Young mans brain kept after autopsy.

[The Central Scrutinizer]

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.

A spot on and excellent summarization. No one older than 6 could fail to grasp such a simple concept.

 

[bluesjnr]

A spot on and excellent summarization. No one older than 6 could fail to grasp such a simple concept.

Wanna bet?

 

[The Central Scrutinizer]

Wanna bet?

No, because I can guarantee there is at least one poster who won't be able to.

 

[aggle-rithm]

Is it weird that I am even mystified by such reactions?

To be useful after death, for research, teaching or medicine, is FUNKING AWESOME! That's what I like for my remains. And yes, if someone wants to play puppets with my skull, GO FOR IT! Have fun! Live! I won't be feeling a thing.

You are the type of person this joke was made for:

A woman went to the funeral home just prior to her husband's funeral, and saw to her dismay that he was wearing the wrong suit.

"My husband is in a brown suit!" she complained. "I wanted him buried in his blue suit!"

"No problem," said the undertaker. He took the casket to a back room, then returned a few minutes later. The body was now wearing a blue suit.

"That's amazing!" the woman said. "How did you change his suit so fast?"

"It's simple, ma'am," the undertaker said. "All you have to do is switch heads."

 

[Skeptic Ginger]

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."

You continue to ignore what I posted. Confidentiality is a professional issue as well as a legal one. It is not limited to HIPAA wording. Nor was there any obligation for the plaintiffs to complain about confidentiality, or the court to address it. That does not mean a duty of confidentiality was not required.

So all you've done is claim you don't need to answer because you are ignoring the totality of confidentiality obligations and ignoring the AMA's paper discussing a physician's obligations to maintain confidentiality.

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.

Notion of of privacy and confidentiality is my invention?


As for the case, you are not saying anything I didn't already say, the court did not address the issue of the students breaching confidentiality of the victim. The court ruled the ME only revealed the confidential information to the students, not the public.


As for all the references to mishandling the remains, none of that had to do with displaying the brain in public or where the students could see it. The mishandling was about not telling the family body parts were still in the morgue.


This conversation is really getting ridiculous. You have such a poor understanding of medical confidentiality it boggles the mind. Why don't you ask someone else since you seem to think I don't know the profession I have practiced in for 35 years. And when you find out how stupid your arguments sound, do come back and apologize.

 

[The Central Scrutinizer]

Why don't you ask someone else since you seem to think I don't know the profession I have practiced in for 35 years.

I know for a fact he thinks you don't know. He PM'd me. With a poem about sheep of all things!

And when you find out how stupid your arguments sound, do come back and apologize.

And another thread is abandoned....

 

[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.

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

So, is that a "no", then, in answer to my question?

 

[qayak]

I blame the parents. How can you not notice that your son doesn't have a brain anymore? Was the kid so dumb that he behaved the same without a brain as he did when his brain was inside his noggin?

Yep, if parents paid attention to their kids these types of things just wouldn't happen.

 

[Skeptic Ginger]

So, is that a "no", then, in answer to my question?

I tried briefly to find it and did not, so yes, that is a no. Maybe someone else will be able to dig it up.

Are you concerned about/interested in other aspects of the case or is this in reference to the fact it wouldn't be ethical and it would be a breach of confidentiality to let people who didn't have a need to know to see a name on a jar with a brain in it?


Because the court did not address the confidentiality issue for the reasons I posted above. It was the students who technically breached the confidentiality not the morgue. One could argue the morgue was negligent in allowing the students to see the name on the jar, even if they were in a legitimate forensics program. In a court, that decision could go either way.

Here's an example of a relevant student policy at a medical school regarding cadaver dissection and viewing:

HIGHER EDUCATION POLICY COMMISSION; POLICY BULLETIN NO . 58; WEST VIRGINIA ANATOMICAL BOARD; APPENDIX A:* RULES AND REGULATIONS]

Confidentiality of the identity of all bodies must be assured, including anonymity for student usage.

It's easier to find rules for medical students and body parts than forensic lab techs. I've wasted enough time in this thread on this absurd challenge already.

There are other sources noting the confidentiality involved with bodies and body parts. For example policies for morgues in mass casualty events often address the confidentiality of the identification of bodies.

Should Health Professionals Allow Reporters Inside Hospitals and Clinics at Times of Natural Disasters?

Health professionals and administrators can and should control media access to hospitals and clinics. The public's right to information should not outweigh the right of victims of natural disasters to privacy, confidentiality, and dignity.

