Chaplain’s uninvited
appearance
poses issue in hospital care
Does ministerial access
violate privacy?
It is a few minutes before
the scheduled 1 p.m. surgery, and I’m sitting in a private patient-prep room –
hospital gown on, a warmed blanket over me from chest to knees, the IV line in
my left arm secured by tape as I wait out the clock.
If there’s a time to be
tense, perhaps it is these last minutes
when you wonder – is this the right decision... will the surgeon find something
unexpected as he fiddles around inside the abdomen... will the anesthesiologist
hiccup? Really, surgery is a crap-shoot. The odds are very good you’ll wake up
afterward just fine, if groggy from the sleepy drugs and a little morphine, and
go home three or four days later.
And that’s when the
unexpected happens. It’s about five minutes before one when the man in a dark
suit appears in the doorway, looks down at the folder of patient paperwork and
then at me, inquiring: “Is your name David? David Ettlin?”
“Yes, I am,” I reply,
wondering who might be this stranger whose immaculate suit set him apart from
the scrub-attired medical team.
He introduced himself as the
chaplain on duty. Politely, I hope, I told him, “No religion, please.” And he
departed.
Friends who kept up with my
Facebook posts know which hospital this is, but for now I’ll skip the name.
Suffice to say it is an institution operating under the umbrella of the Roman
Catholic Church – and which I chose largely because that’s where the excellent surgeon
I wanted happens to practice, and I’ve heard good things about its quality of
care. (A few years ago, before completion of its modern high-rise patient
tower, a friend spent two weeks there and had excellent care, although that
came after an agonizing three-hour wait to be seen in the emergency department
as his appendix ruptured.)
My quibble is about the
religion part of this – about which a new patient evidently has no advance
knowledge – and I’m curious how others see it.
I sent a carefully-worded
letter of concern to the hospital CEO and its senior vice president for
operations which read, in part:
[This] is, of course, a hospital operated under the
umbrella of a church, and religion has a desired place for many of its
patients. But I would not expect an uninvited visit from a chaplain in a
restricted medical area, or that he would have felt entitled to look for my name
on the patient folder. If I had signed any paperwork that allowed for such an
intrusion, I did not notice – for I would never have consented to it.
I have no doubt the chaplain meant well. But perhaps the hospital needs a specific way
for patients to knowingly request -- or refuse -- the presence of a chaplain in
areas that are otherwise restricted except for patient-care staff and
designated personal visitors, and particularly in such a place where a patient
is at his or her most vulnerable.
Another chaplain stopped by my room a day or two
later. I also told her, “No religion, please.” Her presence was
unnecessary, of course, had the hospital noted patient preference. But
at least it seemed a little less intrusive, given the place and time – a private
patient room during a normal recovery after surgery. And it was less surprising
in that context – my having experienced (and rebuffed) chaplain inquiries many
years ago in a few stays at other hospitals.
Not being a legal scholar, I have no idea how such
practices may fall under the federal HIPAA rules that over the past decade have
changed procedures at every level of the health-care industry and wrought a
burden of paperwork. I got dizzy trying to comprehend the HIPAA rules governing
“incidental uses and disclosures,” but suspect the uninvited presence of a
chaplain in a restricted treatment area could be problematic.
Two weeks later, I have
received a reply – not from the hospital CEO or operational vice president, but
from a nurse whose title is “risk manager” in its Office of Risk Management and
Patient Safety. She offered an apology “if you feel we were not sensitive or
respectful to your wishes not to utilize pastoral services, as I can assure you
that was never our intent.”
But my concern was not about
sensitivity – it was about privacy, and the expectation that anyone taking a
role in patient care in a treatment area would be part of the medical staff:
Doctors, nurses, technicians. The hospital sent a chaplain who, five minutes
before surgery, appeared in the doorway and looked at my file.
Here’s what the hospital said
on that subject:
The chaplains... are an integral part of the healing
team and participate in multidisciplinary/interdisciplinary team meetings. This
is done to enhance patient care and patient safety as we are a faith-based
organization and believe that healing happens at all levels of mind, body and
spirit. Our chaplains are assigned to patient care areas and visit all patients
within that specified area regardless of religious practice.
As a patient at [the hospital], you and your family
have the right to decline a chaplain’s visit. But as [hospital] employees, with
a primary role of patient care, chaplains do have access to patient charts and
patient information and do serve in all patient care areas of the hospital.
Under HIPAA,
your rights would have been violated if your patient information was
shared with any [non-hospital employee] or person not involved with patient
care. But again, the chaplains at [the hospital] are a part of the patient care
team so no HIPAA violation occurred.”
Well, I wasn’t going to make
a complaint to the government about this – just to the hospital to raise the
question and suggest it might be better to ask the patient in advance about authorizing
chaplain access. The hospital said in the reply that patient and family have
“the right to decline a chaplain’s visit,” but that “right” was not offered
before the chaplain showed up – and in my opinion the chaplain service should
not have had access to my patient information without my explicit approval.
That said, I add that the
hospital otherwise far exceeded my expectations in its quality of care –
except, of course, in the food. There is nothing to recommend in the liquid
diets, and the eventual upgrade to real food was less than inspiring.
But from the most senior
nurse to the community college student delivering the food tray, everyone had a
patient-focused upbeat attitude and friendly smile. That, better than prayer,
facilitates healing.
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