What? Nursing Home Rights Outweigh Patient Rights?

Reporter: Why can’t the state identify COVID-19 cases at individual nursing homes? Health Secretary Daniel Carey: Just as individuals have a right to protect personal health information, so do nursing homes. …. As for legislation, I’ll let the governor speak for himself. Governor Northam: “No, you’re doing fine.” 

by James A. Bacon

In a press conference yesterday, Virginia’s Secretary of Health and and Human Resources Daniel Carey stated that under current law the right of nursing homes to protect “personal health information” outweighs the right of the public to know which nursing homes have residents or employees infected by the COVID-19 virus and which do not.

By today’s count, 470 of Virginia’s 812 COVID-19 deaths — almost three out of five — have occurred in long-term care facilities. Through his emergency measures, Governor Ralph Northam has shut down much of the state’s economy, and out of a super-abundance of caution, he’s in no hurry to relax those restrictions. But most of the havoc generated by the virus isn’t out there in the workplace, or the nail salons, or the restaurants, or the beaches — it’s in nursing homes!

Kerry Dougherty raised the question of the public’s right to know in the previous post. She makes such an important point that I just had to hammer the nail a little harder in a separate post. The priorities of the Northam administration are mind-bogglingly misplaced.

If you have a mother in a nursing home, wouldn’t you want to know if COVID-19 was running loose in the facility? Wouldn’t you want the ability to act upon that knowledge and, perhaps, withdraw your family member until the threat had passed — or arrange to transfer her to a safer facility? In the world of medical ethics, isn’t this fundamental? Either Governor Ralph Northam doesn’t see it that way, or he is unwilling  or unable to articulate the principle at stake.

Consider the Governor’s press conference yesterday. A Roanoke Times reporter asked why the Virginia Department of Health can’t publish COVID-19 outbreaks by localities rather than health districts. (An “outbreak” occurs when ten or more confirmed COVID-19 cases occur at the same location. Most take place in nursing homes, although some occur in correctional facilities, hospitals, educational settings or workplaces.) Addressing the Governor, she said, you have cited the state code as saying you can’t state the number of COVID cases in nursing homes. A number of legislators have said they disagree with your interpretation. If they were to change the state code for purposes of clarity, would you contest that?

Northam didn’t answer. He asked Carey to address the question and slunk to the background.

Carey looked uneasy, but he tried to address the question. Both sides of the aisle had expressed an interest in changing the law, he said. The nub of the issue, he explained, was that “the Attorney General’s Office, in support of the Department of Health, in the past has said that, just like individuals have rights to their personal health information, nursing homes also have that right.”

He continued:

I think you cited that in the press, both sides of the aisle had expressed, uh, that interest in changing the code, and I think that, uh, I won’t speak for the Governor, but you’re open to… I’ll let you, Governor, speak for yourself.

Carey stepped away from the podium, and Northam moved forward. With a slight wave of the hand, he said, “No, you’re doing fine.”

That was doing fine?

The idea that nursing homes have a right to protect personal health information is absurd. Individuals should have that right, but nursing homes should not. By publishing data stripped of personally identified information, the Virginia Department of Health would not violate anyone’s right to medical privacy. To the contrary, publishing the data on deadly viral outbreaks would provide Virginians vital information they need to look after their loved ones.

Suppressing the incidence of COVID-19 data in nursing homes doesn’t serve the interests of the residents, it serves the interests of the nursing homes!

Ducking the issue also also obscures the Northam administration’s greatest failure in its response to the virus: its monomaniacal focus on shutting down the economy while letting the virus run unchecked in nursing homes.


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19 responses to “What? Nursing Home Rights Outweigh Patient Rights?”

  1. Steve Haner Avatar
    Steve Haner

    When the law is an impediment to what you want to do, ignore it and cite an emergency. But the laws you agree with, follow. This is new behavior how? This is a big, rich, political active and generous industry (just like the hospitals) and will act in its best interests. It also has a giant target on its back now. Infections — deadly infections — are not a new problem (my mom got one when she entered a nursing home, started her rapid decline) but they are now on every front page around the country. A really interesting comparison in the weeks to come: nursing home outcomes for Medicaid patients v. private pay.

  2. Nancy_Naive Avatar
    Nancy_Naive

    One of you smart guys can answer this one. When you put Granny in a nursing home, who has custodial rights? You or the home? I must admit when I put Dad in a nursing home, and Mom in the Alzheimer’s facility, I know I signed at least 20 different documents, any one of which may have included custodianship.
    I know, for example, they agreed to continue care in the event of financial insolvency. Can’t imagine that came from the goodness of their hearts.

