so - what do y'all think?

[NJCubScouter 1389]

OGE, medical privacy is not an area of the law I am very well-versed in, so I did a bit of research on the Internet. The first thing I learned when I did my search is that the acronym is HIPAA, not HIPPA. As I have said before, I make as many typos as the next guy, but when I do a Yahoo! search and it tells me "You might want to try 'HIPAA' instead," I just figured I'd mention it.

 

I found a good site with a basic explanation, at www.hipaadvisory.com/regs/HIPAAprimer1.htm

 

What this site tells me is that the HIPAA requirements apply to "health care organizations." It makes clear that an "organization" can be a 1-physician office, but in other words it must be some person or entity involved in providing the patient with health care. I looked at several other sites and none of them contradict this, most of them specifically mention doctors and hospitals, and more generally, "providers."

 

The basic idea seems to be that when you give a health care provider information about your health for the purpose of obtaining diagnosis or treatment, or the provider learns information about you in the course of providing diagnosis or treatment, the provider is prohibited from providing that information (without your consent) to anyone, with certain exceptions.

 

That being the case, I don't see how HIPAA could apply to this situation at all. The BSA (including a unit) is not a health care provider. Therefore, BSA would not be subject to HIPAA. I don't think this is a mere "technicality." The purpose of the law (I think) is so that people will feel that they are able to get medical treatment without the whole world (including their employer, or a company wishing to sell them products, for example) knowing about their condition. If you choose to give personal information to the BSA, there may be BSA rules about what happens to the information, but I don't think "The Law" gets into it.

 

Another way of looking at it is that the health care provider exists to provide you with health care, and has the means to provide you with that care confidentially without unduly endangering anybody else. If you have a communicable disease, the doctor or hospital can take steps to provide you with care while protecting others from your disease. The BSA, on the other hand, exists to provide a youth group (but see note below) with a particular program. The interests of the "group" require that nobody with a deadly, communicable illness be in the group without other members knowing about it. (Note -- 2 words: Lone Scout. I realize it doesn't provide the "group" experience but at least the boy could get some benefits from the program. Maybe his one friend could join also.)

 

Interestingly, the story doesn't really say how the Scout troop came to know that the boy had AIDS. The mother may have told the troop, so that the leaders would know, but asked that nobody else be told. It does not appear that the leaders went around telling everyone, instead they apparently just told the mother that BSA rules require disclosure, and therefore if the boy joined, it would have to be disclosed. Although I am a big believer in "privacy rights," I don't see anything wrong with this BSA rule, in the limited context of a deadly, communicable illness.(This message has been edited by NJCubScouter)

[eisely 13]

This is a horrible story, but it raised more than just academic questions. The scouts in St. Louis have had to deal with this very real problem.

 

OGE,

 

I am not familiar with the law you cite, but your first post in this thread contains language that seems to allow the parent to disclose anything. The question remains, can BSA ask?

 

I don't see anything in logic, or the law (the two not being the same), that would prevent the scouts from asking such questions. Employers can ask questions about health, provided the questions are work related, such as ability to lift heavy weights, etc. It seems to me that any youth organization, scouts, sports, or otherwise, would be negligent not to ask, and to put the question in writing in the membership application.

 

When you get right down to it, we rely totally on the honesty and intelligence of parents to accurately represent the capabilities of their children and to disclose all relevant medical facts. Being a carrier of dangerous disease is relevant. However, being HIV positive should not disqualify any boy from being part of scouting. Full blown AIDS may be another matter.

 

Having said all that, our first aid training should give greater emphasis to self protective measures.

[NJCubScouter 1389]

Eisely's post made me think of a question: What does the BSA ask in this regard, if anything? I have filled out "Class 1" medical forms for my son, but I don't recall it asking about communicable diseases, or specifically about AIDS (or more generally, immunodeficiency conditions.) The last time I saw the full-scale medical form (Class 3?) was when I was going to summer camp in the 70s, and if course I don't remember what it said. AIDS and HIV had not been discovered yet anyway.

 

I know there is a very short health form on the back of the Cub Scout youth application. I assume the Boy Scout application has the same. I do not have either in my possession at the moment. I will check, though, to see if the Cub Scout application asks anything about this.

[twin_wasp 10]

My impression from many years of experience with medical records, is that much of the law applies to medical institutions, insurance companies and medical professionals. A scoutmaster, or a coach is none of these things.

