Proof's Problem with HIPAA

Proof (not to be confused with my debut medical thriller with the same title) is a medical drama starring Jennifer Beals as renowned cardiothoracic surgion Dr. Carolyn Tyler.

Dr. Tyler is recruited by billionaire Ivan Turing to investigate near death experiences (NDEs) as he is soon to face the other side due to a terminal cancer diagnosis.

Tyler is a skeptical atheist and believes death is the end-- even though she's had a NDE herself and longs to reconnect with her teenage son who died in a car accident.

Of course, Turing uses his wealth and a big donation to the hospital to obtain Tyler's cooperation.

Through the course of her investigations, nearly every religious permutation of the after life is explored-- past lives, reincarnation, and soul jumping among them.

The issue becomes when families become aware of Tyler's investigations and want information that in real life she should never disclose. They're clearly HIPAA violations. I've blogged extensively on HIPAA here, here, here, here and here!

Why is HIPAA so important? It is the law. It's what healthcare workers are instructed (pounded into the head) to protect every single day. It's not taken lightly. Medical people have been fired for violating a patient's privacy by disclosing healthcare related information.

However, the television show Proof seems to not understand what HIPAA entails.

In one instance, a mother who lost her son begins to believe his soul has inhabited another child's body because he has the same rare blood type, same rare heart condition, and was a piano playing genius. The mother latches onto him and offers to pay for his medical care.

It becomes a sticky situation because the mother who lost her child begins to overstep her bounds and Dr. Tyler begins to believe she's at risk for kidnapping this other boy over the loss of her son.

To prevent her from taking that step, she begins to list a litany of medical reasons why this patient isn't her son. The problem is, this mother has no right to any of this information. It is a HIPAA violation.

In another instance, Dr. Tyler convinces a wife to donate her brain dead husband's heart. Now, she has a vested interest in this happening because one of her patient's with a rare blood type (evidently everyone in this show has a rare blood type) has been waiting for a heart for years and is running out of time.

The wife agrees and the heart is transplanted but the patient nearly rejects the heart. When the wife of the heart donor catches wind that this has happened (she seems to be hanging around the hospital after the donation has occurred) Dr. Tyler gives her detailed medical information on how the patient who received her husband's heart is doing.

Again, this wife, even though she donated her husband's heart, has no right to this information. In fact, donor and recipient identities are highly protected. It's not that these families never meet but it usually happens months after and is coordinated by the organ bank and not doctors on site.

In fiction, you can break the rules. Healthcare workers can disclose medical information but they should also face a consequence for it just like we do in real life. The plus, it dramatically increases the tension which is always the goal of any work of fiction.

Book Review: Rush of Heaven

As a nurse, I've seen a few miracles in my career. Kids that lived that should have died. A co-worker of mine had a son and it was looking like he'd developed leukemia on several different tests-- and then a follow-up blood sample before they were getting ready to discuss treatment was clear.

As a Christian, I do believe that miracles still happen. I believe the birth of a healthy baby is a daily miracle. If you study even a smidgen about fetal development and what all must fall in to place for a healthy baby to be born-- you'd be in awe.

However, I do think most other miracles are rare-- the kind where someone is miraculously healed of a devastating chronic illness or a life threatening disease.

Rush of Heaven is the true story of Ema McKinley and how she was healed of Reflex Sympathetic Dystrophy or RSD. Ema developed RSD after a work-related accident where she hung upside down by her leg for several hours. One type of RSD can happen after traumatic injury and there becomes miscommunication between your peripheral and central nervous system as well as a heightened inflammatory response.

What happens in response to this injury can be muscle atrophy and tightening but the syndrome can extend beyond the injured extremity-- as it did in Ema's case-- leading her entire body to become significantly disfigured to the point where she was nearly bent all the time at a ninety degree angle.

Then one night, about eighteen years after her accident, Ema says she received a visit from Jesus and is cured of her RSD. She is healed to the point where she is no longer wheelchair bound and can actually stand up straight. She becomes independent again.

The story is very interesting and the pictures in the middle of the novel are, literally, worth a thousand words. It was very interesting as a nurse to read about all the difficulties Ema had navigating the healthcare system (payment issues complicated by a workman's comp case, a multitude of doctors-- some better than others).

One consistent theme I've noticed that runs through these health related miraculous healing stories is that these patients never "curse" God. All through their illness, they continue to speak their faith in bold ways. Imagine the impact that has on nonbelievers when you're so sick and continue to praise God with every breath-- and then can speak to the healing He provided you.

If you're interested in reading about miracles or even about RSD in particular, I think you'll love this book.

I was provided a free copy of this book to review. A positive review was not required.  

Author Forensic Question: DNA and Donated Blood

Today, I'm posting a forensic medical question I had for Amryn Cross.

Jordyn Asks:

Can you tell if blood from a crime scene is from a donated pint of blood? If so, how?

