Today’s correspondent is an

… ambulance officer working for St John Ambulance WA, I’m interested to know the rights of accessing a patient’s hospital medical record to obtain blood serology results of a patient, following a needle-stick or blood splash injury.

Obviously, should you be exposed to a potential infection source, it’s desirable to know the infectious risk of that particular patient (whether they already have e.g HIV, HEP C, HEP B)

Assuming that patient consent is forthcoming in regards to blood testing for HIV, HEP C etc, and also they consent to the disclosure of those results to the officer, it nonetheless has proven very difficult for an employee of the ambulance service (who has sustained such an injury either via needlestick injury or other bodily fluid high risk contact) to obtain results of the patient’s infectious status following the exposure.

Generally we are advised by hospital staff to ‘follow up with our own GP’ in order to obtain the patient’s serology results, despite the results being available on the hospital computer system. The advice being that ‘unfortunately, your rights to access this information are no different than those of a member of the public’. This seems unsatisfactory, as generally, Post Exposure Prophylaxis (PEP) should be commenced within 72 hours of exposure, and it would likely take much longer than this to obtain results via a GP.

Furthermore, nobody really wants to take a course of strong medication (PEP) if it is possibly unnecessary. It is important also to note in this situation that hospital staff seem to have a much more rapid and expedited access to those results, themselves being direct employees of WA Health. It also seems unsatisfactory as we have generally treated and transported the patient (on behalf of WA Health), been privy to the patient’s medical history and completed paperwork (on behalf of WA Health), and yet we are not entitled to any of the protections a WA Health worker would have (in regards to access to results once available).

Furthermore, this problem frequently extends to receiving notification of ‘notifiable communicable diseases’ from the office of the Chief Health Officer (under the Public Health Act 2016) with often a several week gap between a crew transporting a patient with a notifiable disease (such as meningococcal, measles or anthrax), and being informed of this within the ambulance service. I don’t know where the bottleneck occurs in this instance, but it is frustratingly persistent, and I do wonder if the hospital staff also wait weeks before being notified (I suspect not).

I suppose my questions are:

1)  does being a contractor for WA Health afford ambulance employees in WA any rights in regard to access to medical information (where consented), similar to that of a WA Health direct employee (doctor or nurse for instance)?

2) if not, would appropriate wording in the St John Ambulance service agreement or contract be able to confer any rights in regards to the above?

3) Would an injured workers GP even be able to request the medical results of a third party, who has no relationship with them (not their patient)?

4) is there a reasonable timeframe in which notification of a communicable disease should occur?

It’s true that most of the relevant law is in the Public Health Act 2016 (WA).  That Act provides for notification to be given to the Chief Health Officer and to allow the Chief Health Officer to notify people who may have come into contact with a notifiable infectious disease.  Medical practitioners are not free to simply tell others, including paramedics, about a patient’s medical condition even if it is in that person’s interests to know (see for example Giving feedback to paramedics (April 1, 2017)).

If the patient consents to the release of their information to the paramedics, then there should be no issue but then I guess the question is ‘who do you ask?’   Asking the ward nurse is likely to get a ‘no’ answer as he or she will not be in a position to correctly identify what consent has been given etc.  I can imagine a letter from your GP to the hospital is much more likely to get the results when the person answering the letter can confirm with the patient that the release of information is consented to.  I can also understand why the answer might be ‘take it up with your GP’ so that you don’t get the results in isolation but get them where a doctor can put then in context and where the doctor can comply with obligations under the Public Health Act to both inform you of obligations under that Act and to notify the Chief Health Officer (Public Health Act 2016 (WA) ss 94 and 97).

Hospital staff should have no more access to patient results unless they need that access to provide clinical care.  A person who is no longer involved in the patient’s care has no more right to access the patient’s records than the paramedics but one has to concede that they may have the ability to do so and may in fact do so.

My answers to the questions are:

1)  does being a contractor for WA Health afford ambulance employees in WA any rights in regard to access to medical information (where consented), similar to that of a WA Health direct employee (doctor or nurse for instance)?

No (or yes) depending on how you see it.  No they have no rights to access the patient information but neither to WA health employees unless they need to access it for patient care.  Where the patient has given consent then there should not be an issue but I can understand that they would only be prepared to release that information to your treating doctor as that information, if the answer is that you have been exposed to a infectious disease, imposes obligations upon you that must be explained.

2) if not, would appropriate wording in the St John Ambulance service agreement or contract be able to confer any rights in regards to the above?

No, the processes are set out in the Public Health Act.  No agreement between St John (WA) and the health service could override the patient’s right to have his or her information dealt with in accordance with the privacy principles and the Public Health Act.  If the patient consents to the release of information and if the information is that they do not have a infectious disease then there would be no legal barrier to releasing that information in accordance with that consent, but then the question is making sure you ask the right person and the ward nurse or ward clerk will not be the right person.

3) Would an injured workers GP even be able to request the medical results of a third party, who has no relationship with them (not their patient)?

Yes. Anyone can ask for anything – you don’t need legal authority to ask.  Could the GP demand those results? The answer to that is ‘no’. If that was the issue then the process of the Public Health Act are there to ensure that the Chief Health Officer is notified and he or she, in turn, can notify people who have come into contact with a patient with the notifiable infectious disease.

4) is there a reasonable timeframe in which notification of a communicable disease should occur?

There do not appear to be time limits prescribed by the Act or by the Public Health Regulations 2017 (WA).

See also Paramedics and Patient confidentiality (March 26, 2015).