Young mans brain kept after autopsy.

[Skeptic Ginger]

So a coroner couldn't, for example, tell the media how a person died? Because how a person dies is a medical diagnosis and patient confidentiality does not cease being confidential at death?

Autopsy disclosures are governed by state law. What is law in Pennsylvania is not law in California and so on.

Coroners are not involved in all death reports. Physicians and in some states like WA, nurse practitioners can also pronounce death and sign death certificates. Death certificates are public record in some sates, but in others they are treated like birth certificates, only certain people can request them.

Whether a coroner or ME can release details of a death to the media depends on state law and in some cases it depends on the cause of death. Homicide, accidental death and death by abuse, are often public records. But if you died from cancer, no, your doctor cannot always just disclose that information to anyone who asks.

But all this discussion does not go to the question at hand. Did this morgue have a duty to not let high school students see their friend's name on a brain in a jar during their field trip? Should the ME or coroner have kept names on bodies or body parts confidential from the students?

I cannot imagine any medical ethicists who would say it was tough cookies these kids knew the deceased and all due care was taken. That is absurd!

 

[Skeptic Ginger]

So, basically it boils down to this:

You say it was a "serious breech [sic] of confidentiality"

So now you are stooping to the false claim I don't know the difference between a butt and a breach because it took me all of a couple seconds to correct that typo when I proof read my post? That's pretty petty.

and that we should believe you because you're an expert. The "confidential" information was that the kid's brain was in the morgue.

While also testifying as an expert you claimed that HIPAA prevented medical personnel from calling out your name in the waiting room. I showed conclusively that this is not the case. I also showed that HIPAA allows for incidental disclosure of minor details.

Again you don't get it despite it being pointed out to you time and time again, confidentiality is a professional ethical duty. Legal aspects of confidentiality are separate and additional duties.

I showed conclusively that in some states autopsies are a matter of public record as are death certificates. I showed that the fact that an autopsy is performed is a matter of public record even if the details are sealed. The court ruled that nothing improper was done by the morgue. By your account nobody in the news is talking about a HIPAA violation. Since this was featured in the news, it's reasonable to assume that those in charge of HIPAA and those in charge of the morgue would address it if it were a serious breach.

How about addressing the actual facts in this case rather than your straw men?

I explained that if the the students in the forensic club had legitimate access to the named organs in the morgue, they subsequently violated the deceased's confidentiality. The deceased's parents did not pursue that case. That doesn't mean the case was not valid.

I asked you if the labeled jar in the morgue was not confidential, why did the court bother mentioning that the jar was not accessible to the public therefore the point the parent's lawyers made had no basis? You've declined to respond and instead only repeated your original argument.

And you conveniently continue to ignore the opinion of Dr. Cyril H. Wecht about the ethics breach here.

I have addressed your arguments, but you have not addressed mine. No wonder you imagine you are right, when you only battle straw men and don't address people's actual arguments.

Despite this you insist based on your expert opinion that the name on a specimen jar is confidential information and that students seeing it was a "serious" breach.

Yeah, it was unethical and arguing it wasn't is ludicrous. Technically students in a legitimate program are allowed to see confidential information. That doesn't mean the information isn't confidential.

And anyone familiar with a high school forensics club vs a formal forensics training program would clearly consider the students were on a field trip, they were not performing clinical training. They didn't need to see the names and the morgue was very short sighted in this case.

You seem to think the legal argument is all that matters here. If professionals were only held to legal standards and not professional standards, the laws would have to be written to cover volumes of minutia.

I'm glad we got that cleared. Next time if you're going claim "because I said so" just say so up front and save us the time. Thank you. That is all.

More straw. I didn't say, "because I said so". I gave you a long list of my qualifications. And I note you appear to have no credentials whatsoever in this area.

 

[LashL]

Has anyone arguing either side of this matter seen the court documents filed in the lawsuit at issue? If so, I'd very much like to see them and would appreciate a link. If not, well, they are rather integral to the discussion, and it's kind of pointless to argue in a vacuum.

 

[Skeptic Ginger]

Has anyone arguing either side of this matter seen the court documents filed in the lawsuit at issue? If so, I'd very much like to see them and would appreciate a link. If not, well, they are rather integral to the discussion, and it's kind of pointless to argue in a vacuum.

You mean besides the appellate court ruling?

 

[bluesjnr]

I think you are muddying the waters SG.

So in the case of the DOA kid, first, consent for care in the ED is not needed if an emergency exists and a patient is not capable of giving consent.

The kid was DOA - there was no care to be offered, no consent required. All that was legally required at that exact time was to identify the body and find and inform the NOK.

