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Media Guide for Hospitals in Ohio
General Guidelines for
Hospitals and the News Media Distributed by: Ohio Hospital
Association Contents
General Guidelines for Hospitals and the News Media Regarding Patient InformationThe purpose of
this document is to assist both hospital public relations personnel and the
news media with the communication of facts and data regarding patients. This document will provide reporters with
information regarding hospitals’ legal and ethical responsibilities to patients
in reporting admission and patient status and in sharing other data about the
patient. The federal Health Insurance Portability and Accountability
Act of 1996 (HIPAA) mandated regulations that govern privacy, security and
administrative simplification standards for healthcare information. Final privacy regulations became effective
in April 2001, and hospitals have until April 14, 2003, to come into
compliance. HIPAA requires major
changes in how healthcare organizations handle all facets of information
management, including patient records. HIPAA sets forth minimum standards that hospitals must
follow with regard to the release of patient information. Hospitals may have individual policies,
however, that are more restrictive than what is required in the HIPAA
guidelines. If this is the case, the
more restrictive policy will take precedence. Among other things, the HIPAA privacy regulations restrict
the information healthcare providers may include in a patient directory and
release to the public, including news media. Directory information is limited
to four elements and patients have the option of further restricting release of
the directory information. The directory elements are: 1. Name 2. Condition 3. Location within the hospital 4. Religion Name – information can
be released only to those who ask about patients by name Condition – using terms
defined within this guide Location within the hospital –
provided it does not reveal prohibited information, such as that the
patient is being treated for substance abuse.
(See Addendum I regarding Other Pertinent Federal Law) Religion – although hospitals are not required to ask a
patient’s religious affiliation and this information is available only to
clergy, upon request. (See Addendum II
regarding Release of Information to News Reporters Q&A.) NOTE:
§ Unless
the patient has exercised the “opt-out” provision, directory information about
a particular patient (excluding the religious affiliation information)
can be shared with any person who asks for the patient by name. § Directory
information, including religious affiliation information, can also be
disclosed to a member of the clergy even if the clergy member does not request
information by patient name. While the HIPAA privacy regulations restrict the information
healthcare providers may release, patients are free to release their own
personal information or to consent to interviews providing it does not
interfere with their medical treatment. (See Addendum II regarding Release
of Information to News Reporters) The Rights of Patients
Hospitals have both legal
and ethical responsibilities to preserve patient confidentiality. Patients have specific legal rights to
privacy as governed by several federal and state laws, as well as standards set
forth by the Joint Commission on Accreditation of Healthcare Organizations
(JCAHO). Each hospital has a Patient
Bill of Rights, which includes confidentiality issues. This information is available by contacting
the hospital’s public relations department. According to JCAHO, related patient rights include: Respect and Dignity –
The patient has the right to considerate, respectful care at all times
and under all circumstances, with recognition of his/her personal dignity. Privacy and Confidentiality – The patient has the right, within the law,
to personal and informational privacy, as manifested by the following rights: § To
refuse to talk with or see anyone not officially connected with the hospital,
including visitors, or persons officially connected with the hospital but not
directly involved in his/her care; § To
expect that any discussion or consultation involving his/her case will be
conducted discreetly and that individuals not directly involved in his/her care
will not be present without his/her permission; § To
have his/her medical record read only by individuals directly involved in
his/her treatment or in the monitoring of quality and by other individuals only
on his/her written authorization or that of his/her legally authorized
representative; § To
expect all communications and other records pertaining to his/her care,
including the source of payment, to be treated as confidential. The
Hospital Designated Representative (Spokesperson) The hospital spokesperson is familiar with the special needs
and deadlines of the media and works to provide patient information where
appropriate and arrange interviews.
This is the person who will be best able to help the media. Calls made to others in the organization
will be channeled to the official spokesperson. Gaining Access to the HospitalMedia representatives and
photographers must contact the hospital spokesperson for access
assistance. Hospitals require that a
hospital representative accompany news personnel at all times. It is not possible to grant free access to
some areas in the hospitals due to laws and regulations. Areas most likely to fall in the
non-accessible category include operating rooms, intensive care units,
maternity units, emergency departments, psychiatric departments, nurseries and
substance abuse units. At times,
circumstances may necessitate that other areas be designated as off-limits. Gaining Access to Patients Written permission of the patient is needed for photos or
interviews. Consent forms will be
available through the hospital spokesperson.
