The City of Somerville wants me to violate federal healthcare laws

I'm seeing a client in Somerville, every week at the individual's home, as this is an individual who has difficulty traveling. The individual's street just became resident permit parking only. I talked to the Somerville Traffic and Parking Department, and was told I could get a healthcare provider placard, which costs $25 a year. This sounded annoying, but sufficient to meet my needs and I asked what I needed to do. (I should note here that Boston, where I do most of my work, does not issue any such thing, despite several agencies and providers trying to get them to do so for years.)

The man told me I'd need to disclose the home address of the person, when I'd be there, and what kind of service I'd be providing. I told him I couldn't do this, as it violates this person's confidentiality. I said I was willing to provide the street name along with my professional license number and vehicle information, which I thought should be sufficient to ensure that I'm not abusing the parking permit. He was incredibly rude, cutting me off repeatedly and telling me that "lady, no one has ever had a problem with giving me that information in 15 years" and telling me "you think you're the only one in Somerville who sees people at their homes? There's people from all sorts of VNAs seeing people, and none of them have a problem filling out a form," and, "I can't give you a carte blanche to just do whatever you want all over the city." Wow. Because that's clearly what I really was asking for, not just a parking permit to park on one street for an hour a week, for which I was willing to give pretty much any of my own personal information and was willing to pay the ridiculous $25 fee.

I've spoken to someone at the American Music Therapy Association national office, who agrees that the request is inappropriate and says this should be obvious from the text of HIPAA, the code of ethics, and the standards of practice. This person also emphasized that I would need a release to provide the name of the person's street, since that's also personally identifying information. (I tried calling the Massachusetts Division of Professional Licensure as well, but it went to a voicemail box that was full, as is often the case there.) It seems obvious enough to me as well that they should issue the parking permit based on my vehicle registration and/or professional license, so that if I do abuse the parking privileges, it comes back entirely to me and doesn't involve my completely innocent clients in any way. Of course all of this is obvious, but how do I convey this to the ridiculous Somerville parking guy so I can get a parking permit?

I should mention that this individual is very adamant about not releasing any personal information to anyone, which is fully within this person's rights. When the parking signs went up, I suggested that this person might want to get a visitor parking placard in case anyone wanted to come visit, not specifically me, and offered to do this with this person, but this person was not willing to share any bills or anything with the Traffic and Parking people, and is generally very suspicious of government-type people. I didn't press the issue at all, because it would be unethical for me to put the client in a position of going outside a personal comfort zone in order to effectively provide a favor for me. This person should not be required to divulge personal information to the City of Somerville in order to continue receiving healthcare. Nor should this person be put in a position of potentially being contacted by the City of Somerville should I decide to abuse my parking permit, or even if there's a question about it. I'm ethically required to provide healthcare unconditionally, and I can't tell my client that I can only continue providing services if my client signs a release allowing me to tell the City of Somerville that this person is receiving mental health services.


Jodie said...

I absolutely agree on the confidentiality aspect- but the person would not be "doing a favor for you" if they were to get a visitor parking permit, or for that matter, to sign a release for you to be able to get the information to the parking office so you can get a permit. They would be doing something to ensure that they (or their family member) is able to access a needed service.

If this were (or is) a client accessing your care through insurance, would you see them for free if they refused to provide you with that information? (Providing that they weren't willing to private pay). You wouldn't be under any legal or code of ethics violation if you said you needed to ensure you were paid. I definitely understand the reluctance to push someone further than they want to go (or not pushing if they aren't able to), but it's definitely not about doing you a favor. You're providing them with an essential (I'm assuming) service.

eeka said...

Yeah, thanks for the distinction. I guess "favor" wasn't quite how I wanted to frame it, but just that it puts the client in a bad position and a potential dual role. They DON'T seem to want any of my information, so they'd presumably trace any abuse of parking permit to client's name and address, which, uh, just no. At the very least, if there's a situation where if they need my car moved off the street or want to check and see if I'm abusing the permit, they have the necessary info and presumed consent to knock on the door and say "hey, is [eeka] in there, providing you with your mental health services?" And no, I don't expect that this would happen, but that's just the whole reason why it's sick and wrong; at least with the insurance company, I can tell the individual exactly why I need the consent signed, and exactly what the insurance company does with the information. There's a very clearly spelled out relationship I have with the insurance company that governs how much information they need and what they can and can't do with it. I have no such thing with the City, which is why it's inappropriate for them to request it.

They also have no reason whatsoever to need my client's personally identifying information. The only business they have with me is whether I'm parking for legitimate purposes. If I give them my professional license number, vehicle registration info, and tell them I'll be in a certain neighborhood one time per week, they have more than enough information to monitor what I'm doing and go after me if I'm abusing the Somerville parking permit. Which would be the only reason they need any information about me or what services I'm providing to whom.

Anonymous said...

suggest notifying whomever monitors HIPAA compliance, and tell them a city emplpoyee just admitted the city has violated it multiple times.

eeka said...

That's a thought, anon. It wouldn't be the city violating HIPAA though; they aren't a covered entity. Only the divisions of the city that provide healthcare or related services are required to maintain their medical records in a HIPAA-compliant fashion. I'm pretty sure the Traffic and Parking people don't have ANY sort of medical records storage.

If healthcare providers are providing identifying information without a signed release from the patient/guardian, the providers are violating HIPAA. I'm not sure this is happening though; programs like the VNA often have patients sign a whole stack of forms as a condition of beginning services with them, and may well be including releases to the city for parking purposes.

realsupergirl said...

personally, if it were me, I'd probably just get the client to sign a ROI for the City of Somerville Parking Department, allowing you to release their name for the purpose of providing service.

You can get a ROI that is very narrow in scope, and unless there is some reason why it would endanger your client for some scrub in the city office to know this information, it's probably easier for you and allows you to focus on more relevant clinical issues.

but that might just be my approach.

eeka said...

Yeah, I know that's an option, but without giving too many details, it's not really clinically appropriate to ask that of this person.