Confidentiality and HIPAA

Situation

P.H. is a 22-yr-old woman who recently tested positive for chlamydia.

You tell her to tell her sexual partners of the infection. She refuses to

tell her boyfriend because he will know that she has had sex with

another partner. You later learn that the nursing student who was in

the clinic for the day is a friend of her boyfriend and told him that he

should have STI testing.

Ethical/Legal Points for Consideration

• Each state has requirements for reporting communicable diseases

and other health-related data. Inform the patient of the reporting

requirements for communicable diseases.

• Nurses and other HCPs have both a legal and an ethical

obligation to maintain confidentiality of patient information. The

Health Insurance Portability and Accountability Act (HIPAA)

ensures the privacy of personal health information.

• The duty to maintain confidentiality is not absolute and may be

limited, as needed, to protect the patient or other parties, or by

law or regulation, such as mandated reporting for safety or

public health reasons.

• Your main obligation is to the patient seeking care. Patient

teaching is one way to establish a partnership with this woman.

Share information about the effects of the disease, the

consequences of reinfection, and the effect of the disease on

others who may not know that they are infected. Then encourage

the patient to tell her partners of the diagnosis and discuss the

option of expedited partner therapy (EPT) where applicable.

Discussion Questions

• What are your state’s requirements for reportable conditions?

• In your opinion, what is the best way to balance the needs of an

individual patient with those of the public?

• What are the risks to agencies for the breach of confidentiality

and HIPAA?