The following HIPAA-related documents are
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2003 Code
of CooperationPdf
File (also viewable below) (13 pages, 73 kb) Created by the
Oregon Association of Hospitals and Health Systems to define
the relationship between health-care organizations and the press.
45 CFR, 160 and 164Pdf
File (60 pages, 334 kb) The complete
text of Title 45 of the Code of Federal Regulations, Parts 160
(General Administrative Requirements) and 164 (Security and
Privacy), as published in the Federal Register. This represents
the complete HIPAA regulation.
Summary of the HIPAA
Privacy RulePdf
File (25 pages, 372 kb) Summary document
issued by the US Dept. of Health and Human Services, Office
for Civil Rights, attempting to clarify the privacy aspects
of HIPAA.
This document is provided to assist both health care facilities and
the news media in communicating facts and data about patients. The
Code acknowledges a shared responsibility to provide accurate information
to the public, and to assure patients and health care providers that
the gathering and reporting of this information is consistent with
state and federal laws and does not infringe upon patient privacy,
professional medical ethics, or patient care. Oregon
Association of Hospitals and Health Systems (OAHHS) published the
Code of Cooperation with editorial contributions from member organizations
and the Oregon Medical Association (OMA). These guidelines should
be adapted to the news media policies of individual health care providers
and facilities. Definitions
For purposes of this Code:
“Health Care Facility”
means a hospital, hospital-owned clinic, outpatient facility, ambulance,
nursing facility or hospice.
“Disaster" means any
man-made or natural event that causes significant loss of life, injury
or illness.
“Patient Condition” includes the following standard terms when
describing a patient's condition:
Good: Vital signs such as pulse, temperature and
blood pressure are stable and within normal limits. Patient is
conscious, comfortable and there are no complications.
Fair: Vital signs are stable and within normal
limits. Patient is conscious and alert although may be uncomfortable
or in pain and may have minor complications.
Serious: Vital signs may be unstable or outside
normal limits. The patient is acutely ill or injured and may have
major complications.
Critical: Vital signs are unstable or outside
normal limits. There are major complications. (Most patients in
an intensive care unit are considered critical until ready to
be moved to a regular nursing unit.)
Undetermined/Under Evaluation: Patient in the
process of receiving physician assessment.
Note: "Stable" is not a condition.
“Personal representative” means:
A person appointed as a guardian under state law;
A person appointed as a health care representative under state
law to make health care decisions or mental health treatment decisions;
or
Such other person as designated in the health care facility’s
policies and procedures.
Health Insurance Portability and Accountability
Act of 1996
In 1996, Congress passed the Health Insurance Portability and Accountability
Act (HIPAA). In response to the privacy requirements of the Act, the
federal Department of Health and Human Services adopted regulations
specifying the conditions under which health care facilities, physicians
and other health care providers may release individually identifiable
health information. See 42 CFR 164.500 et. seq. HIPAA changes how
health care facilities may release patient information to the media
and others. Guidelines for Health
Care Facilities
In an effort to be helpful and responsive to the media, OAHHS and
each health care facility will designate an authorized spokesperson
to be accessible to the news media at all times. The spokesperson
serves as the primary resource for the news media and assumes responsibility
for coordinating exchange of information from and access to the health
care facility. When requested or allowed by a patient or a patient's
family, the health care facility spokesperson will direct calls to
the patient's designated spokesperson. News media
in the community served by the health care facility should be informed
of the facility's designated spokesperson(s). It is the health care
facility's responsibility to keep this information current.
When a physician's approval is necessary to release information,
the health care facility spokesperson will assist the reporter to
obtain this information. Before releasing an attending
physician's name, the health care facility spokesperson must get the
physician's approval. However, the spokesperson may acknowledge that
a patient is under the care of the health care facility staff, if
appropriate patient permission is obtained. See the discussion
of HIPAA, page 10. When a health care facility
invites the news media to cover a story, the facility will provide
reporters with requested follow-up information and access consistent
with the Code. The health care facility spokesperson
is responsible for obtaining information about patients as rapidly
as possible without interfering with the health, welfare or privacy
of patients. No information that violates the confidentiality, privacy
or legal rights of the patient can be given. See Psychiatric, Drug
and Alcohol Abuse Cases, and Unusual Circumstances. Guidelines for Physicians
The communications director or designated staff members of Oregon
Medical Association (OMA) will be available to the news media to help
get prompt and accurate information on health and medical subjects.
