QUESTION:      A patient acts erratically, is still ill, leaves the hospital AMA, and tells hospital personnel not to inform his family. That’s a HIPAA patient direction. The patient has two adult children who would want to know this information. What should the hospital do?

ANSWER:         An adult son brought his 60-year-old father to the hospital’s ED with erratic behavior, confusion and intoxication. The patient was diagnosed to have had a stroke. After receiving hospital inpatient care, the patient is transferred to a rehabilitation facility. The patient leaves the rehab facility by taxi after he has a disagreement concerning the facility’s no smoking rules.

After staying at a hotel for a night, the patient comes to the front entrance of the hospital via another taxi ride. He chooses to simply sit there. A social worker who had been working with the patient joins him. While he is still confused, the patient is not a candidate for an involuntary hold or commitment. The patient refuses to go to the ED or receive any hospital care. He calls for another taxi and leaves for a place unknown. Before he leaves, the patient tells the social worker not to report any of this information to any of his adult children. (He has three children, two of whom live in the area.)

Can the hospital notify the adult children under HIPAA? Should it? HIPAA appears to prohibit any notification given the patient’s directions. But there is a HIPAA exception where information sharing is needed to prevent imminent danger to the individual.

The hospital was uncertain what to do. This was an AMA patient, but not in the usual way. It wasn’t clear that he had re-presented to the hospital. The social worker believed that the man was putting himself at real risk from both the post-stroke physical activity and the certainly odd behavior, but that wasn’t a determination made by a physician. Nor was the social worker comfortable with saying that the individual truly lacked decision-making capacity.

The man’s adult children had been very much involved in his care. They would want to know what was happening. Doing the right thing seemed to lead to informing the adult children.

The concern for the patient and doing right by the adult children lead us to feeling comfortable with relying upon the imminent danger exception. There was also some risk management discussion: a potential HIPAA complaint filed by the man versus a potential complaint filed by the adult children that they should have been informed as to what was going on. The outcome was a collaborative counsel-client decision, very much based upon its peculiar facts (as is so often the case).