How is it legal for a hospital to put two patients together in the same room in the US? In the United States we have HIPAA regulations in place to (among other things) prevent healthcare providers, insurance providers, and any other entity that handles medical information from leaking patient information. From my experience with various HIPAA certifications, it seems pretty stringent. No leak is too small. So how is it legal for a healthcare provider to pair up two or more patients in a single room, when they are under inpatient care for several days? I ask this because I recently stayed in the hospital for 2 nights. Never spoke one word to the old guy I was roommates with. When I was discharged, I knew the following details about him: his full name his DOB his medical record # (if I felt like writing it down) some of his prior health history (he fought, and won, a battle with colon cancer) the reason he was in the hospital now (hasn't pooped in over a week) current health concerns (doctors wanted to do a biopsy to make sure the colon cancer wasn't back) These were all details given verbally by one or many different doctors or nurses over the course of my 3 days, 2 nights in the hospital. Of course, I'm sure he knows a lot of my details now, too, for the same reason - we were inpatient roommates in the hospital and the doctors used no discretion when discussing my condition. So how is this legal?
As a short answer, guidance from the Department of Health and Human Services has clarified that HIPAA does not require hospitals to provide separate rooms. As a longer answer, HIPAA is very deeply misunderstood. It does not prohibit "leaking" patient information; it prohibits unreasonable and unpermitted disclosures of protected health information (PHI). Among the PHI disclosures that are permitted are uses that are for the purpose of delivering medical treatment. Of course, the covered entity (in this case, the hospital) is required to take reasonable measures to safeguard that information. One of the areas that trips people up is figuring out exactly what it is we're safeguarding that information from. A lot people assume that the HIPAA imposes an absolute rule against disclosure of PHI, but it's more accurate to say that HIPAA requires reasonable safeguards against the unauthorized use of PHI. With that standard in mind, it becomes easier to see why you don't need to universally separate patients. In all likelihood, neither you nor your roommate is likely to use the other's PHI in any way not allowed under HIPAA. We can look at your question as proof: You've disclosed a person's health condition and medical history, but you were a reasonable person and omitted the man's name, birth date, record number, and anything else that might allow us to link that information to an individual. Hospitals -- and the law -- recognize that most people have no interest in a random strangers' medical information, let alone plans to do something nefarious with it. Because there isn't much of a threat there, the hospital isn't required to take exhaustive measures to protect the information. But when you put all that information for every patient for every doctor for every department for every hospital into a single database, the information starts getting a lot more valuable. That's why there are much tighter regulations surrounding protection of electronic records. Of course, the roommate situation might be different if the hospital had a patient that they somehow knew had a history of identity theft or even a history of disclosing PHI. I've never heard of this happening, but I'd imagine that that knowledge would require the hospital to either segregate that patient or otherwise take extra care to avoid disclosing any information about a roommate.
Maybe, but probably not, although this would be a question of fact to resolve on a case by case basis under broad legal standards by a jury, and would also depend upon the state where it took place, and upon the nature of the employer of the paramedic. The hypothetical facts in this case are rich enough and ambiguous enough that the case could go either way depending upon how it was presented and what could be proven at trial. This is a case it would be good to take to a medical malpractice/personal injury lawyer in the jurisdiction where it happened to be evaluated. Usually a PI lawyer would not charge you for doing so or would ask for only a nominal fee. Additional factual investigation would probably also be necessary regarding some of the key facts identified below. It's complicated and there are multiple issues presented in this case where the law is not uniform from state to state. The general rule is that a medical professional has to carry out the delivery of medical care to a patient with the reasonable care that would be taken by a medical professional of that type. If the medical professional fails to take reasonable care, and that negligence failure to do so causes injury, then there is civil liability for medical malpractice. A threshold issue would be whether a medical professional-patient relationship was established. This would be a question of fact for a jury and would be a question upon which various potentially applicable state and federal laws would often not be uniform. On these facts, it could easily go either way. In federal court and in a majority of state courts (although there is variation from state to state) you need to know the name of the paramedic you dealt with who provided the bad advice to bring a successful lawsuit before suing. In a minority of states, you could sue first and get the name of the paramedic in discovery through the court process from the hospital after the lawsuit was commenced. The standard of reasonable care liability in this case would be judged by the standard of a reasonable paramedic, not a reasonable doctor. But, often states would have statutes that would limit the liability of paramedics in these situations to liability for gross negligence (which the facts in the question would probably not suffice to show), but not for ordinary negligence (which a jury could come out either way upon and which would hinge heavily on expert testimony). These tort reform type laws differ considerably from state to state. Whether or not particular conduct was negligent or grossly negligent, is a question ultimately decided by a jury under very broad and general legal standards after the fact in a trial, based largely upon expert testimony, on a case by case basis, unless the facts are unequivocally clear one way or the other, which is rarely the case. With my layman's level of knowledge about what a reasonable paramedic should be able to diagnose, I could see this determination going either way. Two cases with identical facts in front of the same judge in separate trials, in which juries are presented with exactly the same evidence could come out differently. The resolution of one case of the question of whether a particular act constituted negligence giving rise to liability is not binding as precedent and is not admissible as evidence in another case (subject to a narrow exception called &quot;collateral