Privacy of Care

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Our county jail is accredited by NCCHC. I work in the intake department, usually in an office where there is privacy when doing the medical history. When the jail is short-staffed and there is no deputy available to sit outside my office, I am expected to use an area that is not private at all. The inmate sits in a cubby and the nurse is behind a window. Behind the nurse sits office personnel and they can hear everything that I say and what the inmate says about their medical and mental health history. Does this comply with the standards?

This is a good question and a situation that we heard described before. Standard A-07 Privacy of Care states that health care encounters and exchanges of information are to remain in private. This includes discussions of protected patient health information and clinical encounters. Privacy should be afforded during physical exams, with special considerations for breast, rectal, pelvic or other genital exams. We understand that extenuating circumstances sometimes prevent this, but it should be the exception and not the norm.

— From CorrectCare Volume 34, Issue 1, Winter 2020

 
 

Our administrators are having trouble deciding how to approach PREA Standard 115.15 Limits to Cross-Gender Viewing and Searches, in particular part (e), which addresses trying to determine an inmate’s genital status. The PREA standard states that it can be accomplished by conversing with the inmate, by reviewing medical records or as part of a broader medical examination. Our medical staff are stating that they are not to be involved in the process of determining genital status. Does NCCHC limit them in this way?

Concerning PREA, in NCCHC’s 2014 Standards for Health Services, standard B-04 Federal Sexual Abuse Regulations only requires written policy and defined procedures for how the facility will comply with this federal law. The situation you describe extends to other areas of the standards, particularly involving a patient’s right to privacy and confidentiality of health records. Medical practitioners may learn of an inmate’s genital status through routine medical examinations for medical purposes, such as during the initial health assessment. Health staff should not do an exam for the sole purpose of determining genital status.

NCCHC standard A-09 Privacy of Care requires that discussions among staff regarding patient care occur in private, without being overheard by inmates and nonhealth staff, and that clinical encounters occur in private, without being observed or overheard. Standard H-02 Confidentiality of Health Records requires that health records are stored and maintained under secure conditions separate from correctional records, and that health staff receive instruction in maintaining patient confidentiality.

However, local, state or federal laws may allow certain exceptions to the obligations of health care professionals to maintain confidentiality. The responsible health authority should maintain a current file on the rules and regulations covering confidentiality and a list of the types of information that may or may not be shared. Health staff should inform inmates at the beginning of the health care encounter when these circumstance apply. Otherwise, releasing confidential medical information to nonhealth staff would require the written consent of the patient.

— From CorrectCare Volume 29, Issue 1, Winter 2015