 

The scoutmaster has a responsibility to review the medical forms of the boys in his troop. The SM also has a responsibility to insure that the other adult leaders also know af any health problems. Concurrently, the SM has a responsibility to remind other leaders that, law or not, medical information is basically confidential. (A scout is trustworthy)

 

By extension, and knowing the BSA program, it also makes sense that junior leaders also know about certain health problems that might require

intervention, or where assistance from another scout might help. For example, we have had guys who were allergic to bee stings. We have a guy

who is liable to collapse unconscious from time to time. In these cases, it helps if everybody who can handle it is in the know.

 

It is conceivable that a parent might not want some health information revealed. However, BSA reasonably requires a medical form, and that form is only useful if folks read it.

 

Every troop has a responsibility to practice universal health precaustions about blood and other bodily fluids. Most people think of HIV as a

risk, and it is, but Hepatitis B poses an even greater risk.

 

For the latest info at the CDC go to:

 

http://www.cdc.gov/ncidod/hip/Blood/blood.htm

 

http://www.cdc.gov/ncidod/hip/Blood/Exp_to_Blood.pdf

 

 

twin_wasp

 

 

 

 

[littlebillie 10]

...but if the Scoutmaster (or, I suppose, any Troop-associated adult) were a doctor, AND was told of the condition, which mantle would be in control - the doctor thing, even if you're not the kid's personal physician? or the Scout thing, with its various Constitutional and moral aspects?

[mk9750 11]

I am dipping my toe in water with which I am VERY unfamiliar, so forgive me if I am wrong, but...

 

My wife works in a hospital in an area that is more diagnostic than care giving. She is in contact with patients all day long, both in house and out patients. She was told she has no right to know the medical status of a patient. Medical Right to privacy trumps the right of the health care worker. Universal precautions expected of health care workers, to be used in every instance of patient contact, should be sufficient to protect both the worker and the patient. since Universal protection is the norm at hospitals, etc., although I disagree with the policy, it seems at least reasonable.

 

In Scouting, however, universal precautions are not taught or enforced as policy. And even if they were, the likelihood that a scout would be able to produce protective equipment while administering first aid to a fellow scout who was hurt in capture the flag is extremeely low. I'll bet even the most stringent of Scoutmasters in this forum don't require that Scouts carry their first aid kit with them when they play capture the flag.

 

Noting the differences in the two organizations, and how each are likely to encounter any victim, common sense to me says that even if it is acceptable to withold medical information from health care workers as a matter of privacy because standard operating procedures protect everyone, it is vital that the troop know the condition of a boy with HIV because SOPs do not protect everyone in the instance of a Boy Scout event.

 

I'll use one other analogy. We have a boy who is EXTREMELY allergic to peanuts. When he joined, his mother told us, gave us an EPI pen, showed us how to use it in case it was needed, and asked that the boys in the troop not be told, so no one treated her son differently. This seemed like a reasonable request to us, so we complied. First campout, the Troop Guide planned the meals for the new patrol to cook. Desert was a cobbler that includes nuts. You can fill in the rest. It's a good thing we were shown how to use the EPI pen, and it's a good thing the Troop Guide had a brother who is allergic to bee stings, because he recongnized the symptoms immediately and came and got us. Disaster was averted, but could have been prevented if the Scout who planned the meals knew the situation. The mom realized quite quickly that maybe it would be OK if everyone knew. BTW, it's actually been kind of cool to see how the kids get creative when they want to make something that usually needs nuts. It's one of those troop inside jokes now, and we (including the boy) have a lot of fun with it. I know that can't be compared to having HIV. But I certainly believe there is a correlation between one situation and the other.

 

Mark

[Twocubdad 665]

This seems to be an area where national needs to provide a little more guidance -- AND another example of how poorly BSA communicates policy to the volunteers. Had anyone else heard of the policy requiring notification of deadly communicable diseases?

 

I generally agree that in the cases of communicable diseases, severe allergies or similar situations, there is a need to know among leaders. I'm not sure that this extends to everyone in the troop. HIV is an extreme example. There are many other situations where the adults need to be aware of things in the case of an emergency, but the information doesn't need to be made public.

 

This past summer I led our pack's group to Webelos Resident Camp, which was my first time dealing medical forms. I was somewhat uncomfortable having the forms, especially the class 3 forms for some of the adults. Do I really need to know what someone's blood pressure is or that their last PAP smear was normal? Why is it necessary for anyone to have the exam results, other that the MDs okay to participate?

