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Privacy law has little effect on notification policy

As an April 14 deadline approaches for implementation of the Health Insurance Portability and Accountability Act of 1996, designed to protect medical patient privacy, Student Affairs administrators are not significantly changing their policies for parental notification of alcohol-related hospitalizations.

Sue Wasiolek, dean of students and assistant vice president for student affairs, said her office has instructed Emergency Department personnel to ask students for consent to notify Student Affairs upon arrival. In addition, Wasiolek said her office will continue to receive reports of police transports to the Emergency Department.

Wasiolek admitted, however, that despite those two efforts, her office has known about several emergencies involving students that went unreported.

"I know there have been a couple of students who have been admitted to the hospital-not necessarily alcohol-related conditions--and we have not been made aware of it until well after the fact," she said.

She added that Student Affairs will not change its procedure--for now.

"It was basically what was happening before, although I think there were some health care providers in the Emergency Department who routinely called us without necessarily even asking for the student's consent," she said.

Jeff Kulley, a counselor for Counseling and Psychological Services and the University's alcohol specialist, said the law will not change much of what he does, because of the already-stringent confidentiality mandated by CAPS.

"I do worry about those students who could fall through the cracks, who have a large blood alcohol content level, or several emergency room visits, which would be red flags," Kulley said.

HIPAA, the first federal law comprehensively dealing with patient medical privacy, represents more than 100 regulations on security standards and the proper use of health information. The law is backed up by severe civil and criminal penalties for noncompliance, including fines up to $250,000 and/or imprisonment for a maximum of 10 years for knowingly misusing personally identifiable health information. Duke University Health System has already begun to train employees in the new privacy and security regulations.

The laws, designed to protect patient information, have made it more difficult for Student Affairs to monitor when and why students enter the Emergency Department.

Wasiolek also said that in accordance with the alcohol policy approved two years ago, her office is still notifying parents of alcohol violations.

"We're doing that routinely," she said. "That is continuing to happen. Our routine is we ask the student to call their parent first, and we ask that they have the parents call us. We encourage that first contact to come directly from the students."

The law does not affect communication between Student Affairs and parents, said Britt Crewse, associate vice president and chief compliance and privacy officer of the Health System.

Although administrators had hoped last year that legislators or staffers in the federal departments of Education and Health and Human Services might find a way to exempt student affairs offices from the requirements at academic hospitals, neither Wasiolek nor Crewse said any such exemption has been proposed.

Although Crewse did not have specific information on how Emergency Department personnel obtain consent, he said students had to give consent via a written form. In some cases, however, a doctor can reserve professional judgment about notifying parents, administrators or others.

"If a patient is incapacitated, the physician can make a decision about whom he needs to notify about the student's care," Crewse said. "The physician does have ultimate authority when the patient is in critical care."

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