Guarding prisoner patients in Texas

[Antipas]

Interference with a Law Enforcement official may result in obstruction charges. Hospital Policy doesn't trump Law Enforecements authority to conduct business.

Another excellent point that I had anticipated. Suppose an overzealous medical center employee gets in the face of the LEO and demands that he leave the patient's room because it is medical center policy when the LEO's general orders tell him to not to leave the patient's room.

[Antipas]

I would (probably not so politely) tell you to shove your form. I don't answer to hospitals. Not once, not never.

There have been instances of LEOs refusing to sign, and I don't blame them. As a security professional, the difference between security and law enforcement was drummed into my head long ago, and it bothers me that I'm being told to tell LEOs how to do their jobs. I'm going to club this policy like a baby seal...

[G35 Mass]

A part of the sign off policy states that the LEO agrees to obey all policies of the medical center. Of course, without knowing what all the policies are, the LEO may very well be signing off on something that may violate his general orders.

Hahaha.. Thanks for that laugh, man. I needed it.

Seriously, you and your hospital need to get bent. We're not bound by any hospital policy, "expectation of privacy", or your lawyer's interpretation of State statute regarding detention of prisoners. Prisoners are in the custody of a Government agency to 1) answer for criminal acts, or 2) keep them from harming themselves or others, and as such that government agency decides the appropriate level of security to ensure they do not escape and pose a risk to the public or commit additional crimes.

Tell me, what is this hospital's course of action when officers refuse to sign? (Because I am quite confident it's not an "if they refuse...") Don't treat the patient? Criminally liable. Bar the office from the hospital? Criminally liable. Sounds like a win / win situation for us.

[TEXASCOP]

I found this under the Texas Occupations Code.

Sec. 159.004. EXCEPTIONS TO CONFIDENTIALITY IN OTHER SITUATIONS. An exception to the privilege of confidentiality in a situation other than a court or administrative proceeding, allowing disclosure of confidential information by a physician, exists only with respect to the following:

(1) a governmental agency, if the disclosure is required or authorized by law;

(2) medical or law enforcement personnel, if the physician determines that there is a probability of:

(A) imminent physical injury to the patient, the physician, or another person; or

(B) immediate mental or emotional injury to the patient;

(3) qualified personnel for research or for a management audit, financial audit, or program evaluation, but the personnel may not directly or indirectly identify a patient in any report of the research, audit, or evaluation or otherwise disclose identity in any manner;

(4) those parts of the medical records reflecting specific services provided if necessary in the collection of fees for medical services provided by a physician, professional association, or other entity qualified to provide or arrange for medical services;

(5) a person who has consent, as provided by Section 159.005;

(6) a person, corporation, or governmental agency involved in the payment or collection of fees for medical services provided by a physician;

(7) another physician or other personnel acting under the direction of the physician who participate in the diagnosis, evaluation, or treatment of the patient;

(8) an official legislative inquiry regarding state hospitals or state schools, if:

(A) information or a record that identifies a patient or client is not released for any purpose unless proper consent to the release is given by the patient; and

(B) only records created by the state hospital or school or its employees are included; or

(9) health care personnel of a penal or other custodial institution in which the patient is detained if the disclosure is for the sole purpose of providing health care to the patient.

[Antipas]

Tell me, what is this hospital's course of action when officers refuse to sign? (Because I am quite confident it's not an "if they refuse...") Don't treat the patient? Criminally liable. Bar the office from the hospital? Criminally liable. Sounds like a win / win situation for us.

We've received instructions to notate on the form that the officer refused to sign.

Now as I mentioned above, the passage I quoted about the officer leaving the room for patient confidentiality turned out to be plagiarized from a university medical school police department policy that went on to say that if officers from other agencies who were guarding patients could not abide by that policy, other arrangements would have to be made for the treatment of the patient. I take that to mean that arrangements would be made to transfer the patient to another facility. So we have a university medical school PD presenting its own policy to visiting PDs and then giving them the option of transferring their patient to another facility if there cannot be a meeting of the minds. Our medical center plagiarized the part of their policy about officers having to leave the room and then "requires" them to sign off on it--leaving out the important qualifier from the medical school PD policy about the option of making other arrangement for the treatment of the prisoner.

[Antipas]

I found this under the Texas Occupations Code.

