New laws that protect patients' privacy are increasing the cost of health care in Colorado.
They could cost someone their life.
The final portion of a 1996 privacy law came into effect in April and residents are just now discovering that the best intentions sometimes have unforeseen implications.
The Health Insurance Portability and Accountability Act (HIPPA) was created to give working Americans and their families access to health insurance even though they may have preexisting conditions that cause them to suffer discrimination in health coverage.
The law limits what information can be released about a person's health and medical history.
And it means, area emergency dispatchers say, that releasing a victim's name over the police-band radio is a violation of that person's right to medical privacy.
"We've always tried to maintain patient privacy but the old school way of doing it is, if nothing else, people know places by people's names," said Ruth Wade, communications supervisor for the Colorado State Patrol Regional Dispatch Center in Craig.
Because not all roads in Moffat County are clearly marked and because not all houses have addresses, dispatchers have often given names to indicate location.
"We were told 'You know, the old Johnson place,'" said Karen Burley, president of the Maybell Ambulance Service and coordinator of rural emergency services in Moffat County. "That's the way it's done in a small town."
HIPPA prevents that type of distinction -- even in an emergency situation.
The conflict came to a head, and to the attention of Moffat County commissioners, a few months ago when Moffat County Commissioner Daryl Steele's daughter was injured after falling off a horse.
A third party called 911 from the Maybell store asking for an ambulance to be sent to the Steele Ranch. For more than 30 years, Maybell residents have called the Maybell Store in emergency situations and the person manning the store contacted the ambulance service. That's because, until recently, the town of Maybell wasn't linked into the 911 system.
Old habits die hard, Steel said, and the Maybell Store was again called when his daughter was injured.
Rio Blanco County Sheriff Phil Stubblefield called 911 and the dispatcher told him she needed an address.
He didn't have it.
She asked him to have someone call from the Steele Ranch to activate advanced 911, which displays the address for dispatchers.
Precious minutes were lost when the dispatcher called the Steele Ranch and got an address she could air.
In that case, those involved were lucky there was an address available.
Dispatchers estimate HIPPA concerns added six minutes to the response time.
"A lot of this has handicapped us to the point of paranoia," said Lynette Stieb-Sorenson, head of regional dispatch services.
Moffat County resident JoAnn Lighthizer blames the new law for the death of her neighbor. Because of poor addressing and because the ambulance service was given no name to help indicate location, she estimates it took 15 minutes for emergency responders to arrive at the County Road 7 home.
"The EMTs went everywhere but here," she said. "If they would've said the name, they would've had no trouble finding it at all."
The victim was suffering from chest pains when 911 was called,
and ended up dying from a heart attack.
"It took them forever to get here," Lighthizer said. "I think it's asinine that they withhold the name in an emergency situation. They should be able to release the names. That's more than half the battle."
She was at her neighbor's house during the incident and was administering CPR while waiting for emergency responders.
"(Lawmakers) drew a fine line," she said. "I don't think they thought well enough beforehand about what they were doing."
Burley remembers a call when the ambulance crew drove up and down a county road for 20 minutes looking for the site where a critically injured individual waited for assistance because the homes weren't properly addressed and they were told only to look for an open gate.
"If they had been able to say 'go to so and so's house,' we would've known exactly where to go,"
Wade said there are extreme cases where dispatchers will risk breaking the privacy laws to get medical teams to the site of an emergency.
"We'll continue business as usual to protect the victim, but if it's a life or death situation, we'll do what we have to do," she said. "If it's the only way to get an ambulance there, we'll air the name but that's a last
Dispatchers will page an ambulance immediately and tell them the address will follow to save time in many cases, Wade said.
Dispatchers have been told they're bound by HIPPA regulations but Chris Beall, attorney with Faegre and Benson in Denver, says that's not the case.
Agencies that do not bill patients are not bound by HIPPA regulations, Beall said, which means the dispatch center, because it charges neither the ambulance service nor the patient for its services, is not a "covered agency" under HIPPA.
"The information provided from the patient to the 911 dispatcher is not protected health information and that information may be shouted through a megaphone if desired," he said.
Even if it were, there are exemptions under HIPPA for the broadcast of some information.
The ambulance service is a covered entity.
Being able to respond to the correct location in an emergency situation isn't the only problem created by HIPPA. Mountains of paperwork accompanied the legislation that touches areas outside of health care.
"It really hasn't impacted our investigations, it has impacted us in detention -- when inmates go to the hospital," Moffat County Sheriff Buddy Grinstead said. "It's harder to get records. There are lots of hoops to jump through."
He said he needs to know the medical issues that could impact his budget and getting that information has been a trial.
Ed Otte, president of the Colorado Press Association, said that as these types of issues emerge, lawmakers will be forced to re-evaluate the legislation. But, he said, don't expect changes to come fast. The law was six years in the making and it could take as much time to revamp it.
"At some point common sense has to enter back into the picture," Grinstead said.
Christina M. Currie can be reached at 824-7031, Ext. 210 or by e-mail at firstname.lastname@example.org.