HIPAA-Its Negative Influence on Mental Health Care?
I recently received this letter about HIPAA from a husband who believes it played a role in his wife’s death. I was saddened to read his letter, but grateful to him that he is speaking out in order to do something to improve health care in his wife’s memory. With his permission, we are sharing it with you- the patient safety community- to generate discussion. We would love to hear your thoughts. Sorrel and the Josie King Foundation Hi Sorrel: Nearly three years ago, my wife took her life shortly after an anti-depressant prescription change. She had been treated for depressive illness for several years. The change, a very risky period when psychotropic drugs are consumed, produced dramatic mood changes, a continual desire to sleep and other danger signs all indicated on the manufacturer’s warning label. The manufacturer also stressed that no one should take the medication without the knowledge of family or others close to the patient. Unfortunately, my wife was essentially alone in her medication program. Although she had told me she was taking anti-depressant and anti-anxiety drugs, I did not know the details of possible side effects, including a suicide risk. Her doctor, who knew the manufacturer’s emphasis on family awareness, failed to advise the family or counsel my wife to make sure I and other loved ones knew the risks and their danger signs. The doctor elected to prescribe the drugs without counsel, citing HIPAA confidentiality restrictions. HIPAA, The Health Insurance Portability & Privacy Act of 1996, was originally intended to control electronic distribution of personal medical information by insurance companies. It has since evolved to become a much broader restrictive force. My wife had elected confidentiality at the beginning of treatment, assuming it would apply to the content of sessions with the psychiatrist and therapist, not to the details of medication, especially the risk of fatal reactions. Medical staffs receive regular briefings that focus on HIPAA penalties which have created a high level of paranoia among health care providers to the point where they are intimidated from passing essential knowledge to those, especially the spouse, who are in most frequent contact with patients. Family awareness is arguably most essential because doctor monitoring of anti-depressant medication is undependable, especially during the risky medication change periods. Policy, established by the American Psychiatric Association, requires that medical providers check the patient at least once every seven days. In my wife’s case that was too late. She demonstrated negative reaction the day after prescription change. Doctors expect the patient to call if there is a medication problem before the next appointment. But my wife was in no condition to call anyone. She probably did not realize she was having a reaction. And she was a registered nurse with 40+ years of experience. And I, who noticed her behavioral changes immediately, did not see them as potentially dangerous, and certainly not suicidal. But I had not been briefed. There was no family awareness. My wife was essentially alone as a direct result of misguided HIPAA interpretation. Before more lives are lost, HIPAA needs to be revisited by Congress and its implementing agency, the U.S. Department of Health & Human Services. HIPAA is going in the wrong direction. It has become a barrier to effective health care. Disclaimer: These views are those of the author, not those of the Josie King Foundation.