But when the patient is incapacitated or dead, as soon as next of kin is identified and contacted, they are now the person who consents for the patient or deceased. And that next of kin or person assigned with durable power of attorney, they now speak for the deceased. The deceased is not left with no rights.

There is the issue. My position is not that deceased had no rights, earlier in the thread I pointed out a couple of areas where they do. What I'm getting to is how confidentiality was breached and you are not dealing with that question. You seemed to say that the confidentiality of the owner of the brain was breached and that the dead person had the right not be identified to a school forensic club by virtue of having his name on the jar and the jar on display. You kinda moved a bit to the assertion that confidentiality was breached by the kids blabbing about seeing his brain and being able to identify him.

And when there is no NOK or DPA, the court can assign a guardian including a guardian to speak for the deceased.

But they would not have the rights to the body or it's parts. They do not "own" the body and cannot insist that any part thereafter removed should not be identifiable back to the deceased. There is no dispute as to why the brain was removed.

 

[Uncayimmy]

http://www.med.umich.edu/quality/toolkit/npp.htm
Personal health information or “PHI” (also called “protected health information”), is current, past or future information created or received by the University through its health care providers, health plans and contractors. It relates to the physical or mental condition of a patient or plan member, the provision of health care to that person, or payment for the provision of health care to that person. The term PHI does not generally include publicly available information, or information available or reported in a summarized or grouped manner.

California law says:

http://info.sen.ca.gov/pub/01-02/bill/sen/sb_1351-1400/sb_1386_bill_20020926_chaptered.html
(e) For purposes of this section, "personal information" means an individual's first name or first initial and last name in combination with any one or more of the following data elements, when either the name or the data elements are not encrypted: (1) Social security number. (2) Driver's license number or California Identification Card number. (3) Account number, credit or debit card number, in combination with any required security code, access code, or password that would permit access to an individual's financial account. (f) For purposes of this section, "personal information" does not include publicly available information that is lawfully made available to the general public from federal, state, or local government records.

To the best of my knowledge the fact that somebody is getting a required autopsy done is a matter of public record.

 

[Skeptic Ginger]

I think you are muddying the waters SG.



The kid was DOA - there was no care to be offered, no consent required. All that was legally required at that exact time was to identify the body and find and inform the NOK.



There is the issue. My position is not that deceased had no rights, earlier in the thread I pointed out a couple of areas where they do. What I'm getting to is how confidentiality was breached and you are not dealing with that question. You seemed to say that the confidentiality of the owner of the brain was breached and that the dead person had the right not be identified to a school forensic club by virtue of having his name on the jar and the jar on display. You kinda moved a bit to the assertion that confidentiality was breached by the kids blabbing about seeing his brain and being able to identify him.



But they would not have the rights to the body or it's parts. They do not "own" the body and cannot insist that any part thereafter removed should not be identifiable back to the deceased. There is no dispute as to why the brain was removed.

Muddying the waters?

Come on people, you are arguing from ignorance. Let's take this one step at a time.

The court ruled SINCE the brain with the name on its jar was not in PUBLIC display, no breach of confidentiality occurred. What is the court saying? They are saying the students may have had a legitimate reason to see the jar, but the jar was not suitable for public display.

Duh! Confidentiality, what else do you think the court meant?

 

[LashL]

You mean besides the appellate court ruling?

Yes, I was asking specifically if anyone had read the docs filed by each side in the appeal (I'd be particularly interested in the memoranda of law filed by each side) so that I could see what the actual legal arguments were that were made by each side and what each side was relying upon in support of their arguments.

I've read the appellate decision that was posted earlier in the thread viz the the summary judgment motion, but that's all I've seen so far. Thus my question.

 

[Skeptic Ginger]

I'm waiting for my question in post 67 to be answered before I ask my follow up question.

 

[Uncayimmy]

The court ruled SINCE the brain with the name on its jar was not in PUBLIC display, no breach of confidentiality occurred. What is the court saying? They are saying the students may have had a legitimate reason to see the jar, but the jar was not suitable for public display.

Duh! Confidentiality, what else do you think the court meant?

The court did not say anything at all about confidentiality - that word doesn't even appear in the document. The document says that the complaint alleges "Jesse's brain was mishandled by being placed on public display." The case was about the right of sepulcher. It doesn't appear to have any questions regarding privacy.

 

[Swagomatic]

Interesting thread, indeed.

Here's a couple of links that may be informative: silive.com and Jonathan Turley Blog

 

[The Central Scrutinizer]

So they waited a year before filing suit? I guess they had to make sure they were traumitized enough, and could cry on cue in the courtroom.

