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In the United States we have HIPAA regulations in place to (among other things) prevent healthcare providers, insurance providers, and any other entity that handles medical information from leaking patient information.

From my experience with various HIPAA certifications, it seems pretty stringent. No leak is too small.

So how is it legal for a healthcare provider to pair up two or more patients in a single room, when they are under inpatient care for several days?

I ask this because I recently stayed in the hospital for 2 nights. Never spoke one word to the old guy I was roommates with. When I was discharged, I knew the following details about him:

  • his full name
  • his DOB
  • his medical record # (if I felt like writing it down)
  • some of his prior health history (he fought, and won, a battle with colon cancer)
  • the reason he was in the hospital now (hasn't pooped in over a week)
  • current health concerns (doctors wanted to do a biopsy to make sure the colon cancer wasn't back)

These were all details given verbally by one or many different doctors or nurses over the course of my 3 days, 2 nights in the hospital.

Of course, I'm sure he knows a lot of my details now, too, for the same reason - we were inpatient roommates in the hospital and the doctors used no discretion when discussing my condition.

So how is this legal?

  • Just as a slightly off topic comment: I've seen in a German hospital that fellow patients (who were not too sick to do so) were asked to leave the room to give a patient more privacy for examination and/or treatment. – cbeleites supports Monica May 25 '18 at 21:21
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    @cbeleites I am curious how long it will take until two-bed-rooms will be challenged under the GDPR ... – Hagen von Eitzen May 26 '18 at 11:42
  • @HagenvonEitzen: I guess the way to approach this is to challenge any consent given by the patient as they were obviously so ill that they had to stay in the hospital - and that is known to drain mental resources, including the will to resist subtle pressure... – cbeleites supports Monica May 27 '18 at 10:24
38

As a short answer, guidance from the Department of Health and Human Services has clarified that HIPAA does not require hospitals to provide separate rooms.

As a longer answer, HIPAA is very deeply misunderstood. It does not prohibit "leaking" patient information; it prohibits unreasonable and unpermitted disclosures of protected health information (PHI).

Among the PHI disclosures that are permitted are uses that are for the purpose of delivering medical treatment. Of course, the covered entity (in this case, the hospital) is required to take reasonable measures to safeguard that information.

One of the areas that trips people up is figuring out exactly what it is we're safeguarding that information from. A lot people assume that the HIPAA imposes an absolute rule against disclosure of PHI, but it's more accurate to say that HIPAA requires reasonable safeguards against the unauthorized use of PHI.

With that standard in mind, it becomes easier to see why you don't need to universally separate patients. In all likelihood, neither you nor your roommate is likely to use the other's PHI in any way not allowed under HIPAA. We can look at your question as proof: You've disclosed a person's health condition and medical history, but you were a reasonable person and omitted the man's name, birth date, record number, and anything else that might allow us to link that information to an individual.

Hospitals -- and the law -- recognize that most people have no interest in a random strangers' medical information, let alone plans to do something nefarious with it. Because there isn't much of a threat there, the hospital isn't required to take exhaustive measures to protect the information. But when you put all that information for every patient for every doctor for every department for every hospital into a single database, the information starts getting a lot more valuable. That's why there are much tighter regulations surrounding protection of electronic records.

Of course, the roommate situation might be different if the hospital had a patient that they somehow knew had a history of identity theft or even a history of disclosing PHI. I've never heard of this happening, but I'd imagine that that knowledge would require the hospital to either segregate that patient or otherwise take extra care to avoid disclosing any information about a roommate.

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    Ahh yeah, PHI, that's right... Thank you, this is an excellent answer and has been very informative. – Adam Plocher May 25 '18 at 14:17
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    A more reasonable situation for your last paragraph might be if the roommate were a celebrity, perhaps. In a situation like that it's much more likely that the other person would want to brag about it to their friends/family, if it's a celebrity they know. – JAB May 25 '18 at 15:06
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    I'd agree there. Besides bragging, there may also be a monetary incentive to blab to a tabloid. I'd bet that hospitals around L.A. have policies addressing exactly this issue. – bdb484 May 25 '18 at 15:09
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    In contrast, most of the pharmacies I've been in for the past few years have taken steps to make it harder to overhear people's conversations with the pharmacists/technicians, many with signs claiming that these measures are being taken in order to comply with HIPAA's privacy requirements. – Adrian McCarthy May 25 '18 at 21:11
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    @AdrianMcCarthy Those measures, however, would not dramatically increase the costs of providing medical care, in contrast to moving to an all-private-room. – chrylis -on strike- May 26 '18 at 1:06
4

Aside from all else, it's a matter of practicality. For instance ADA requires government facilities to be wheelchair accessible, but many stations in the NYC subway are not because it's impossible - or to be more precise, impracticable.

Your thesis that HIPAA requires separate rooms would require either require a) that hospitals instantly slash their capacity by 50% (or more in the case of 3+ per room); or b) massive construction work, effectively the rebuilding of every hospital. It simply cannot be done.

Impracticability is a defense to pretty much everything.

Of course some would try, and potentially bankrupt themselves doing so... so Congress tends to cover that by codifying the fact that they don't have to do something that's impracticable. That's why ADA notches out exceptions for too-difficult projects, and HIPAA notched out an exception for shared rooms.

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    This overstates the point. The fact that eliminating shared hospital rooms is impractical is more likely to cause Congress to construct legislation that doesn't require eliminating them. (With the ADA, for example, the law has transitional provisions for existing construction.) It will also cause courts to favor interpretations of ambiguous provisions in ways that do not require their elimination. But if Congress passed a law explicitly outlawing shared hospital rooms, hospitals would not be able to avoid that because it's impractical. – phoog May 25 '18 at 16:02
  • @phoog Good point. Edited. – Harper - Reinstate Monica May 25 '18 at 16:19
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    @phoog: Actually, laws have been found unconstitutional because they made impractical demands. The courts may judge the validity of a law based on whether it serves a compelling government interest and whether it is the least restrictive means for achieving that interest. Laws that impose demands that are less practical (more restrictive) could be overturned. – Ben Voigt May 25 '18 at 21:09
  • @BenVoigt do you have an example? – phoog May 26 '18 at 0:53
  • Pretty much every content-based speech restriction gets run through this test. – bdb484 May 26 '18 at 18:36

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