…Arguably, the universal obligation of health-care professionals and administrators to respect the privacy and confidentiality of their patients should suffice,…

And it appears the state UY found where autopsy reports are public is not some universal thing. It's not the case in at least one county in this state:

www.co.whatcom.wa.us/medex/mepolicy2002.pdf

By statute the reports and records of autopsies are confidential

 

[Uncayimmy]

This conversation is really getting ridiculous. You have such a poor understanding of medical confidentiality it boggles the mind. Why don't you ask someone else since you seem to think I don't know the profession I have practiced in for 35 years. And when you find out how stupid your arguments sound, do come back and apologize.

You claim expertise in the medical field to make up for your lack of any third party support for your claim. Allow me to explain why I dismiss your claim of expertise.

* You thought that medical offices couldn't call out names in the waiting room.

* You seemingly knew nothing about incidental disclosure in HIPAA.

* You didn't know that that private health information does not include information that the government makes publicly known.

* You thought a human mating with a sheep could produce a sheep with a human face.

* You thought that women who were raped could not have an orgasm.

These are glaring errors that I would never expect to be made by a woman with 35 (it was 30 yesterday) years of experience in the medical field, even if she's just a nurse. This is the Internet. Anybody can say anything they want about themselves. I don't know you from Adam. For all I know your claims about being a nurse are just a fantasy. If the claim is true, it still doesn't mean much considering these basic mistakes you make.

So, please, support your arguments without resorting to claims of expertise.

 

[Schrodinger's Cat]

Am I the only one here who sees the obvious truth that the ME is keeping brains around to feed to the zombie horde he's creating and is soon to let loose on the general populace?

We shouldn't be sitting around here arguing, we should be RUNNING!

 

[Skeptic Ginger]

You claim expertise in the medical field to make up for your lack of any third party support for your claim. Allow me to explain why I dismiss your claim of expertise.

* You thought that medical offices couldn't call out names in the waiting room.

* You seemingly knew nothing about incidental disclosure in HIPAA.

* You didn't know that that private health information does not include information that the government makes publicly known.

* You thought a human mating with a sheep could produce a sheep with a human face.

* You thought that women who were raped could not have an orgasm.

These are glaring errors that I would never expect to be made by a woman with 35 (it was 30 yesterday) years of experience in the medical field, even if she's just a nurse. This is the Internet. Anybody can say anything they want about themselves. I don't know you from Adam. For all I know your claims about being a nurse are just a fantasy. If the claim is true, it still doesn't mean much considering these basic mistakes you make.

So, please, support your arguments without resorting to claims of expertise.

This post is full of outright lies. If you want to discuss the issues in the thread, fine. Posting straw man lies is not.

 

[Uncayimmy]

This post is full of outright lies. If you want to discuss the issues in the thread, fine. Posting straw man lies is not.

For those keeping count at home, that's 265 posts in 117 threads in which SG has written the word straw. Those following this thread and others know I'm not lying.

 

[Skeptic Ginger]

UncaYimmy claims that Skeptic Ginger made up medical confidentiality, it doesn't really exist*.


It's not a straw man, he really said it.

 

[The Central Scrutinizer]

This post is full of outright lies. If you want to discuss the issues in the thread, fine. Posting straw man lies is not.

Evidence?

 

[NobbyNobbs]

I may be way off base here so please correct me if I'm wrong, but I think what is at the core of SG's argument but has not been explicitly stated is that privacy is not equivalent to confidentiality. To put it somewhat clumsily, privacy is about who knows while confidentiality is who tells (or is told ). For example, telling your psychiatrist about your secret love affair with your neighbor's border collie is both private and confidential. Private, because it's knowledge imparted just between the two of you and confidential because he is ethically bound not to share it. The secret handshake at the Order of Badger lodge isn't private, since all the members know it, but it's confidential because it's not to be shared with the public. I'm sure there are other examples that better articulate what I'm thinking but I'm too tired to come up with any.

Does anybody understand what I'm rambling about, and am I even close?

 

[elgarak]

It just occurred to me that we would not have this thread, if the brain was of a person the kids would not have known personally.

The only reason this story broke was because some of the girls in the group broke down since they KNEW the boy (which makes them unsuitable for a forensic profession, IMO).

I don't think one can construct a legal or ethical obligation for the morgue's staff based on the probability of a witness breaking down emotionally. It's just a simple unfortunate coincidence. An apology, and the story should be out of the world.

 

[Skeptic Ginger]

It just occurred to me that we would not have this thread, if the brain was of a person the kids would not have known personally.

The only reason this story broke was because some of the girls in the group broke down since they KNEW the boy (which makes them unsuitable for a forensic profession, IMO).

I don't think one can construct a legal or ethical obligation for the morgue's staff based on the probability of a witness breaking down emotionally. It's just a simple unfortunate coincidence. An apology, and the story should be out of the world.

There are multiple issues here. The fact the high school kids knew the deceased is an example of why certain information is confidential, but the same standards of confidentiality would exist regardless.