If the patient is a minor, permission must be obtained from a parent or
legal guardian. Medical judgment: Hospitals may deny the media access to the
patient if it is determined the presence of photographers or reporters would
aggravate the patient’s condition or interfere with appropriate clinical
care. Release of Patient InformationA hospital’s first
responsibility is to the health and welfare of the patient. The patient has specific legal rights to
privacy. The patient’s medical records
by law are private and confidential.
The medical records are subject to release only with the permission and
written authorization of the patient or patient’s legal representative or as
required by law. (See Addendum III
regarding Cases of Public Record) Directory information will
be released to the media after a patient has been given the opportunity to
review and chooses not to restrict directory information, providing the request
includes the patient’s name. Directory
information may be delayed or unavailable for an emergency or unconscious
patient. (See Addendum IV regarding Public Figures/Public Officials) Condition of PatientOnly a physician can determine the patient’s diagnosis
and/or prognosis. Most physicians in
hospitals use the following terms to describe a patient’s condition: Undetermined –
Patient currently being evaluated. Good –
Vital signs are stable and within normal limits. Patient is conscious and comfortable. Indicators are excellent. Fair –
Vital signs are stable and within normal limits. Patient is conscious, but may be
uncomfortable. Indicators are
favorable. Serious –
Vital signs may be unstable and not within normal limits. Patient is acutely ill. Indicators are questionable. Critical –
Vital signs are unstable and not within normal limits. Patient may be unconscious. Indicators are unfavorable.
Treated and Released – Patient received treatment but was not admitted. Treated and Transferred – Received treatment. Transferred to a different facility. (Although a hospital may disclose that a patient was treated and released, it may not release information regarding the date of release or where the patient went upon release without patient authorization.) Deceased/Coroner’s Cases – The
death of a patient, while considered a matter of public record under Ohio law,
is considered protected health information under HIPAA. Thus, the condition of
death may be released for expired patients who have not opted out of the
directory. However, hospitals are advised to first notify the next of kin or
make a reasonable attempt to do so.
Information regarding the cause of death must come from the patient’s
physician, and its release must be approved by a legal representative of the
deceased. When a death is investigated by the county coroner, questions
about the cause of death should be addressed to that public office. The
coroner’s office may also have information about which funeral home is handling
arrangements for the deceased. (See Addendum V regarding types of coroner’s
cases) NOTE: § The term
“stable” should not be used as a condition.
Furthermore, this term should
not be used in combination with other conditions, which, by definition, often
indicate a patient is unstable. § With
written consent from the patient, a more detailed condition statement can be
drafted and approved by the patient or legal representative. Releasing Information After Hours
Most hospitals have an
after hours phone or pager number to allow the news media access to hospitals
at all hours. Employees who answer calls during late-night or weekend shifts
may release basic information or refer the reporter to the person with
authority to release information during non-business hours. The after hours
number can be obtained by calling a hospital’s main phone number and asking to
speak to someone in media relations. Addendum I Other Pertinent Federal and State Law
In addition to HIPAA,
federal laws prohibit hospitals from releasing any information regarding a
patient being treated for alcohol or substance abuse. (The Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment
and Rehabilitation Act of 1970; the Drug Abuse Office and Treatment Act of
1972; and 42 C.F.R. Part 2, 188) There
are also various state laws which address privacy of health information, such
as HIV and mental health statutes.
Addendum II Provided
by the Ohio Hospital Association and Bricker & Eckler LLP Release
of Information to News Reporters Privacy/HIPAA-Related Questions and Answers Do news reporters
have the right to receive information regarding a hospitalized patient? Under
Ohio’s public records law, the public has the right to access information
regarding births, deaths, admissions and discharges from hospitals deemed
public entities. Under the HIPAA
privacy regulations, however, this component of Ohio’s public records law would
be preempted since it provides for more access to protected information than
HIPAA. HIPAA does allow a hospital to
develop a directory that may contain the patient’s name, location, the
individual’s condition described in general terms that do not communicate
specific medical information (i.e., the condition can be described as “fair,”
“critical,” etc.) or religious affiliation.