If information is not immediately available to comply with news media
deadlines, OMA will inform the news media and, depending on the nature
of the request, either continue to gather the information for a later
deadline, or refer the reporter to another competent authority as
a resource. Officers, committee chairpersons or designated
spokespersons of OMA are expected to agree to be quoted by name in
matters of public interest for the purpose of authenticating medical
information. This policy is not to be construed by
OMA members as a breach of the time-honored medical practice of avoiding
personal publicity. It is intended only to serve the best interests
of the public and the medical profession. In matters
relating to the private practice of medicine, physicians are encouraged
to give information to the news media, as long as the physician fully
complies with the HIPAA privacy regulations and all other patient
privacy rights. The physician may choose, however, to provide information
through a health care facility or OMA spokesperson. Guidelines for News Media
It is the responsibility of the news media to determine what constitutes
news. It is the responsibility of physicians and health care facilities
to safeguard each patient's life and health. Therefore, health care
providers and the news media should work cooperatively together to
safeguard patient privacy and well-being and report news accurately
and promptly. Access to Health
Care Facilities and Patients
Health care facilities are bound by state and federal laws, regulations
(including Oregon Administrative Rules Chapter 333) and policies that
restrict public access to certain service areas and departments. Before
entering a health care facility, reporters and photographers should
obtain permission from the health care facility and abide by facility
rules regarding media access. When using a tape
recorder, the reporter should advise the health care facility spokesperson,
patient or physician prior to questioning. (ORS 165.540) Access to
a patient for an interview, photograph or videotaping will be arranged
if the patient or patient's personal representative has signed a written
authorization and the patient's condition permits. The health care
facility will assist a reporter in accessing a patient by attempting
to obtain written authorization from the patient or the patient's
personal representative. Health care facilities urge
reporters to provide advance notice of visits so that arrangements
can be made to ensure that electronic equipment used by the news media
will not impede patient care and/or patient confidentiality will not
be compromised. In some areas of the health care facility, news people
may be required to wear special clothing and have their equipment
disinfected or protected. Release
of Information to News Media
To facilitate prompt and accurate response to news media inquiries,
reporters should direct inquiries to the health care facility spokesperson.
HIPAA privacy regulations, health care facility
privacy policy and common sense dictate how a health care facility
or other health care provider may use and disclose individually identifiable
health information. Release of information about certain patient situations
and conditions is further controlled by state and other federal law.
See state HIV regulations, Psychiatric, Drug and Alcohol Abuse
Cases. HIPAA and Release
of Patient Information to the Media With a Signed, Written Authorization
See the OAHHS Sample Media Authorization form on the OAHHS
HIPAA website at www.oahhs.org If a patient or the
patient’s personal representative has signed a written authorization
allowing release of information to the media, the health care facility
may release the information indicated on the authorization to the
media representative(s) specified on the authorization. The following
frequently requested information specifically requires patient authorization:
A detailed statement about a patient's condition
Taking photographs of a patient
Interviewing a patient
Confirmation of patient age, gender, admission and discharge
dates and city of residence.
Prognosis should only be released if, in addition to patient
authorization, the physician has approved release.
Remember that if a patient or his personal representative signs an
authorization form, the health care facility may release only the
information specified on the authorization form and release that information
only to the media specified on the form. See the
definition of “personal representative” in the definition section
of this Code. Without
a Signed Written Authorization
Without a written patient authorization, HIPAA allows a health care
facility or provider to release only location in the facility and
one-word general condition (refer to the definition of “patient
condition” in the definition section of this Code), and only if the
following requirements are met:
The media representative asks about the patient by name;
and
The provider has told the patient this information may be released
and the patient has not expressly stated that he/she does not
want this information released.
Asking for the patient by name may be difficult for media representatives.