For example, I use coded identifiers on HIV tests I perform because there is always the chance someone I am testing has a neighbor who works in the lab. And if it is a medical worker I am testing, there is a chance the lab worker might know the person because they both work in the same hospital.

Students in a legitimate forensics program would have access to confidential information in a morgue.

It's arguable if high school students in a forensics club should have the same access to confidential information in a morgue as students doing a clinical lab as part of a forensics tech program.
1) They aren't really students.
2) There was no "need to know" which there might have been if these were forensics tech students on a clinical assignment.
(I posted 2 citations addressing this: the Med School policy, and the physician/attorney's expert opinion in one of the news reports.)

The consequences in this case are a demonstration why one should not allow unrestricted access to such confidential information as the fact a deceased's brain is in a jar in a morgue.

The court did not address the issue, should the morgue have allowed the kids to see the name on the jar? The court only addressed the issue, were the kids seeing the jar the same as the public seeing the jar? We know that because that is what the court said it was addressing.

The kids breached the deceased's confidentiality. The parents of the deceased, understandably, were not interested in suing the kids for disclosing confidential information they saw in the morgue. Had the parents done so, the court would have had to rule on whether or not a high school forensics club should have the same access to confidential information as forensic tech students in a legitimate program.

If lawyers do not bring up an issue in a civil lawsuit, the court does not address it, even if it could have been brought up.

Confidentiality is an ethical and professional obligation, in addition to a legal obligation.
(I posted the American Medical Association's paper addressing this in depth.)

And while confidentiality most often refers to verbal information, in written or in electronic form, the fact a brain is in a jar in the morgue is also confidential. The same is true for things such as acknowledging a person is physically present in a psychiatric or drug treatment program.

Confidentiality is a requirement when you learn something in the course of your job. Whether or not the information is known to someone else has nothing to do with this standard. It's the fact you came upon the information in the course of your duties that defines what is to be kept confidential and what isn't. And need to know is the standard for disclosure.

Privacy is a separate but overlapping issue.

Disclosure would include providing something a court ordered disclosed or something which in the public domain by law, such as states that make autopsy reports public. By law I am obligated to inform a sexual partner of someone I diagnose an STD in if that person will not willfully inform their sexual partner(s). By law I'm obligated to report to public health certain infections I diagnose. By law a physician treating a gunshot would is obligated to report it to law enforcement. By law I am obligated to report suspected child abuse.

 

[Skeptic Ginger]

I may be way off base here so please correct me if I'm wrong, but I think what is at the core of SG's argument but has not been explicitly stated is that privacy is not equivalent to confidentiality. To put it somewhat clumsily, privacy is about who knows while confidentiality is who tells (or is told ). For example, telling your psychiatrist about your secret love affair with your neighbor's border collie is both private and confidential. Private, because it's knowledge imparted just between the two of you and confidential because he is ethically bound not to share it. The secret handshake at the Order of Badger lodge isn't private, since all the members know it, but it's confidential because it's not to be shared with the public. I'm sure there are other examples that better articulate what I'm thinking but I'm too tired to come up with any.

Does anybody understand what I'm rambling about, and am I even close?

Confidentiality is a professional, ethical and legal obligation in a number of professions. The standard is did you learn the information in the course of your duties and does the person you are disclosing it to need to know.

Who else knows the information is technically irrelevant.

If I diagnose you with HIV, I can't tell anyone unless they need to know. It doesn't matter if all your friends know you have HIV or no one knows. If you give me permission to discuss it in front of your friend who has come to the clinic with you, then I can. But if your friend comes up to me without you there and asks questions, even if they tell me you disclosed your HIV status to them, I cannot discuss it with them.

When I have a police officer who has been exposed to a patient's blood, and the patient was taken by the police to a psych facility, and I need to test that patient by law because the officer was exposed, I have to get the public health officer involved. The psych facility cannot tell me they have the patient, even when I know the police delivered the patient to the facility and even when the patient is under arrest for assault or some other crime and is being held in mandatory inpatient treatment for an assessment. Only the public health officer can find out the patient is in the facility. Even the police cannot inquire about the patient while they clearly know the guy is there, since they took him there.

 

[Schrodinger's Cat]

There are multiple issues here. The fact the high school kids knew the deceased is an example of why certain information is confidential, but the same standards of confidentiality would exist regardless.

For example, I use coded identifiers on HIV tests I perform because there is always the chance someone I am testing has a neighbor who works in the lab. And if it is a medical worker I am testing, there is a chance the lab worker might know the person because they both work in the same hospital.

You can't really apply the rules the apply to HIV confidentiality to health care as a whole. HIV is a specially protected category that requires more confidentiality than other diagnoses. I don't know what the rules are because I don't work in HIV care, but I know they are different.

