On mixing religion and medicine

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.