    1. Steve Haner Avatar
      Steve Haner

      Great question above my pay grade. I never saw the paperwork. You know an army of lawyers is preparing for the avalanche of litigation. States and localities own such facilities, as well, (and the feds) so their legal interests will line up with the industry’s. The wagons will circle….foxes guarding hen houses, etc.

      1. Nancy_Naive Avatar
        Nancy_Naive

        Well, if the facility is granted custodial rights, then the facility’s “right to privacy” surely derives from the ward’s rights. Think of it this way. Suppose the facility had only one patient, then surely no one could expect them to answer a poll requesting a breakdown of patient’s diseases and conditions.

        I’m certain that my doctor doesn’t publish a list of conditions and numbers of each he is currently treating.

        1. Steve Haner Avatar
          Steve Haner

          It wasn’t until I worked in the AG’s office that I fully grasped it is mainly a large insurance defense firm, protecting state government from aggrieved citizens/taxpayers/employees.

          1. Reed Fawell 3rd Avatar
            Reed Fawell 3rd

            There is an old proverb that you can judge the quality of a culture and society by the care that they take to protect their elders.

  3. Nancy_Naive Avatar
    Nancy_Naive

    Kerry and Jim keep confusing patient’s rights with the public rights. The keep saying “patient” and “public” interchangeably.

    If a patient’s custodian were to ask if his charge were at risk, I could see where they would have a case of “need to know”, but does Joe Sixpack have the right to know? Don’t think so.

  4. Nancy_Naive Avatar
    Nancy_Naive

    Tuberculosis? How many nursing home patients have tuberculosis? Cancer? Renal failure? AIDS?

    What you mean they’re not required to make public proclamations of these diseases? Then why would you expect COV2?

  5. I would like to recommend this article from the Star Tribune. The author is asking very similar questions.
    https://www.startribune.com/minnesota-must-recover-from-its-pandemic-of-fear/570289552/

    1. Reed Fawell 3rd Avatar
      Reed Fawell 3rd

      Just John –

      That you for linking in this very informative opinion article in the Star Tribune, one I liked so much that I am going to copy in its beginning. This matter is beginning to Jell. People are beginning to wake up to the reality around them, and to what’s been allowed to happen and sense that we have lost our way, and been bumped off course, and must change that course. Even the Washington Post in places shows signs in some quarters of returning to its senses. There is much to discuss and consider.

      Here is opening to Star Tribune Article:

      “Katherine Kersten: Minnesota must recover from its pandemic of fear – On top of that, this experiment with government by decree needs to end. By Katherine Kersten

      Minnesota has been in the grip of coronavirus hysteria for the last two months. We have submitted to unprecedented restrictions on our freedoms and stood by as our economy crashed, all because politicians, experts and journalists have warned we face an apocalyptic scenario.

      Gov. Tim Walz justified his first shutdown order with a mathematical model that predicted — horrifyingly — that 74,000 Minnesotans would die from COVID-19 without social distancing, and 50,000 even with the economic shutdown. A public health crisis remotely on that scale has not materialized. But an economic and social crisis has, and it is just beginning.

      We have reached a critical moment. In his latest extension of the shutdown order, Walz decreed that our economic life will resume by unpredictable fits and starts, with no end-date for lifting the order in sight.

      That is not good enough. We must insist on a detailed, transparent account of how — and whether — the executive branch, with its newly unchecked power, is fulfilling its duty to responsibly balance the risks from COVID-19 with the shutdown’s increasingly unbearable economic and social costs.

      We will only get the truth if we demand it. But fear of two kinds is blocking accountability.

      The first is people’s fear of the virus. The second is government policymakers’ fear of acknowledging that, by overreacting, they have created a monster, a genie they don’t know how to put back in the bottle.

      Today, an irrational panic seems to account for many Minnesotans’ tendency to defer unquestioningly to the government’s shutdown dictates. That panic springs from weeks of exposure to frenzied, overblown “body count” headlines, government briefings and social media reports that claim we face a looming Armageddon. …”
      https://www.startribune.com/minnesota-must-recover-from-its-pandemic-of-fear/570289552/

      Just John – clicking your name brought up your website (yours I assume). Most interesting. Thanks, again.

  6. djrippert Avatar
    djrippert

    So, what does this mean (from the AARP web site, article updated yesterday):

    “As soon as even one case of COVID-19 is confirmed at a nursing home, the facility will have to alert its residents and their families or representatives within 12 hours, the Centers for Medicare and Medicaid Services (CMS) announced late Sunday. The information will also have to be reported to the Centers for Disease Control and Prevention (CDC) and be made public.”

