Health Care – Case Assignment – Medical Records Hospitals dealing with sexually abused minors and their parents who are in denial have a difficult, complex series of tasks to complete. Both Federal and State laws require report of the alleged abuse to authorities. Furthermore Federal and State laws require that the medical provider use his/her judgment to decide whether medical records may be released to the parent. The parent, particularly a parent who wishes to obtain and illegally alter medical records must be reminded of HIPAA and child protective requirements that may well lead a medical provider to deny access. Furthermore, a follow-up memo should be released to all staff reminding them of Federal and State laws regarding medical records, reporting requirements for child abuse and hospital policies regarding both.
¶ … Medical Records
Each individual/entity in this scenario has an agenda. Sandra: is a child under both State and Federal Law; her immediate concern is hiding her sexual abuse by her stepfather; however, hospital administration must be concerned with her best interests on three counts: first, because she is a patient; secondly, because she is a child; third, because she is an allegedly abused child. Mrs. Anderson: is both the patient's parent and a mid-level hospital administrator; her immediate concerns are obtaining and editing medical records to keep her family together on religious grounds; however, the patient's best interest, both as a patient and a child, conflict with Mrs. Anderson's concerns. The hospital: is bound by both Federal and State law; its immediate concerns are serving the bests interests of its patient, who is also a child, while honoring Mrs. Anderson's rights as a parent/representative of the minor patient. In this case, Sandra's best interests as a patient and minor who is allegedly sexually abused trump all other concerns.
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The Obligations Regarding Reporting Of The Alleged Abuse Under Federal And State Laws, Identifying Mandated Reporters And Their Legal Obligation.
Both Federal and State laws require report of the alleged abuse. Federally, the "Keeping Children and Families Save Act of 2003" (CAPTA) requires reporting because Sandra is under the age of 18 and has been molested, raped, or statutorily raped by her stepfather (Smith, 2009). CAPTA acts a leader and guidepost to California State law, which is more specific. California's "Child Abuse and Neglect Reporting Act," specifically in this instance, California Code §11165.7(21) makes the health care professionals who are treating Sandra "mandated reporters" who must report her sexual assault as defined by §11165.1(a) and (b) (California State Legislature, 2003). These health care professionals include the emergency room physician and/or licensed nurses who treated Sandra. Furthermore, I as an administrator may not impede them in reporting, though the hospital is allowed to have internal procedures to facilitate reporting and inform the administrators/supervisors, per California Code §11165.7(3)(i)(1) (California State Legislature, 2003). The sexual assault must be reported to the police department, sheriff's department or county probation department if it is designated by the county in which the hospital is located, per California Code §11166.05 (California State Legislature, 2003). This will also require a frank, confidential and supportive discussion with Sandra about the legal requirement to report the abuse and giving her several choices about discussing it with her mother with my help and/or reporting the abuse along with the hospital or doing nothing, in which case the hospital must report the alleged abuse to the police/probation department.
What Should Be Said To Mrs. Anderson About Her Access To Records, Including Laws Regulating Access To And Disclosure Of Medical Records/Information Of A Minor Receiving Reproductive Care/Treatment.
Mrs. Anderson should be told that she is there solely in her capacity as a parent of a minor patient, that her capacity as a mid-level administrator is irrelevant to her instant rights, that any attempt to use her authority as a mid-level administrator to obtain her daughter's original records is an abuse of her authority, and that altering original medical records by unauthorized personnel (i.e., her), is illegal. She should also be told that her work as a mid-level administrator gives her greater insight into laws and hospital policies: the law and the patient's well-being supersede religious beliefs; that the record is what the record is and it cannot be changed by her; that access to the records is severely restricted by law and by hospital policy; that medical records are rarely released immediately upon request in any event; that medical records are not normally released to individuals in any event; rather they are released from facility to facility for purposes of treatment; that it is the provider's judgment that must determine whether it is in the patient's best interest to release the records; that in the instant case, neither the records nor a copy of the medical records will be released to her because, in the provider's judgment, release would not be in Sandra's best interests.
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