estoppel&quot; which applies when the same individual is sued by multiple people for the same conduct in different lawsuits that have resulted in final orders resolving key questions of fact that the lawsuits have in common). Many states would require that someone suing the paramedic have a medical professional certify that the paramedic's actions constituted legal negligence before the suit could go forward in a court. If there is a medical professional-patient relationship, and if the medical professional was found to have negligently caused injury, the medical professional's employer would have vicarious liability in some (but not all) states under a respondiat superior doctrine. Usually, the paramedic at an ER would be an employee of a private EMS ambulance company or a municipal fire department, and not of the hospital that runs the ER. But, some hospitals have their own in house paramedics. Also, some hospitals are run by for profit or nonprofit private companies, some are state or local governmental agencies, and some a federal government agencies. Usually only a small minority of the medical professionals in a hospital are employed by that hospital, and most of them merely have &quot;privileges&quot; to provide medical services for which they bill patients separately while working for their own professional corporation through which they are self-employed. Legally, the hospital itself is more like a hotel or a WeWork office space than to being a firm that directly provides medical services, although it isn't quite that black and white. Holding the ER directly responsible for failing to have good triage policies, as opposed to holding the paramedic responsible and assigning vicarious liability to the employer of the paramedic, would be very difficult, although not necessarily impossible if the ER had official policies that fell far below the standard of care for emergency room triage. It would be very uncommon for an ER to have bad policies of this type. Typically, ERs are only held directly liable for bad triage policies when, for example, they have a policy of not evaluating at all someone who does not have health insurance, which is a practice expressly prohibited by federal law. If the paramedic's employer was a government entity such as a fire department or a government owned hospital, the paramedic would be entitled to absolute immunity from civil liability under the doctrine of sovereign immunity, unless an exception applied. Usually there is an express exception to absolute immunity for medical malpractice liability by a medical doctor who has established a doctor-patient relationship with a patient, when the medical doctor is employed by a state or local government, usually there isn't when the doctor is employed by the federal government. But these laws differ from state to state in fine details that matter in a case like this one regarding whether the exception to immunity from liability is limited to medical doctors or applies also to paramedics. Causation would also be an important factual issue for trial. There is liability only to the extent that taking a non-negligent action could have prevented the harm. If you are infected with COVID, one common consequence is a stroke, and if someone had a stroke while infected with COVID, the case that taking them to the ER would have prevented the stroke from doing serious damage in the long run is weaker. On the other hand, guessing that a stroke was really something else, might or might not be reasonable. The injured person would also have to prove that the EMS response occurred at a time within the roughly 1-2 hours after the start of a stroke when it is possible to take medical action that could do something about a stroke. If the stroke had already happened an hour and a half later and it was rush hour and would have taken half an hour to get to the nearest hospital, causation might be absent and there would be no liability. There would be a legitimate question of fact over whether there was an actual diagnosis and treatment, or whether there was a refusal to get treatment. The reasonable care test is a balancing test. It takes into consideration not just the potential benefits of taking action, but also the cost that would be incurred if action was taken, and the downside risks of a proposed action. The paramedic's concerns about getting a COVID infection at the ER when the person responded to didn't appear to have it at the time would make the cost of a false positive diagnosis higher and would thus influence what would constitute reasonable care in this situation as the jury applies the relevant legal test. Liability would be evaluated based upon what the paramedic reasonable understood he was being told. This would be a question of fact for the jury. It is likely that different people who were present understood what was being said differently. Even if bystanders understood what was being said and meant, what matters is what the paramedic reasonably understood was being said and meant. Given the communication difficulties involved, that question could go either way.
Prove my work is not a trade secret violation Please don't. It's not your job to prove your innocence. The burden is on them to be specific, explain fully, and prove specific claims about your actions. In other words, don't justify, don't explain, and don't defend yourself to them. It's actually best you do not say anything to them, and just forward the letter to your legal counsel (Since you're selling software to be used in the medical field, I assume you already have some kind of legal counsel). For instance, even saying something as innocuous as "Managing patients, Exams, Bills etc are all public knowledge." could be used against you. Because it establishes the fact that you've been working on those features with them and that you've been working on those features with your new company (which doesn't necessarily follow, for all they know, you could have purchased a library module from someone else with those exact features). In other words, even if you were to reply with such an innocuous-sounding statement, you could be saving them months of cross-border discovery and litigation about some of their claims (even if you believed you were being entirely reasonable by defending yourself). But at the same time, don't take what I'm saying to mean that you should lie to them about which features you recently worked on. When I say that you shouldn't be talking to them. I mean that you should not be talking to them. You shouldn't be engaging with them and you shouldn't be giving them any shred of information whatsoever (implied or otherwise). It's not your job to make their job any easier. Do not reply to them. Don't even acknowledge the receipt of the letter (unless you already did by signing for it, which can't be helped). Use a legal intermediary. Give the letter to your own legal counsel (whether you signed for the letter, or not) and leave any reply to him or her (assuming he/she thinks this warning letter even warrants a response). And if this former employer gives you a phone call, kindly refer them to your legal counsel without saying another word.