I work at a cancer hospital, and people's records are identified by name, not a coded number alone. Any person who even comes across the patient's chart, lab work, pathology, etc by happenstance, even if they do not need to see it, will be able to see the patient has for example sarcoma, and who they are, because it is clearly labeled with their name and DOB. Also, our administration people work off of computer work lists which lists huge numbers of patients with their diagnoses. ANYONE who has access to our computer systems can see this information, and does, whether they are looking for it or not, because when you pull up a work list, it lists ALL the patients being seen in the various clinic. As clinics are identified by the diagnosis they treat (leukemia clinic, melanoma clinic, etc) you will automatically know your patient's diagnosis just by what clinic they are scheduled for. People typically work by alpha split. So if your job is to get referrals, you'll work last names A-D. But the work list you print out will list ALL patients with pending referrals, even those outside your alpha split which you won't be touching personally.

We work at one of the top hospitals in the world, and they are very concerned with being HIPPA compliant. But in our HIPPA training, what we were told is that we just can't share this information from outside people. Not that we have to keep the the patient's names hidden from any kind of documentation or specinmens in the hospital so that no one except people directly involved with the patient would know they exist.

So for example, once I was going through faxes in our office and I came across a fax sent to another employee, for a patient who I was not working with. This fax was an authorization from an insurance, and it clearly listed the patient's name, address, cancer diagnosis, etc. I recognized the patient's name as being a very close friend of my parents. It is not a HIPPA violation for me to have seen this piece of paper even though I personally am not working with this patient. It would only be a HIPPA violation if I had then called my parents or anyone else (who were aware of the patient's diagnosis), "Hey Mom and Dad, did you know so and so is being treated here at Dana Farber?"

I should also say that I have worked at several other hospitals, which are also top hospitals, we're talking some of the top ranked in the country, and have entire departments that exist to make sure we are HIPPA compliant...and I have never worked somewhere where patients' lab work, charts, or anything else was identified ONLY by their medical record number or a coding number. They have always been identified by name and date of birth, which is clearly labeled on the scans/slide/chart etc that can be seen by anyone in the hospital who is in that area and happens to catch a glance.

Now certainly, I can't LOOK in a patient's chart and go through their records if I have no legitimate professional reason to. But merely the fact that I saw the chart with the patient's name and DOB in the sarcoma clinic is enough to tell me this patient has sarcoma (or at the very least, has a history of or high risk of sarcoma). And if I were to see a labeled scan or specimen outside of a particular clinic, like in a lab, this may not reveal their exact diagnosis, but I know they are patient at our cancer hospital.

It sounds to me like you work in a very specified area (HIV) with very specified rules regarding the labeling of patient information and specimens with identifying information (such as their name), and are under the impression these rules apply universally in healthcare, but they don't.

Also, we have high school interns who come in and do a few hours a week in the summer. This also has been true at other major hospitals I have worked at. They are in the same situation as the rest of us - they are able to see patient information all the time, because they are constantly around charts and specimens and computer systems and other things which have people's names on them. They are just counseled beforehand, like the regular employees are, what the rules of HIPPA are and that they cannot share any information with anyone. They are not prevented from seeing patients' names and diagnoses just because they are 16 years old.

I also was a candy striper starting at age 13, and I volunteered in the surgical unit. Mostly they had me going through and organizing their charts and medical records. So at 13 years old, I had full access to a wide array of patient information. And in this case, I had to read some of their charts' specific information because my task was to organize their records. So not only did I know their names and diagnoses, I knew a lot of other personal stuff about this. I was counseled on HIPPA, as were all the other kids. No one ever prevented me from seeing patient information because I was a kid. Also, because I worked in a surgical unit, I got to see all sorts of specimens that were sent from the surgical department to the pathology lab. These were labeled with the patient's name and date of birth. Furthermore, this was in a small county hospital, so not only was it possible that I would come across someone I knew, it was likely, and it in fact did happen several times.


Though I don't know enough about this case to know if the teens in this particular instance were counseled on HIPPA.

I don't really understand why you seem to think that hospitals concern themselves with making sure no one at the hospital (including 13 year old candy stripers) ever finds out if someone they know is being or has been treated there. If you live in the same town/city as the hospital you work in, stuff like that happens all the time. You just can't go around then telling people, "Hey, guess who has this disease and is being treated at the hospital where I work?"

Again, my guess is that perhaps this works this way for *you* because you work with AIDS, which is a highly sensitive and specially protected diagnosis. But that's not the way healthcare works as a general rule. Specimens, charts, etc are typically labeled with name and date of birth, and are in places where they can be seen by plenty of people who do not actually work with the patient and need to know that information.