They may be able to access this information through police, fire or
other public officials. Incapacitated
Patient
In some cases, patients will not have had the opportunity to state
a preference about having their information released. For example,
a patient's medical condition may prevent health care facility staff
from obtaining authorization or asking about information preferences
upon admission. If the patient is unable to sign an authorization
or object to release of condition and location information, that condition
and location information may be released only if the reporter has
the patient’s name and past patient preferences are known, or such
release is determined to be in the best interest of the patient, in
the professional judgment of the medical service provider. Public Airwave
The fact that patient information may already have been disclosed
over public airwave does not affect the health care facility's obligation
to protect patient information under HIPAA. Information in those circumstances
will be released following the same guidelines for other disclosures
under HIPAA. Interviews
and Photographs
Media-requested photographs, videotapes or interviews can be granted
only with the patient's written authorization. When the patient is
a minor, written authorization of a parent or personal representative
must be obtained. The patient's physician should be informed of news
media requests. Requests to interview or photograph
a patient under arrest or in custody will be handled in consultation
with the police department or government agency holding jurisdiction.
The health care facility spokesperson may stay with the
news media and the patient throughout the session to provide assistance.
News media coverage of unconscious patients, or patients
suffering from severe illness or injury, will be permitted only with
written authorization of the patient's personal representative. Special Situations Police and Accident Cases
Information about police and accident situations is the most frequent
request a health care facility receives from the news media. HIPAA
treats victims (or perpetrators) of a crime or accident the same as
any other patient when the media seeks health information about them.
See page 11, Without Written Authorization. In
addition to HIPAA requirements, the health care facility may not make
a statement as to whether a patient was intoxicated, whether injuries
were the result of assault or an attempted suicide, whether a patient
is suspected of being a drug addict, the circumstances in which a
patient was shot or stabbed, or the details relating to an automobile
accident and whether there was an arrest. News media may be referred
to law enforcement for matters that are still under police investigation.
If written authorization from the patient or the patient's
personal representative is obtained, further medical information dealing
with specific injuries may be given by health care facility spokespersons
as follows:
Fractures (except head injuries): Indicate the part of
the body involved and whether the fracture is simple or compound.
The words "possible" or "probable" should be used when a diagnosis
is not available.
Injuries to the head (except fractures): A simple statement
may be made that there are injuries to the head. However, it may
not be disclosed that the skull is fractured. No opinion may be
given regarding severity of the head injury until the condition
is definitively determined by a physician.
Trauma and internal injuries: Trauma cases usually involve
injuries to more than one body location. A statement may be made
that there are multiple trauma injuries. It may be stated that
there are internal injuries, and the general site of such injuries
may be given.
Unconsciousness: If the patient is unconscious when brought
to the hospital, this fact may be stated. However, the cause of
unconsciousness may not be given.
Shooting or stabbing: A statement may be made that there
is a gunshot or stabbing wound and its position indicated. The
health care spokesperson may not state how the accident occurred
(i.e., accidental, suicidal, homicidal, etc.), nor describe the
situation under which it took place.
Paralysis, loss of limb: No statement may be made without
permission from the family or designated health care representative.
Hospitals and the news media recognize that in cases of paralysis
or loss of limb, there is great emotional turmoil for the patient
and family. Often the family opts to wait for a short time to
tell the patient of the extent of his or her injuries. In such
cases, both hospital personnel and the news media will cooperate
to ensure that the patient's privacy is protected.
Burns: A statement may be made that the patient is burned
and the health care facility spokesperson may identify the area
of the body involved. A statement as to the severity and extent
of burns may be made if indicated by the physician.
Poisoning: A statement may be made that the patient is
being treated for a suspected poisoning. The cause of the poisoning
may not be described (such as suicidal, homicidal or accidental).
However, when poisoning is proven to be accidental and reported
to public authorities, the hospital spokesperson may confirm the
nature of the poisoning. The product ingested should be described
generically (such as "weed killer" or "detergent") and not by
trade name. When the ingested material has not been identified,
this fact should be so stated.
Battered children: No statement shall be made that a
child's injuries appear to be the result of child abuse, even
if an official report has been filed. The general nature of injuries
may be released if appropriate authorization is obtained and all
other state and federal privacy provisions are followed.
Rape: Every effort will be made to protect the privacy
of an alleged rape victim. Names will not be released. No statement
will be made concerning the nature of the incident or injuries
without the specific written consent of the patient. Once a case
is reported to the police, further news media questions should
be directed to law enforcement authorities.
Disaster Situations
In the case of a disaster, health care facilities may release general
information to help dispel public anxiety when specific patient
identifiable information is not yet releasable. For example, a health
care facility may say, "the facility is treating four individuals
as a result of the explosion." Specific information should be made
available to the media as soon as possible.