I'm not a lawyer or a medical professional, but on Wikipedia's page about DNR, we see the following quote: In the United States the documentation is especially complicated in that each state accepts different forms, and advance directives and living wills are not accepted by EMS as legally valid forms. If a patient has a living will that states the patient wishes to be DNR but does not have an appropriately filled out state sponsored form that is co-signed by a physician, EMS will attempt resuscitation. Based on this, I would hazard the guess that you can't treat anything other than those forms as legally binding, as they even ignore a living will without that state's form.
To my knowledge there is no actual law requiring a provider to file anything on your behalf. Most do it as a courtesy but if you read the terms of service that you almost certainly agreed to, it will say that YOU are the responsible party. If the insurance company doesn't pay, even if the provider doesn't submit a claim, the responsibility is still yours. There is nothing stopping you from filing your own claim using whatever forms or procedures that they have established. I'll also note that many provider networks have rules that providers must adhere to in order to remain in that network. Some may include language about timely filing of claims but that is in no way universal. These days many providers have taken to billing the patient the full amount immediately and then will issue a refund to you if/when the insurance pays.
The WHO regulations (according to that page; I haven't seen them) &quot;provide an overarching legal framework that defines countries’ rights and obligations in handling public health events and emergencies that have the potential to cross borders.&quot; They don't dictate the conditions for practicing medicine. it does not make that much sense that an American living in Germany could not get telemedicine from America with the same level of convenience - for example, German insurance covering it, and the American prescription being somewhat valid. This would result in a geometric increase in the administrative burden. You need a system for the American prescriber to know what medicines are approved in both countries (and in every other covered country). You need some way for the German health authorities and the insurers to trust that prescribers in the United States are not endangering the health of people in Germany, which means that they need to evaluate the education and certification systems in place in the US (and every other covered country). You need to consider the legal recourse in cases of malpractice: if the prescriber makes a mistake, does the case go to the US courts or German? If German, will the US state that licensed the prescriber honor a judgment revoking the prescriber's medical license? And more. There are simply too many elements that need to be coordinated. With two countries, you have to reconcile one pair of systems. With three countries, three pairs. With four countries, six pairs. With N countries, it's N(N-1)/2, so even with a modest number of countries such as 20, you have 190 pairs of systems to consider. With 196, the number is 19,110.
As you say, the roommate who was there "did not equate the sound of a running toilet with wasting water". That, I am afraid to say, is negligent: normally, when you hear constantly flowing water, you do something about it. Somebody has to pay for the water, and assuming the water is in your name, that is you. You could yell at the roommate, but legal negligence is irrelevant to the water bill. However, if there were any resulting damage (for example to wiring or walls), that is where the question of negligence would come up: you probably would be found liable for damage to the building that resulting from letting the condition persist. But unless the fill valve broke at the tank and leaked water onto the floor (which would be clearly obvious) there won't be any damage that you are liable for. I assume that the leak developed from an old part giving out. This would be normal wear and tear, for which you would not be responsible (assuming you didn't cause the problem, for example by putting concentrated bleach in the tank). You you are saying that the landlord is trying to charge you for the repairs, and on this point, the landlord is on thin ice. A landlord cannot just make up rules about assigning liability for damage: that is a matter to be determined by the courts. A tenant can do things to a fill valve that can cause a leak; and the seal has to be replaced every few years. The tenant is not liable especially for routine replacement of the fill value seal, and does not become liable because they failed to inform the landlord in a prescribed manner. Not reporting a leak within 24 hours does not contribute to the underlying failed part. You could probably contest the legality of that bit of maintenance clause 24, in that the landlord cannot unilaterally declare who is responsible for damage. At the trial, both sides will present relevant evidence, and the judge / jury will decide whether the tenant's negligence caused the seal to fail.
It is mandatory for the employer to provide sufficient restrooms (“cabinets d'aisance”), as per article R4228-10. Other provisions regulate evacuation, ventilation, heating, disabled access, etc. There is no provision regarding when employees are permitted to use the restrooms. There can't be a single rule that works for every profession: some jobs don't let you leave your post whenever you like (e.g. machine operator, driver, guard, teacher, etc.). The most common dispute regarding restroom use is whether employees should be paid during that time. Some employers want to count restroom use as unpaid pause time. Strictly speaking, that's legal: an employee who is in a restroom is not at the employer's disposal, therefore this doesn't count as work time. However enforcing this is often logistically difficult and wildly unpopular, so in practice it's only done in places where employees must clock out to reach a restroom. I could only find one case with actual jurisprudence. In 1995, an industrial butchering company (Bigard) decided to limit restroom breaks to three fixed times a day. This was, as you might expect, unpopular; the employees went on strike, and eventually the labor court struck down this measure. That's a precedent, but it doesn't seem to have made its way to the appellate court. Your case is also slightly different in that the restrooms would only be inaccessible for an hour, which is shorter than in the Bigard case. So legally speaking, it isn't clear who will win. You'll have a better chance of success by banking on the unpopularity of the measure. Talk with your colleagues and your representatives and shop stewards. Point out that employees who are trying to hold it in are unlikely to be at the top of their productivity.