Gretchen Schenck was born in Germany. Her parents moved to the United States when she was 15 years old, leaving a significant amount of close family behind in Wittenberg.


C A S E 1 1

International Release of Information II

Gretchen Schenck was born in Germany. Her parents moved to the United States when she was 15 years old, leaving a significant amount of close family behind in Wittenberg. Gretchen and her parents traveled to Wittenberg to visit family at least once a year, and she also maintained a close relationship with them via e-mail.Gretchen became pregnant when she was 25 years old. Soon after that, her grandmother in Germany was diagnosed with cancer that metastasized significantly. Gretchen was admitted to Commontown Hospital early in her pregnancy with a twisted fallopian tube and enlarged ovary that had to be surgically corrected via laparoscopy. Her doctor followed her closely on a weekly basis after her surgery until she completed her first trimester. Her obstetrician was confident that the problem was related to her becoming pregnant but that the problem was fixed to the point where it would not interfere with management of the duration of her pregnancy. Gretchen was in her fifth month of pregnancy when her grandmother passed away. Her obstetrician cleared her for international air travel so that she could attend her grandmother’s funeral. Her flight was uneventful, as was the funeral. She planned to spend two weeks with her family in Wittenberg to help with going through her grandmother’s belongings.While eating dinner at her cousin’s house, Gretchen experienced a sharp pain on the same side where she had her laparoscopy for the problems with her ovary and fallopian tube. She laid down, and the pain became increasingly worse later in the evening, so her family took her to the nearest hospital. Luckily, Gretchen’s German and English translation skills were excellent, so she was able to explain her condition to the German doctor. She had a sonogram, which revealed that the ovary had become enlarged again. The German doctor wanted to review the records from her previous surgery, so Gretchen filled out a record request form, and the fax number for Commontown Hospital in the United States and for her obstetrician were obtained. Jasmin was the Release of Information Specialist who received the record request at Commontown Hospital.The first thing she noticed was that the form was not written in English. She took it to Helen, who was director of Health Information Services. Helen contacted the hospital’s contracted translator service and was easily able to get an English translation for the record request form.Helen read the translated document carefully and found that it was not compliant with Health Insurance Portability and Accountability Act (HIPAA) requirements. She contacted the translation service again to have them translate a HIPAA-compliant release of information form into German. The German version of the HIPAA compliant release of information form was faxed to the Wittenberg hospital along with a cover letter that explained why the form they had faxed could not be utilized to release Gretchen’s documents.

The Wittenberg hospital responded that they were unable to utilize the U.S. documents because they did not

exactly match their organization’s guidelines but that they needed Gretchen’s records right away because the

Physician there felt she might need emergency surgery.

Discussion Questions

  1. Refer to the document that was sent from the Wittenberg hospital and identify why it is not compliant


  1. If you were in Helen’s position, would you have released the records upon receipt of the Wittenberg form?

Why or why not?

  1. What internal and external forces impact this case?
  2. What are the legal issues addressed in this case?
  3. What are the ethical issues addressed in this case?
  4. How are the ethical issues in this case covered in the American Health Information Management Association Code of Ethics?

7.Using the case method, determine what the best action is at this point.

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