How much is too much when it comes to sharing patient info?

Recently, my client hired me to attend a conference regarding her adult daughter’s care in a residential setting. My client held LPS power of attorney for her daughter. When we entered the conference room, eight staff members were present. At the beginning of the meeting, everyone introduced themselves. At the end of the meeting, I informed the Administrator that the presence of five team members who were only there to listen constituted a HIPAA Privacy Rule violation, as they did not meet the Minimum Necessary Standard.

Under HIPAA’s Minimum Necessary Rule (45 CFR 164.502), covered entities—like clinics, hospitals, skilled nursing facilities, psychiatric residential placements, and healthcare providers—must only disclose the minimum necessary protected health information (PHI) to accomplish a specific purpose. That means no more “just-in-case” or “full file” transfers.

Only what’s absolutely needed.

So no more have the whole team present meetings!

The base standard is reasonable and necessaryfor that professional person need to know.

But here’s the tricky part: words like reasonable and necessary are open to interpretation. That puts a lot of pressure on healthcare workers to use sound judgment—and to have solid training and policy guidance.

Another Case in point: A nurse HIPAA violation alleged by a patient culminated in the termination of the registered nurse’s job.

The nurse had been assigned to the Post Anesthesia Care Unit. She was assisting with a transesophageal echocardiogram. At the time of the alleged HIPAA violation, the patient was in an examination area that was closed off with a curtain. The nurse was present along with a physician and an echocardiogram technician. Before the procedure took place, the nurse ensured that the patient understood what the procedure would entail, checked to make sure the site of the procedure was clearly marked, and made sure appropriate diagnostic tools were available. Also, the nurse told the technician and the physician that they should wear gloves because the patient had hepatitis C.

After the procedure the patient filed a HIPAA complaint, alleging the nurse had spoken loudly so that other patients and medical staff in the vicinity would have heard that she had hepatitis C.

In her action for unfair dismissal, the nurse claimed this was an ‘incidental disclosure’, which is not a violation of HIPAA Rules. The nurse subsequently took her case to the Kentucky Court of Appeals. With respect to the wrongful dismissal claim, the court based its decision on the minimum necessary standard, which requires any disclosure of PHI to be limited to the minimum necessary to accomplish the necessary purpose – 45 CFR 164.502 – explaining, “Under “HIPAA, the nurse statement was not the minimum amount necessary to accomplish the warning.” The court concluded a nurse HIPAA violation had occurred.

This is clear reminder of how nuanced and serious this standard is.

This rule applies to all forms of PHI—paper, digital, and verbal.

That’s why it’s essential to:

· Train employees on the policy and its importance It’s important that all employees read and understand your policies related to the Minimum Necessary Rule.

· Conduct initial and ongoing training on the policy and its importance as well as the proper handling of PHI based on specific roles and responsibilities.

· How to avoid the first Case Study mistake? When introducing everyone on the medical team is a conference meeting, ensure that their role and job title is stated and align with the need to know the PHI presented .

Remember: Every decision around PHI disclosure should be backed by clear, rational justification. And every employee should know where that line is—and why it matters.