    “Verma said during a Monday conference call with reporters that she expects nursing facilities to begin reporting the COVID-19 cases and deaths to residents, family members and their representatives right away.”

    https://www.aarp.org/caregiving/health/info-2020/nursing-homes-to-publicly-disclose-coronavirus.html

    1. Nancy_Naive Avatar
      Nancy_Naive

      It means “the public” has no expectations, just families and representatives. One can assume that they also have to report to the CDC, and perhaps other agencies, but they aren’t required to call the RTD and take out a personals.

      1. djrippert Avatar
        djrippert

        Try again …

        “The information will also have to be reported to the Centers for Disease Control and Prevention (CDC) and be made public.”

        What part of “be made public” do you find confusing?

        1. Nancy_Naive Avatar
          Nancy_Naive

          By whom? The home? Or, the CDC?

  7. djrippert Avatar
    djrippert

    Here is Maryland’s reporting of nursing home COVID19 cases. They also report COVID19 cases by zip code for any zip code with more than 7 cases.

    Of course Maryland is a competently run state where special interests can’t make unlimited campaign contributions.

    https://coronavirus.maryland.gov/pages/hcf-resources

  8. generally_speaking Avatar
    generally_speaking

    The idea that nursing homes have a right to protect personal health information is absurd. Individuals should have that right, but nursing homes should not.

    My understanding is that they have a fiduciary duty, not a right, to protect their residents’ personal health information.

    Wouldn’t you want the ability to act upon that knowledge and, perhaps, withdraw your family member until the threat had passed — or arrange to transfer her to a safer facility?

    There is an old proverb that you can judge the quality of a culture and society by the care that they take to protect their elders.

    These go hand in hand in my opinion. Some people probably do want to act on that knowledge, but many people just dump their elders in a home and forget about them. The Simpsons made fun of this for decades with Grandpa Simpson.

    Given the ease at which the virus seems to spread in such facilities worldwide, I’m not sure if there are “safer facilities.”

  9. Acbar Avatar

    In an emergency, the public safety, backed by the police power of the State, which authorizes the Governor to act so broadly to trump many of these otherwise lawfully-enacted freedoms, like the freedom to go out and gather where you want (at least on public land). Here, we have an emergency; we have restrictions on the public declared pursuant to that emergency. As raised the other day by Jim Sherlock, there are laws out there on public rights and the Governor has gone beyond those laws; by what authority? It is the police power of the State in an emergency, that’s what authority.

    By that same authority, if the State can tell me I can’t open my business or go to the beach and sunbathe, it can also tell the nursing homes to damn-well cough up any statistics it wishes — maybe not advisedly, as to named residents or employees; but legally for sure, and certainly at least as to covid cases overall and their breakdown as to status inside each nursing home facility. That trumps any objection on the basis of privacy or fiduciary duty in my opinion.

  10. The citations issued for nursing home violations specify in detail the issues and impacts on patients who are identified by a number, with age, diagnosis, medications and other personal identification redacted. The surveyor’s interviews with staff are quite detailed, and staff are identified by designation and number, such as LPN#1. These details are fully disclosed on the Medicare Find and Compare Nursing Homes site. Anyone can compile statistics from them.

    For example, of the 120 one or two star nursing homes (much below and below average), 70 were cited for deficiencies because they needed to “Provide and implement an infection prevention and control program” as were 21 of 46 three star (average) nursing homes. And for those 91 of 166 nursing homes, surveyors observed staff members failing to wash hands, change gloves, ppe, or handle used dressings appropriately, or provide hand soap in patient bathrooms, and other such issues.

    Health care entities may be persons according to Va Code §1-230, but § 32.1-127.1:03 says “There is hereby recognized an individual’s right of privacy in the content of his health records” and “Individual” means a patient who is receiving or has received health services from a health care entity.” The patient has the right not the health care entity.

    So how is it improper for the Commonwealth to compile statistics on the number of COVID-19 cases in which facilities as long as they don’t identify specific patient names or details?

  11. Inthemiddle Avatar
    Inthemiddle

    I’d like to repeat cjbova’s question in a slightly different form – what is the value in keeping confidential the number of Covid patients in each facility?

    I imagine there are practical problems of keeping the information updated in a meaningful timeframe. By the time the facilities report and the data is collated, would the information be coming to late to do anything? (Btw, Do we know how many Covid patients have died in each hospital?)

    And I’m not sure what recourse someone would have for their elderly parent when they learn of the situation – other facilities will not accept anyone coming from a facility with high mortality rates.

    Just wondering.

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