 

Emergency information and medical information that the leaders' need should be handled on a different form. There also needs to be some guidance as to how to handle the information.

 

 

[eisely 13]

Twocubdad's point about better guidance and communication of that guidance are well taken. Clearly privacy has to be balanced with need to know, but need to know should always trump privacy. I cannot afford to be in ignorance about the health status of any other member (adult or youth) in the boondocks. I am Type II diabetic, but that has not kept me off the trail. But I do make a point of informing the other adults I am with. Likewise I expect to have access to the health forms of all participants in any outing where I am the adult in charge.

[berkshirescouter 11]

The health forms are what you need if you take someone to the ER. If the parent is not there that is your permission plus history. I agree there is a lot of sensitive info. there but as a leader that is part of the job.

[NJCubScouter 1389]

I don't think the subject of how to handle personal information has ever been mentioned in any training, roundtable, memo or anything else I have attended or seen. I was not aware of the "rule" on notification about communicable diseases until I read the first post in this thread. There should be some formalized instructions about this, especially now that privacy is becoming a larger and larger concern. If nothing else, I'd like someone to tell me how the health forms should be handled. For myself, I have never had any interest in reading them, we just collect them and have them in a big stack. Sometimes the people running the Cub Camporee want them, sometimes they don't. Peoples' personal information is being handled in a pretty cavalier manner.

[OldGreyEagle 5]

From the BSA website, G2SS

 

Life-Threatening Communicable Diseases

 

Local Scouting units and their chartered organizations traditionally determine their own membership, absent any legal constraints. Accordingly, units and sponsoring institutions should determine the feasibility or desirability of allowing youth or adult members who have or are suspected of having a life-threatening communicable disease to participate in Scouting activities. A youth member who is unable to attend meetings may continue to pursue Scouting through the Lone Scout program.

 

AND

 

Religious Beliefs and Medical Care

 

The following is the policy of the Boy Scouts of America regarding medical requirements:

 

Medical examinations for camp attendance are required of all campers for the protection of the entire camp group. The immunization requirement is waived for persons with religious beliefs against immunization.

All Scouts and Scout leaders need to learn first aid, not for their own use, but for service to others who may require it. A Scout or leader may ask to be excused from first-aid instruction, but no advancement requirement will be waived except as indicated.

Requirements 1 and 5 for the Personal Fitness merit badge call for examinations by a physician and a dentist with appropriate follow-up recommendations. This may be set aside on presentation of a certificate by the Scout's parents and a proper church official that a definite violation of religious conviction is involved.

 

So, while the Policy on Deadly Communicable drugs is spelled out, in the G2SS, I agree with NJ, its often not talked about, ok, I have never heard it until this thread. And more grist for the mill. What about a strict Christian Science family? No Doctors means no Physicals which means a scout/scouter could have a deadly disease and never have it diagnosed. Now, does the right of the scout/scouter to follow his beliefs over rule the need of the troop to know if he has a severe medical condition?

 

BTW, I didnt find a section on handling personal information, it could be there, but I havent found it(This message has been edited by OldGreyEagle)

[NJCubScouter 1389]

OGE, good points and thanks for the quotes. I have to wonder how this all works even for boys who DO have physical exams. Medical exams are fine for the more "traditional" things like hepatitis, t.b., etc., but what about HIV? As far as I know, HIV tests have not become routine for 11 year old boys. And someone can have the virus for years with no symptoms.

 

And one thing you quoted from the G2SS concerns me: The reference to persons "suspected" of having a life-threatening communicable disease. I can see if a boy is coughing all the time or something, but for most diseases I am not sure how a non-medical person would "suspect" someone of having such a disease. Some people are too suspicious; I'd be concerned about giving them the power to exlude someone based on a suspicion.(This message has been edited by NJCubScouter)

[Twocubdad 665]

Thanks for the cite, OGE. Note, however, what it does and does not say and compare that to what the BSA spokesman said in the original post. It does NOT require disclosure of communicable diseases, but it DOES allow local units/charter organizations a local option to determine the "desirability" of allowing individuals with communicable diseases to join their unit. Of course, there may another policy somewhere to which we mere volunteers aren't privy.