 

[Skeptic Ginger]

The court did not say anything at all about confidentiality - that word doesn't even appear in the document. The document says that the complaint alleges "Jesse's brain was mishandled by being placed on public display." The case was about the right of sepulcher. It doesn't appear to have any questions regarding privacy.

This is an interesting example of refusing to admit you are wrong by refusing to answer the question.

Why did the appellate court ruling mention public vs not a public display?

 

[Skeptic Ginger]

Interesting thread, indeed.

Here's a couple of links that may be informative: silive.com and Jonathan Turley Blog

I think both of those have been cited. I read them both anyway.

There are two issues here (or more). One is about the coroner keeping body parts and not telling the family they were kept. That is the main issue the lawsuit is based on because the court threw out the claim confidentiality was breached when the students saw their friend's name on the brain jar.

The confidentiality issue, however, is still a real issue and the fact the lawsuit is not addressing it does not mean it isn't a real issue. For whatever reason, a number of people in this discussion are ignoring the existence of a professional duty to maintain a patient's confidentiality doesn't exist because in this individual lawsuit, which was against the city/ME office, didn't include the city/ME office technically breaching that confidentiality. The suit was not against the high school kids who technically were the ones who violated confidentiality.

In addition, a number of people in the discussion are unaware that professional conduct also includes the poor handling of confidentiality that led to the students see the brain jar's name in the first place. There are very few medical professionals who would not recognize why that was a breach of the patient's confidentiality whether you think the ME or the high school students violated the confidence.

Students in legitimate programs are allowed to see confidential medical information. They are also supposed to be educated as to their obligations on confidentiality. What could be argued here is that the students in this case did not need to see that name on that jar, and that high school kids could not be expected to maintain confidentiality. Some of them could be expected not to be mature enough even if others among them were.

The plaintiffs did not argue that and therefore the judge would not have considered it. We know that because all the judge ruled on was that the 'students' were not equal to the 'public'. As you probably know, judges address what the attorneys address in lawsuits, no more no less. Had the attorneys argued, the ME should have anticipated the kids were not capable of maintaining confidentiality, we don't know what the judge would have ruled on that matter. But if it had been argued, it would have been addressed by the judge, likely with a comment on whether or not a "forensics club" was the same as a legitimate educational function allowing the same access to confidential information a student in a legit program would have access to.


One reason I know about the way the law treats underage medical/nursing students is because I provide consulting services as to how the worker safety law also addresses the same issue. You cannot allow an underage volunteer the same access as one allows an underage student in a legit program. Candystripers is an underage program to introduce students to the nursing field. The Explorers is an underage program to introduce students to the emergency medical and fire fighting field. And certified lifeguards can be under 18. They are all allowed access to a number of things underage volunteers are not allowed access to.

 

[Uncayimmy]

This is an interesting example of refusing to admit you are wrong by refusing to answer the question.

Why did the appellate court ruling mention public vs not a public display?

You wrote, "Confidentiality, what else do you think the court meant?" I pointed out that the court did not mention confidentiality and that the case was about a right of sepulcher. How is that not answering your question? But, hey, if you need me to elaborate, I will.

The complaint was for damages for a violation of the right of sepulcher, which is the right to control how remains are treated. We didn't get to read the complaint. If we are going to infer from the ruling, the most likely inference is that the remains were alleged to have been mishandled. The court ruled that the coroner has the right to do their job, and that included keeping the brain in a jar in a cabinet. The court ruled that it was not on public display, which would have been an inappropriate way to handle the remains. In other words the coroner wouldn't be permitted to exhibit body parts for public display without permission. They are, however, allowed to do their jobs and if incidentally the public sees the remains as part of a tour for students, that's acceptable.

Let's recap here. You were wrong about the legality of calling out names in the waiting room. You were wrong about incidental disclosure being a HIPAA violation. You were wrong about the information being private health information (I provided links that expressly demonstrated that publicly available information is not private health information).

Now you're trying to infer an issue of confidentiality from a court ruling that doesn't mention that word (or "privacy" or any other similar term). In fact, a Google News search returns zero hits for Jesse Shipley HIPAA (same for privacy and confidentiality). If you search for the exact phrase Jesse Shipley and the word HIPAA, only about 30 results come up, and in most of those "HIPAA" is not part of the article (it appears elsewhere on the page).

You're the only one carrying this torch. It's all based on your "expert" opinon, but we've already seen that your expert opinion regarding things medical has some glaring flaws that have been pointed out elsewhere on this board. In other words, you really got nothing.

