The relationship paramedics have with patients usually lasts hours, or even minutes. As a paramedic’s relationship with patients ends as soon as the patient leaves their care, the paramedics often never know what how things worked out for their patients or even the patient’s final diagnosis. If paramedics are supposed to benefit from repeat exposure to different problems so they can learn from the experience, there is a huge deficiency if paramedics are often left in the dark as to what the patient were actually experiencing.
Many good paramedics go back and ask hospital staff about the diagnosis and treatment of the patients they brought in. This helps them understand various medical conditions, what they look like and how they are best treated. That, in turn, allows the paramedic to better diagnose those problems in the future. But are paramedics even allowed to get this information about their former patients?
Medical records are an intensely private, and personal set of documents. Medical professionals are only capable of sharing personal health details under a very limited set of circumstances, or with those the patient consents to sharing the information with. The limits on who and when medical professionals can disclose patient’s health concerns with is set out in the Personal Health Information Protection Act.
Section 37(1) of the PHIPA says that a health information custodians may disclose personal health information about patients for the purpose of education.
The College of Nurses of Ontario issues a Practice Standard called the Confidentially and Privacy – Personal Health Information which addresses these concerns. In it, it says of the PHIPA:
“PHIPA permits the sharing of personal health information among health care team members to facilitate efficient and effective care. The health care team includes all those providing care to the client, regardless of whether they are employed by the same organization.”
Despite this, paramedics are still not able to access medical records for educational purposes.
In Bluewater Health v. Ontario Nurses’ Assn, the arbitrator ruled that just because a health care worker was previously involved in a file and her hospital was still dealing with the patient, she lost the right and ability to learn about the patient’s health care records as soon as she stopped working with the patient, even if it was educational to her.
In the same case, the arbitrator ruled that individuals can only access personal health information for the purpose of education if the hospital gives them explicit permission to do so.
Arbitration cases are not decisions by a judge in court. They are not binding on a court. So a judge could reach a different decision in a court case. However, even if a decision is not binding, a judge may like the legal reasoning and use it anyway.
In Ontario Nurses’ Association v Norfolk General Hospital, the Labour Arbitrator determined that: “the circle of care does not include: "A physician who is not part of the direct or follow-up treatment of an individual;”
In North Bay Health Centre v Ontario Nurses’ Ass’n. (McLellan Grievance), Arbtirator Abramsky stated:
“40 Further, if accepted, the Association’s argument that all “health care practitioners” are health information custodians entitled to rely on Section 37(1) would undermine the goals and purposes of the legislation. If a nurse (or any health care practitioner – and there are many health care practitioners at a hospital) is a health information custodian and may freely access patient health information for personal educational purposes, the privacy of patient health records could be significantly undermined. The Act does allow for the use of health information for “educating agents to provide health care” but it must be done by the health information custodian, not by an agent for his or her own purposes.”
PHIPA states in regards to agents in section 37(2) agents can only access health care information for educational purposes if its on behalf of the heath care custodian. This would indicate that paramedics are not able to learn about health care records for educational purposes, as they are not being educated for the goal of implementing the custodians service. As paramedics do not work for hospitals, they cannot be seen as their agents.
Under the provisions of the PHIPA paramedics are only able to learn about their patient’s diagnoses if they receive consent from their patients to do so. Section 18 of the Act provides the following requirements for consent:
Elements of consent
18. (1) If this Act or any other Act requires the consent of an individual for the collection, use or disclosure of personal health information by a health information custodian, the consent,
(a) must be a consent of the individual;
(b) must be knowledgeable;
(c) must relate to the information; and
(d) must not be obtained through deception or coercion.
The Act goes on to further state that if the disclosure is not for the specific purpose of providing another health care worker assistance in providing care, then the consent given must be explicit. Based on this, it seems clear that if paramedics want to learn about the diagnosis of their patients, they must receive express consent from their patients. The act does not make clear what classifies as express consent, but the most obvious form of consent would be the patient writing a note, providing clear evidence of their explicit consent.
This is problematic and is unlikely to assist paramedics in obtaining the knowledge they require. When a patient is with a paramedic, things are hectic and the patient often is in great distress. The last thing a patient wans to think about, if it is even possible, is to sign a form allowing their medical information to be disclosed.
Another question is whether the state of mind that people are in wine they are in a paramedics care allows them to give “knowledgeable” consent. Further, since most Ontario Paramedics create their patient records (called Ambulance Call Reports) electronically, on tablet computers, they have no way to collect and record their patient’s consent to release health information or to transmit that consent to the hospitals, without a change to the “charting” software that paramedics use.
It would be very helpful for paramedics to learn about their patient’s diagnosis, but under the current framework of the PHIPA, paramedics are prohibited from learning this valuable information.
This blog was written by John Schuman, who is both an Ontario Lawyer and has been an active paramedic for almost 25 years. John has knows about how the law affects paramedics and other first responders. Watch the below video on legal issues affecting first responders or listen to the Ontario Family Law Podcast on special issues in Family Law for first responders.
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