition, I have to demonstrate that my medical decision making was very complicated, considering the number of possible diagnoses and treatments, the complexity of the data and/or the patient’s risk of serious complications. That type of visit is supposed to take about 40 minutes. 

Last week, I spent 40 minutes with a patient who had just placed her mother into hospice care. My patient was distraught, not sleeping, not eating. I gave her some advice, but mostly I just listened. By the end of our visit, she was feeling much better. But I wouldn’t be able to bill much for that visit based on my documentation: I didn’t review her medical or family history, conduct a review of organ systems or perform a physical exam. 

What the payment system tells me to do is to cut her off after 10 minutes, listen to her heart and lungs and give her a sleeping pill. Which doctor visit would you prefer? 

Of course, I would never go back to the bad old days of lost charts, illegible writing, manual prescription refills and forgotten information. Electronic medical records help us avoid dangerous drug interactions and medical ordering errors, remind us to provide preventive care and allow us to view data as trends over time. Even copy and paste have legitimate uses. 

But physicians need to be better stewards of our records so they remain useful, regardless of skewed incentives and new technology. And as a nation, we should question whether paying physicians by documentation — instead of by time spent on quality patient care — is such a great idea after all.