 

[The Central Scrutinizer]

This is an interesting example of refusing to admit you are wrong by refusing to answer the question.

 

[Uncayimmy]

"The next day John seeth Jesus coming unto him, and saith, Behold the Lamb of God, which taketh away the sin of the world.”

Thus proving where Jesus got that second set of chromosomes. And to think that I thought the H in Jesus H Christ stood for haploid.

 

[Skeptic Ginger]

You wrote, "Confidentiality, what else do you think the court meant?" I pointed out that the court did not mention confidentiality and that the case was about a right of sepulcher. How is that not answering your question? But, hey, if you need me to elaborate, I will.

The complaint was for damages for a violation of the right of sepulcher, which is the right to control how remains are treated. We didn't get to read the complaint. If we are going to infer from the ruling, the most likely inference is that the remains were alleged to have been mishandled. The court ruled that the coroner has the right to do their job, and that included keeping the brain in a jar in a cabinet. The court ruled that it was not on public display, which would have been an inappropriate way to handle the remains. In other words the coroner wouldn't be permitted to exhibit body parts for public display without permission. They are, however, allowed to do their jobs and if incidentally the public sees the remains as part of a tour for students, that's acceptable.

Let's recap here. You were wrong about the legality of calling out names in the waiting room. You were wrong about incidental disclosure being a HIPAA violation. You were wrong about the information being private health information (I provided links that expressly demonstrated that publicly available information is not private health information).

Now you're trying to infer an issue of confidentiality from a court ruling that doesn't mention that word (or "privacy" or any other similar term). In fact, a Google News search returns zero hits for Jesse Shipley HIPAA (same for privacy and confidentiality). If you search for the exact phrase Jesse Shipley and the word HIPAA, only about 30 results come up, and in most of those "HIPAA" is not part of the article (it appears elsewhere on the page).

You're the only one carrying this torch. It's all based on your "expert" opinon, but we've already seen that your expert opinion regarding things medical has some glaring flaws that have been pointed out elsewhere on this board. In other words, you really got nothing.

Round and round the mulberry bush
you ignore the question

I ask you again, what was the court referring to when the judge noted the brain was only seen by the students and not by "the public"?

And you continue to repeat your ignorance that confidentiality is solely confined to HIPAA wording as if that was the only requirement of confidentiality.

Again, from the AMA which I tried to show you earlier and which you continue to ignore:

Physicians have always had a duty to keep their patients' confidences. In essence, the physician's duty to maintain confidentiality means that a physician may not disclose any medical information revealed by a patient or discovered by a physician in connection with the treatment of a patient. In general, AMA's Code of Medical Ethics states that the information disclosed to a physician during the course of the patient-physician relationship is confidential to the utmost degree.

Does that say the physician is only obligated to follow the law? Does it say that obligation stops at the death of the patient? Did the court say it was OK for the ME to show the brain in a jar with a person's name on it in public because there was no issue of confidentiality?


By the way, in case you didn't know, a medical examiner is a physician. Or maybe you didn't know that.
ME

A medical examiner is required to have a medical degree

 

[Uncayimmy]

I answered your question. Twice, in fact, the second time in great detail. I understand what you're trying to infer in a last ditch effort to defend your claim of a "serious breech [sic] in confidentiality." As I noted, the court didn't mention privacy or confidentiality. The court says the "complaint additionally alleges that Jesse's brain was mishandled." If the allegation was that privacy was violated, they would have said as much. But they didn't. They said the complaint was that it was "mishandled."

The case is about the right of sepulcher, which is the right to determine how remains are handled. The remains would have been mishandled if the brain was put on public display even if it was not personally identifiable. They can't use specimen jars with body parts in them to hold candles in their holiday Menorah or as ornaments on their Christmas tree. They can't use them to decorate the lobby or as paperweights on the receptionist's desk. They can't make necklaces out of skull fragments or use amputated limbs as part of a Halloween haunted house. It wouldn't matter in the least that the body parts could not be matched with a person.

What they can do is whatever is necessary to do their jobs. That's what this ruling is about. The notion of privacy and confidentiality is your invention. Nothing at all in the ruling discusses it. The one paragraph you're referring to fits neatly within the context of sepulcher. It's a stretch to say that privacy is involved, especially since the implication would be that it would be acceptable to publicly display remains that are not personally identifiable.

 

[The Central Scrutinizer]

"The next day John seeth Jesus coming unto him, and saith, Behold the Lamb of God, which taketh away the sin of the world.”

Thus proving where Jesus got that second set of chromosomes. And to think that I thought the H in Jesus H Christ stood for haploid.

Nominated