Sec. 159.004. EXCEPTIONS TO CONFIDENTIALITY IN OTHER SITUATIONS. An exception to the privilege of confidentiality in a situation other than a court or administrative proceeding, allowing disclosure of confidential information by a physician, exists only with respect to the following:

(1) a governmental agency, if the disclosure is required or authorized by law;

(2) medical or law enforcement personnel, if the physician determines that there is a probability of:

(A) imminent physical injury to the patient, the physician, or another person; or

(B) immediate mental or emotional injury to the patient;

(3) qualified personnel for research or for a management audit, financial audit, or program evaluation, but the personnel may not directly or indirectly identify a patient in any report of the research, audit, or evaluation or otherwise disclose identity in any manner;

(4) those parts of the medical records reflecting specific services provided if necessary in the collection of fees for medical services provided by a physician, professional association, or other entity qualified to provide or arrange for medical services;

(5) a person who has consent, as provided by Section 159.005;

(6) a person, corporation, or governmental agency involved in the payment or collection of fees for medical services provided by a physician;

(7) another physician or other personnel acting under the direction of the physician who participate in the diagnosis, evaluation, or treatment of the patient;

(8) an official legislative inquiry regarding state hospitals or state schools, if:

(A) information or a record that identifies a patient or client is not released for any purpose unless proper consent to the release is given by the patient; and

(B) only records created by the state hospital or school or its employees are included; or

(9) health care personnel of a penal or other custodial institution in which the patient is detained if the disclosure is for the sole purpose of providing health care to the patient.

Thanks for posting this. It dovetails with what we've been taught about instances in which "protected healthcare information" may be passed on to another party under certain circumstances.

[Antipas]

2. I was agreeing with you, businesses and organizations generally have policies to protect them from getting sued. For some reason your hospital's policy makers felt that protecting a patient's medical information was more important than the staff members safety (witch I don't agree with). There is noting in the Texas Statues that says a doctor or nurse may order an officer to leave the patient's room under the color of patient confidentiality. Like I said before that person is my prisoner and I will keep close proximity to him no matter what. The police officers duties supersede the hospital's policy.

I went back and re-read this and wanted to comment. The general patient confidentiality policies floating around in the healthcare sector come from federal laws that impose strict penalties for releasing "protected healthcare information." Now if a LEO guarding a prisoner patient overhears a physician giving a diagnosis to the patient, and this constitutes a breach of federal law, wouldn't state criminal procedure codes and penal codes be adjusted to take this into account, as well as local LEO general orders? I can't say that I've ever heard of a case where some prisoner patient claimed that his rights were violated because the LEO in the room assigned to guard him overheard the physician give a diagnosis.

[TEXASCOP]

I went back and re-read this and wanted to comment. The general patient confidentiality policies floating around in the healthcare sector come from federal laws that impose strict penalties for releasing "protected healthcare information." Now if a LEO guarding a prisoner patient overhears a physician giving a diagnosis to the patient, and this constitutes a breach of federal law, wouldn't state criminal procedure codes and penal codes be adjusted to take this into account, as well as local LEO general orders? I can't say that I've ever heard of a case where some prisoner patient claimed that his rights were violated because the LEO in the room assigned to guard him overheard the physician give a diagnosis.

Well anything that is not specifically listed in the constitution is left up to the state, according to the 10th amendment.

10TH AMENDMENT- The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people.

From what I read from HIPAA it appears HIPAA follows along in accordance with state law.

[Samuel]

Once they become inmates/prisoners, they lose a few "rights" and privileges. Officer/staff safety trumps all when push comes to shove. Thus, I/we have every right to know about sensitive medical conditions such as aids/hiv/hep/TB/etc.

[Legoate]

Another excellent point that I had anticipated. Suppose an overzealous medical center employee gets in the face of the LEO and demands that he leave the patient's room because it is medical center policy when the LEO's general orders tell him to not to leave the patient's room.

I've had something like this happen before. However, as a law enforcement officer I have learned how to say "No". I'm not leaving my prisoner alone with you, and if you don't like it- Too bad.

[retdetsgt]

I've had something like this happen before. However, as a law enforcement officer I have learned how to say "No". I'm not leaving my prisoner alone with you, and if you don't like it- Too bad.

Yep. I had that experience several times even years ago. Whether they treat or don't treat the prisoner is up to them, but I ain't leaving. I've gone nose to nose with more than a few doctors who seemed to think they were God. They get used to people jumping when they shouted and it was a bit hard to their egos to find I wasn't the least bit impressed.

It's sometimes amazing how they react when someone else with authority barks back at them. I've found most don't know how to handle it and put their tails between their legs pretty quickly.

Seriously, who are they going to call? The police?

[Antipas]

Well anything that is not specifically listed in the constitution is left up to the state, according to the 10th amendment.

10TH AMENDMENT- The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people.

From what I read from HIPAA it appears HIPAA follows along in accordance with state law.

But I recall coming across in my research that HIPAA was justified under the Constitution's interstate commerce clause. Of course, that doesn't mean that there might not be facets of it left to be decided by state law.

My point is that IF some legal interpretation along the way had set a precedent for Texas LEOs to have to step out of a forensic patient's hospital room when asked by hospital staff, then wouldn't that have percolated down into all the various agencies' general orders?

[Antipas]

Thanks to MikeG for passing on some interesting HIPAA stuff.