(The HHS commentary makes it clear that the facility is not required to
inquire about the religious affiliation of an individual and individuals are
not required to supply that information. In addition, religious affiliation is
available only to clergy, upon request.) Every
patient must be apprised of the directory and its content, informed what the
practice is as to the types of entities and individuals that may receive the
information upon request, and given the opportunity to restrict the type of
information provided and to whom the information may be provided. (This may be done orally.) Thus, if the patient has not restricted the
hospital from release of hospital directory information to the media and has
been informed that such information is routinely released to the media, then
the hospital may give the directory information to the media, absent religious
affiliation. How should hospitals
handle requests from news reporters regarding admissions, discharges, births
and deaths? Although
this information may be deemed “public information” under Ohio’s public records
law for purposes of information that must be released by public entities, such
as government-owned and government-operated hospitals, the HIPAA privacy
regulations will preempt any state statutes which are less stringent than HIPAA
in terms of protecting privacy. Thus,
whether a hospital is a public entity or not, this information should not be
released to news reporters except as allowed in directory information under
HIPAA. If a hospital is
obligated by statute to report certain information to a governmental agency,
does such reporting obligation then allow the hospital to release the same
information to news reporters? No. There are numerous reporting statutes in
most states which deal with reports for everything from child abuse to gunshot
wounds. The fact that a hospital has an obligation to report certain
confidential information to a governmental agency, however, does not make that
information public and available to news reporters. In addressing questions from news reporters regarding such
information, the hospital may want to refer the reporter to the public entity
which receives such reports such as the police, fire or health department. The public entity will be guided by the
applicable statute as to whether it can release any or all of the information
received. If a patient arrives
unconscious or is incompetent, may the hospital create directory information on
that patient and release it to news reporters? This
practice requires discretion. The
regulations provide that if the opportunity to “opt-out” of the facility
directory listing cannot practicably be provided due to the patient’s
incapacity or emergency treatment situation, the facility may use and/or
disclose some or all of the allowed information if such use/disclosure is
consistent with a prior expressed preference of the patient that is known to
the facility or if such use/disclosure is considered in the best interest of
the patient as determined by the facility.
In these cases, the patient should be informed of the use/disclosure as
soon as it is practical to do so. The
commentary to the rule encourages facilities to take the following into account
when deciding whether to include some or all of the patient information in the
directory:
If a news reporter
has a patient’s name and is calling to confirm that the patient has been
treated or admitted or is asking for other information regarding the patient,
may the hospital confirm the identity or respond to the specific questions? The
fact that the media may know the name of a patient who may, for example, have
been involved in an accident or a crime, does not give them any additional
rights with respect to confirming the patient’s treatment, admission or other
patient-related information. The only
rights they would have would be with respect to information contained in the
hospital directory to the extent the patient has not limited or opted out of
having that information made available. Addendum IIICases of Public RecordState law generally defines
a public record as information kept by any public office, not otherwise
privileged or confidential. The fact that someone has been transported to the
hospital by a police or fire department from an accident, crime scene or fire
is a matter of public record likely to be reported by those agencies. These public records are available from the
reporting agencies, not the hospital.
These public records, however, may prompt media calls to the hospital
requesting a patient’s condition. Addendum IVPublic Figures/Public
Officials Public figures are
individuals well known in their local area, such as a news anchor or community
leader. Public officials are elected
individuals, such as a city council member, or those in other government
positions, such as a school superintendent or a police chief. Some patients may be considered newsworthy because of their
occupation, office or accomplishments.
A public figure or public official often may have a spokesperson who
handles media requests for information.
When possible, hospitals should cooperate with the patient’s
spokesperson. Although the public status of a patient may prompt media
inquiries, public persons should not be subject to different standards than
other patients when it comes to a hospital’s policy for releasing information
to the media. Addendum VTypes of Coroner’s CasesThe following conditions of death are examples which require
inquiries to public offices; hospitals cannot share information on the
specifics. Sudden or Violent Deaths:
Accidental Deaths from:
This guide was developed
through the collaborative efforts of Ohio’s allied hospital associations: Akron Regional Hospital
Association
190 Montrose West Ave., Ste. 201 Akron, Ohio 44321 (330) 668-6180 (t) (330)
668-2013 (f) Center for Health
Affairs
1226 Huron Road East Cleveland, Ohio 44115 (216) 696-6900 (t) (216) 696-1875 (f) Greater Cincinnati Health Council
2100 Sherman Avenue,
Suite 100 Cincinnati, Ohio
45212 (513) 531-0200 (t) (513) 531-0278 (f) Greater Dayton Area Hospital Association 32 North Main
Street, Suite 1441 Dayton, Ohio 45402 (937) 228-1000 (t) (937) 228-1035 (f) Hospital Council of Northwest Ohio 3231 Central Park
West Dr., Suite 200 Toledo, Ohio 43617 (419) 842-0800 (t) (419) 843-8889 (f) Ohio Hospital Association 155 E. Broad St., Floor 15
Columbus, Ohio 43215
(614) 221-7614 (614) 221-4771 Special thanks goes to a
task force at the Center for Health Affairs for leading the project. Updated July 2005 |
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© 2001-2008 OHA. Last updated
January 03, 2008. |
