Priviledged Communication

[KYChief350]

This is a legal question, but isn't related to EMS only, so I'll post it here.

Background information - I am chief of a fairly large mostly-volunteer department covering about 40 square miles of rural/suburban territory. We operate out of three stations, and provide, besides fire, a BLS ambulance service using two ambulances.

My question has to do with how to handle those runs which possibly may result in legal action, where it would seem prudent to have the personnel involved write a "contemporaneous" document so as to have something to refresh their memory should they, months or years later, have to testify in court about what they saw or heard on a run.

The attorney for the Fire District advises that they address any such communication to him, as it would then fall under attorney-client priviledge.

Experienced firefighter/EMT's on the department say that they always made notes in such cases and kept them in a file at their homes.

When we took our HIPAA training a few months ago, I recall that it was specifically stated in the class that we were NOT permitted to keep individual notes on patient condition.

If we do as the attorney suggests, and send him notes that may contain patient information, isn't that, in itself, a violation of HIPAA?

Now to the question:

What is policy at other departments - who are the notes kept by, what sort of information is permitted to be inthe notes, etc? What's you policy?

[Weruj1]

are you talking EMS runs ? or fire calls ? Injury accidents ? what exactly are you talking about keeping notes about />? need some more info Chief in order to help you ..... I will also say that on any EMS run your crew should be filling out some kind of patient report form........... I will look forward to yuor reply

[KYChief350]

My question relates more to EMS runs. We have had several responses lately (car accidents that will likely result in a "wrongful death" suit against the other driver, a case where a toddler got into one of the parents' "recreational pharmacuticals", etc.) where we are pretty sure that our crews will be called to testify. Some of these cases take a significant amount of time before they actually end up in court.

I believe that HIPAA forbids us to keep "notes" on our patients. However, that's what most of our emt's did pre-HIPAA. Maybe the best thing to do is to attach these narratives to the run sheets in our files?

[kghemtp]

Chief,
I wouldn't presume to avoid your question by redirecting it, but this is how I would approach situations: evaluate the thoroughness of patient care reports (PCR's) in terms of what was seen, what was said, what was done, and which order, and how complete these reports are. The theory of "if it wasn't written it wasn't done" applies here, and when it comes to court cases and depositions, your EMT swearing to THIS being a correct documentation of what he did, will be what the court is looking for. To swear that the report was written as honestly and completely as the provider knew is generally what people are looking for. It is, after all, the legal document pertaining to that call.

Bring in people who can give advice and training sessions on reports. We can't be afraid of people dying in our ambulances, for example, if a paramedic wasn't available to give drugs. If we operate to our scope of practice and document situations appropriately, litigation will go much easier. We're never immune to suits, you are well aware. However, a thorough account of what happened as documented in a runsheet will give the judge greater ability to throw out a case.

Good luck!

[ADSNWFLD]

I agree with making sure the guys write an outstanding and highly detailed report, ems or fire report.

As for HIPPA check with your attorney, but how are you violating HIPPA if you treated a patient and you and only you have notes about the call. If no one else sees it you aren't violating anything.
I would recommend just doing a good job report writing.

Your examples should be documented in the run report.