A location should be provided for all media to gather
so that information can be released in a press conference format
that does not compromise patient privacy or the health care facility's
need for added security in a disaster situation. Outpatient and Emergency Care
In health care facilities where outpatient care is provided by medical
staffs, the facility may choose to release information on patients
consistent with the guidelines for Release of Information to
the News Media in this Code.
Similarly, when a patient is brought to the emergency
department but is not admitted to the health care facility, the
spokesperson also should respond to inquiries consistent with the
guidelines for Release of Information to the News Media in
this Code. Psychiatric, Drug and Alcohol Abuse Cases
State and federal laws prohibit the disclosure of any information
about psychiatric, alcohol and drug abuse cases (42 USC Section
290; 42 CFR Section 2.1; ORS Chapter 426). This includes confirmation
of the patient's admission to or discharge from the facility when
the treatment is for psychiatric, drug or alcohol treatment.
When reporters have information from the police or
other sources concerning persons who are being treated as psychiatric,
drug or alcohol abuse cases, it is recommended that all such inquiries
to the healthcare facility be answered, "We cannot, under federal
or state law, comment on such a case." Organ Transplants
Organ recipient. The facility spokesperson will confirm or
respond to inquiries about the following if written authorization
has been provided by the transplant recipient or the recipient's
personal representative: name, city of residence, sex, age and condition. Organ donor. A potential organ donation will
not be discussed by the facility spokesperson. When a potential
organ donor dies, as determined by the attending physician, the
disposition of the body will not be revealed. The hospital spokesperson
shall refer questions on definition of death to the attending physician.
The hospital performing the transplant will not release information
about the donor that might ultimately reveal the donor's identity. Maternity
Health care facilities must obtain written authorization from the
parent before permitting photographs or release of information about
newborns.
No information may be provided about drug-affected
newborns (babies born to drug-addicted mothers) without written
authorization from the parent or legal representative. Unusual Illnesses
Health care facilities will refer to the health department all questions
about reportable diseases or unusual illnesses. Names of patients
and other health information that could be used to identify a patient
will not be released without written authorization from the patient
or the patient's personal representative. An HIV patient’s privacy
is protected by state and federal law. The identity of a person
tested for HIV or the results of an HIV-related test is confidential
(OAR 333-23-270(1)). Death
A patient death may be confirmed by a health care facility after
notification of next of kin and with written authorization from
the deceased's personal representative.
Information on the cause of death may be given by the
health care facility spokesperson after receiving approval from
the attending physician and the patient's personal representative.
If a death becomes the object of a medical examiner's
investigation, news media inquiries as to the cause and circumstances
of death will be directed to the medical examiner's office. Suicide: The health care facility spokesperson
should never release statements asserting suicide or attempted suicide
as a reason for hospitalization or death of a patient. A medical
examiner is usually the qualified authority for rendering such a
judgment. Patient Discharges
Once a patient is discharged, the health care facility no longer
will disclose information about him or her to the news media. All
further inquiries should be directed to the patient or the family.
Without written patient authorization, the health care facility
may not release information related to the date and time of discharge.
A facility may, however, indicate that the patient “is no longer
located in the facility.” Newsworthy Persons
HIPAA does not distinguish between public and private persons or
infamous and ordinary injuries. A person whose activity is a matter
of public interest, a person whose livelihood or success depends
on being kept in the public eye (e.g., a sports figure, an elected
official or an actor), or a victim of a newsworthy injury, does
not forfeit a right to privacy of their medical information. Health
care facilities should release information in accordance with the
guidelines for Release of Information to the News Media in
this Code.
When a prominent person is hospitalized, the health
care facility will coordinate with the patient, family and physician
to provide information about the patient's illness in a manner that
is consistent with the law.
The prominent person may elect to name his or her own
spokesperson, who will receive all requests for information. Media
should seek out the person's spokesperson when requesting information
about the person.
When a newsworthy person is in serious or critical
condition, the health care facility should arrange for medical bulletins
to be issued on a regular basis, while complying with the guidelines
for Release of Information to News Media in this Code. These
bulletins should be issued by the health care facility spokesperson
in cooperation with the attending physician and the family.
The above practices also may apply to the patient who,
whether willingly or not, has been involved in an occurrence of
public or general interest and, as a result, becomes hospitalized.
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