Amryn Says:

You can actually tell the difference. A donated pint of blood will only have red blood cells and not the other components of blood (white blood cells, platelets, etc.). When the DNA from the donated blood is tested, the scientist would probably think it odd that they got little to no DNA yield (red blood cells don't have nuclear DNA). They might chalk it up to degraded blood, or they might look at it under the microscope and find only RBC, which should make them suspicious. But probably the first indicator is that the blood at the crime scene would not clot if it were from a donated unit. The investigator may or may not pick up on that, but a crime scene tech probably would.

Jordyn Asks:

What about a pint of whole blood? Would it still be the same? Would small amounts of dry blood give DNA?

Amryn Says:

Whole blood would give DNA results but wouldn't clot, so that would be something they would have to pick up on at the crime scene. If it was suspected and they wanted it verified, tests could be done for the preservatives in the bag.

Yes, if they were just droplets, they would still dry over time. And as long as it's whole blood, it will give lots of DNA.

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Amryn Cross is a full-time forensic scientist and author of romantic suspense novels. Her first novel, Learning to Die, will be released in September. In her spare time, she enjoys college football, reading, watching movies, and researching her next novel. You can connect with Amryn via her website, Twitter andFacebook.

Author Question: Nursing 1940's

Anonymous Asks:

First and foremost, I have to say that I am in love with Medical Edge. I've been spending a lot of time on it lately because I enjoy studying medicine and also because I am starting to do research for my novel. It's set in 1939 through to 1943. I have three questions for you.

One of my main characters is a nurse in Sioux Falls, South Dakota. I want to be able to write her doing her job correctly. I was wondering what kind of equipment they used, how they used it, and for what illnesses (No need to be extremely specific here, I think). Also, what would her responsibilities be within the hospital? Would she rotate through all the wards or do/did nurses have particular specialties like physicians?

Jordyn Says:

Thanks for your compliments on my blog! Glad you find it helpful.

Nursing in your time frame of 1939-1943 would have looked a lot different than it does today. They definitely wore uniforms and caps. Doctors would have been formally called "Dr. Smith" versus using first names like we do now (although not in front of patients).

Nursing work was viewed as inferior to the physician meaning—you do what the physician says. Now, a nurse’s input is more respected. Doctors and nurses realize they can't work separate from one another.

Nurses likely didn't specialize then like we do now and there was likely not a lot of physician specialties either as there weren't any intensive care units or emergency departments until the 1970s. Equipment would have been non-existent like the heart monitors and stuff we now use. Read through this info to get a general feel of how the floors or "wards" would have been split up.

This link is from Britain but would probably have some cross-over to the US. Here is a link to some personalized stories from people who nursed during your time frame. I would read through these for the 1930's and 1940's to get a feel for what their jobs were like.

This is also from the UK but should provide some insight. 

Question:

Another one of my main characters goes off to fight in the war. How severe would an injury have to be for him to be discharged? Presently, I have a situation designed where he is aiding a family out of a bomb shelter; there is an unexploded shell nearby, and a child accidentally kicks rubble at it and sets it off. Big boom, main character loses part of his leg and half of his body is burnt. I'm also thinking that he loses his hearing. Would this be plausible?

Jordyn Says:

I would search military discharge related to a medical condition two ways. One—what medical conditions are prohibitive for military service and those conditions that would lead to discharge.

 I found this list, but you could probably find more and if it's the 1939-1942 time frame it may be different than those that cause discharge in these times.

The injuries you list related to the bomb blast are realistic and I think would be enough to cause his discharge from the military as well.

I contacted a cousin of mine who serves in the medical corp of the military and he said to look at AR 40-501 which is the standard of medical fitness. Basically, if you couldn't do what's listed than you could be discharged from service. He did say that there are personnel who are still serving who have amputated limbs.

Question:

Lastly, my nurse has a patient, a woman in her 40s or 50s, who she loves with all her heart. I want this patient to die. What would be a good way to kill this woman off? I need her to have been in the hospital for around four years. I also want to have her weak but able to speak with my other characters. What's a good malady for this situation?

Jordyn Says:

This kind of criteria would mean the character would need a chronic illness that's debilitating. You could look into multiple sclerosis, Lou Gehrig's Disease, Huntington's Chorea or some of the autoimmune disease like Lupus or Sarcoidosis.

These diseases fall on a spectrum (more MS and the autoimmune diseases) but Lou Gehrig's Disease and Huntington's Chorea lead to neuromuscular wasting, etc that does lead to death and there is currently no cure.

In that time frame you're looking at you'd have to determine if they were able to diagnose these diseases. To do that you could Google search "When was Lou Gehrig's Disease discovered?" That should get you in the ballpark to know if the medical community knew about whatever disease you chose for your time frame.

Keep in mind—it would be highly unusual for someone to be hospitalized for four years straight.