 

NJ, I agree with you completely that the medical info is handled in a far-too cavalier manner. At Webelos camp this summer, the medical forms were all kept unattended in a notebook on a table in the corner of the dining hall. At the end of camp, the forms were left for us in an envelope along with our camp patches. There needs to be some guidance as to has access to this information. I agree with the previous posters who have written that the information needs to be available on a liberal need to know basis. If parents and leaders think general knowledge of a particular boy's condition is helpful, that's up to them. (This is probably fodder for another thread, but given BSA's lack of care in handling medical information, how do you think they will safe guard Social Security numbers they will now require on all applications to facilitate background checks?)

 

I don't see any reason a camp or unit leader needs the results of a physical, like that which is reported on a Class 3 form. All that is needed is a can/cannot participate statement from a doctor. (Frankly, I don't think most doctors know what activities are included in order make that judgement. My doctor signed my Class 3 this summer without knowing if I would be spending the week in a hammock or climbing at altitude. But again, that's another subject.)

 

But more than that, I don't think the current medical forms are useful in the least. Please show me on the Class 1 or 2 forms the space where communicable diseases are to be reported? In the event of an emergency, no physician anywhere is going to treat anyone on the basis of a form they bring in with them. Every doctor will do their own evaluation, even in an emergency sitation.

 

What is needed is a consent form which is acceptable to hospitals (I believe several months ago there was a thread which mentioned that the current consent wasn't accepted somewhere) and plain-language information a leader needs to keep those in his unit safe and healthy.

 

"Johnny is asthmatic. Excessive dust or pollen and strenuous exercise may trigger an attack. He has an inhaler if an attack occurs."

 

"Bill has hemophilia. He cannot participate in contact sports or rough activities. Small cuts and bruises can be life-threatening."

 

"Joe takes allergy medicine. One pill at bedtime."

 

That tells me exactly what I need to know either to prevent or to handle an emergency.

 

 

 

[twin_wasp 10]

Just a few more points,

 

The class 1 and two forms are utterly useless, in my opinion. The class 3 medical form is a confusing mess, and my doctor considers it quaint and obsolete. To me it appears to be three forms taped together, perhaps there were once three commitees? I too have encountered rejection of the portion that authorizes treatment when a boy needed a bone set at an ER.

 

Don't be confused by the plethora of laws and rules about confidentiality. They generally do not concern laypersons, but are designed to limit (or at least appear to correct) abuses of our medical records by insurance companies, employers and the government.

 

I firmly believe that someone in the troop, the scoutmaster or medical professional perhaps, should review the medical records before big trips like summer camp. You are unlikely to ever have a problem about knowing what is in them, but you can definitely be held accountable if you do not know. Copies of the class 3 forms should always be close at hand on outings. You do not need to give out details, but a list of things to be aware of - who needs medication, who has allergies, etc should be shared with other leaders.

 

I understand that the forms do not cover all diseases, but the doctor who completes the form has an obligation to make sure he notes anything of importance to outdoor activites.

 

I also understand that while it understandably will make any person nervous to know that the troop has an HIV positive member, the greater risk, by far is assuming that anyone is "safe" in a first aid situation involving blood or other fluids. We need to make sure our first aid kits have plenty of disposable gloves, and scouters and boys need to get out the gloves in anytime there is blood present, as a matter of course. It needs to be drummed into their heads the same way we teach them not to let the raw chicken contaminate their cutting boards and give everybody salmonella.

 

Look at it this way, the first time you have to apply direct pressure to an injured person, he or she may be a stranger, and in any case you are very unlikely to know their HIV status. You can, however arrange to have gloves in your first aid kit or improvise with a plastic bag - which essentially makse it a moot point.

 

I cringe when first aid courses gloss over universal precautions, when folks assume that because we are nice folks from good families there is no risk.

 

I do not think that we can ever rely on a medical form as the final word. The forms do provide info about pre existing conditions, at the time they were filled out. They cannot list undiagnosed or emerging conditions. Do not forget that the non glamorous low tech side of modern medicine is the dogged adherence to procedures, such as handwashing and the universal precautions concerning blood.

 

Finally, although there are probably more facts to consider in theis case, I believe this boy should be allowed in scouts. I hope his mom reaches some understanding with the troop about how to handle sensitive information.

 

 

[nldscout 18]

I bet if you ask the scouts they already know anyway that this kid has AIDS. I mean it was in the paper. The Boys know more then some give them credit for.