HIPAA, HIPAA, Hooray for Bureaucracy!

We were getting a new patient on the psych unit. This person had been picked up by the police with no ID, psychotic and mute. We were informed we couldn’t admit them as J___ Doe, which was the name the police had given them, because that would reveal their gender, thereby violating their privacy. The admitting office, therefore, assigned them the name “Tangerine Doe.”

What I still can’t figure out is exactly who we were trying not to reveal this person’s gender to, and why? Even if I yelled from the rooftops, “We have a new psych patient named John/Jane Doe!!!” it wouldn’t matter, because the name is arbitrary and isn’t any more identifiable because there is a gender attached to it. The person in question could have been any one of millions of people in the Greater Portland Area and surrounding countryside. Sure, knowing their gender cuts that number by roughly 50%, but that just is not enough to make any measurable difference in the odds against anyone being able to figure out who they might be. After all, we’re still talking millions to one!

Aside from all that, this poor person was psychotic. They were seeing and hearing things that weren’t there, and struggling to know which things were real and which were hallucinations. It’s no wonder they weren’t talking; they couldn’t tell who was real and who wasn’t; what was really happening and what was just part of some waking nightmare. How in the world were they supposed to be able to get oriented to reality, when reality consisted of a place they’d never seen before containing a bunch of people they didn’t know who kept calling them by some goofy 70s flower child fruit name?

There’s another problem, too. As I see it, this issue opens a whole new can of worms. If being known in the hospital by a gender-revealing name violates a patient’s privacy, then we’ve got to get busy and figure out what to do about the rest of the patients. Many of them, in fact the great majority of them, have gender-specific names, and are actually admitted under them. These are their REAL names, which makes them much more identifiable, even without the handicap of an easily-determined gender. How can we give “Tangerine” preferential treatment by obfuscating his/her gender for the sake of privacy, without granting the rest of the patients equal protection?

The only solution I can think of is to begin reassigning names to patients upon admission.

Sorry, Mrs. Johnson, but we can’t admit you with the name ‘Mary.’ People would know you’re female, which would violate your privacy. Therefore, during your stay here you will be known as ‘Artichoke Johnson.’

I bet you thought the crazy people were the ones *inside* the psych unit, didn’t you???

Oh, incidentally, Tangerine arrived on the unit during evening snack time, and was escorted past the dining room where the other patients were all gathered to eat and watch TV. As fate would have it, Tangerine’s oversized scrub pants chose that moment to suddenly come undone and fall to the floor.

Staff acted quickly to correct the wardrobe malfunction, but the damage was done. Tangerine’s gender, despite the precautions taken by the admitting office, was no longer a secret.

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2 Responses to HIPAA, HIPAA, Hooray for Bureaucracy!

  1. Felicity says:

    What I don’t understand is why ‘Tangerine’ instead of ‘Jan Doe’. 😛

    Maybe the person who wrote that part of HIPAA was thinking of protecting anonymous transgender patients? But given the government’s record on protection of trans people, that seems really far-fetched.

  2. Ruth says:

    That’s the thing — it’s *not* part of HIPAA. It’s an overreaction based on misinterpretation of HIPAA.

    HIPAA protects people’s privacy concerning medical treatment. So if I tell you about a patient and let slip enough details to allow you to figure out who the patient was, I’ve violated HIPAA, because now you know who they are and that they are undergoing medical treatment. But that would require something like a name, age, partial address, or maybe a peculiar/unusual medical condition that not many people have. A gender and a made-up name simply do not constitute enough information to qualify as a privacy violation!

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