Also, HIPAA allows disclosure of names of patients in the hospital as a default. Alerting the authorities to the presence of someone at the hospital is NOT a HIPAA violation and does not even require the deferral to state law mentioned in the above comment.

Peggy, the selectivity is fairly simple in your examples. The report of suspected child abuse comes under not using medical ethics as a reason to conceal evidence of a crime. Your hypothetical murderer is supposed to be reported if they were observed to commit a crime, are committing a crime, are about to commit one, or are threatening to commit one.

The situation with reporting the presence of accused criminals is more subjective. Will you report the presence of a person accused of failure to pay a library fine, and hence subject to arrest? Will you compare all of your patient admissions against the national warrant databases? Do you think that by doing so you would deter people who might otherwise seek medical treatment? Is that appropriate and ethical?

If you plan only to report selectively, which warrant databases will you search? Which accusations will be worth reporting? If you plan to report only felonies, will you be reporting all instances of homosexual activity in Georgia? Will you be reporting all patients who desire treatment to address substance abuse problems? Those are felonies.

These are not simple issues. I can accept not reporting the presence of accused criminals of any sort, provided they are not in any way threatening anyone. I would report any evidence of a crime that I might happen to find while treating them, e.g., gun wounds.

In the Bundy case, go ahead and break the law. The HIPAA fine is less than the fine for running a red light, and under those circumstances is unlikely to be enforced. Rather than encumber the rules with excessive detail I prefer simpler laws and a recognition that there will be occasions where the right thing to do is break the rules and take the consequences. I’ve deliberately run red lights for lesser cause.

The HIPAA fine for non-malicious violations is maximum $100/person/violation. Arresting a Bundy would be worth a small fine. On the other hand, if it is a well known dangerous person, why aren’t the visitors and patients calling the police? They are under no obligation to protect his privacy at all.

Last time I had someone wanted by the police, they waited until the guy was ready to be discharged, then they put the cuffs on him as he walked to the elevator.

That way, the county didn’t get hit with the hospital bill. Apparently, at least in my area, the moment the hospital patient gets cuffed to the bed, the hospital bill is now on the county’s tab.

I mean I’m just sayin’

Dr. Sammual Mudd comes to mind. Set the leg of JW Boothe who had a day previous killed A. Lincoln. Dr Mudd failed to notify authorities and ended up in a Fed Pen.