Health Care Privacy Laws and Gun Violence

When you go to a doctor’s office these days, some of them have these new-fangled sign-in sheets that prevent you from seeing the names of the other patients who also have signed in at the office.  You can still see those other patients sitting right there in front of you, in the waiting room, and as you walk from the waiting room to an examination room, but a decision was made that your privacy needs protecting and the new-fangled sign-in sheets are designed to do exactly that.  Of course, it might be reasonable to ask what kind of privacy is being protected when other patients can still see you, plain as day, in the waiting room of your doctor’s office.  Also, it’s not as if you sign in with something along the lines of “J.S., burns during urination, may be syphilis.”

Your doctors are only doing what their lawyers are telling them to do – and yes, The Curmudgeon knows, doctors and lawyers together can be a pretty nasty combination.  Their actions are driven by the 1996 passage of the Health Insurance Portability and Accountability Act, which most of us know by its acronym of HIPAA.  You may not remember it, but at one time or another over the past dozen or so years all of your doctors have required you to sign a document that informs you of your HIPAA rights.  The only one of those rights that most of us encounter first-hand, though, is the right to prevent your proctologist’s 3:15 appointment from trying to guess why you’re there to see him at 3:00 – as if that would be hard to guess.

The Curmudgeon’s had HIPAA on his mind ever since that nut-job stormed into a Newtown, Connecticut school and killed twenty people.  In addition to all of the renewed cries for tighter gun restrictions, this latest mass murder has led to calls to get the mental health community more involved in flagging people who might be predisposed, in light of their emotional problems, to commit acts like those committed in recent years in Newtown, Columbine, Aurora, Oak Creek, and elsewhere.

Assuming there are ways for mental health professionals to anticipate the possibility of mass mayhem by one of their patients – The Curmudgeon doesn’t have a particularly high opinion of the mental health community, although he’s receptive to the idea that in this particular area he could be totally full of you-know-what ­– this idea actually makes sense and offers some potential for helping to prevent the next mass murder.  At worst, it’s probably more likely to be productive than any future attempt to prevent the next mass murderer from gaining access to the weapons he needs to do his thing.  (The Curmudgeon normally would write “he or she needs to do his or her thing” in the previous sentence, but it seems grossly unfair in this case because along with refusing to ask for directions, painting their torsos green at football games, and thinking belching is entertainment, men seem to have pretty much cornered the market on this particular type of behavior.)

The only thing is, this latest idea is almost certain to fail, thanks to HIPAA.  If we’re interpreting patients’ right to privacy so narrowly that we can’t even see the name of the person who signed in before us at the dentist’s office, what are the chances that a mental health professional is going to task the risk of picking up the phone one day, calling the police, and saying, “I just got finished a session with a patient.  He hates his mother, listens to too many Marilyn Manson albums, and kicks his dog when the poor pooch misses the paper.  I’m afraid that one day if he goes into McDonalds and thinks there aren’t enough pickles on his Big Mac he’ll go out to his car, get his AK-47, and mow down everything that moves”?  It might be took much of a stretch to expect a health care professional who has to guard his sign-in sheet with all sorts of devious new tools to take the risk of violating a patient’s HIPAA rights in such an extreme way.

The idea of getting mental health professionals involved in identifying prospective mass murderers isn’t necessarily a bad one, but in the end, it’s probably unworkable.  If we have laws designed to protect women with swollen bellies from having other patients at their obstetrician’s office suspect that they might be pregnant, we certainly can’t expect mental health professionals to put their lives, their livelihoods, and their reputations on the line every time they think they have a patient with a nasty temper who might have more than just a nasty temper.


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  • Barbara S  On May 20, 2013 at 2:44 pm

    I so agree with your post. As a middle school teacher, I knew within weeks which one(s) of my students had serious mental issues. But, due to laws, privacy issues, etc. there was nothing to be done. Whenever these tragedies happen, the public cries out about how nobody saw the warning signs and nobody did anything to prevent a tragedy. Inwardly, I respond that I bet his/her middle school teachers saw the signs. What can we legally do? Slander a student by predicting his future will involve acting upon his Charles Manson tendencies? Mental health worker/middle school teacher — often one in the same. 😉

  • foureyedcurmudgeon  On May 20, 2013 at 3:55 pm

    I hear you. The Curmudgeon’s sister is an elementary school teacher in Philadelphia and has a number of former students who will be spending a looooong time in prison. In most of the cases, she said she had a pretty good idea that was going to be the case. (Side note: she has a childhood friend who’s a shrink in those prisons, and they’re able to compare notes about their mutual acquaintances.)

    • Scott  On May 30, 2013 at 8:38 am

      A tangential point about physicians and gun violence: I believe that, just as physicians ask “Do you smoke?” or “Do you use alcohol?”during routine physical examinations, the question “Do you own a firearm?” should be added. There are many, many people, especially children, who are injured or killed by the accidental discharge of guns that owners thought had been safely tucked out of harm’s way. Physicians could save lives by urging gun owners to educate themselves on the safe use and storage of guns, the availability of gun locks as a preventive measure, etc.

  • foureyedcurmudgeon  On May 30, 2013 at 8:59 am

    The Curmudgeon wholeheartedly agrees – but the very prospect has stirred anger among the gun nuts. Legislatures in Kansas and South Carolina are currently considering laws that would make it illegal for doctors to ask these questions. Florida already passed such a law, but it was overturned as a violation of freedom of speech by the state’s Supreme Court. Imagine that: people who value the first amendment as much as the second!

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