Chapter 14: Health Care Information: Oregon Code of Cooperation

The Code of Cooperation provides a set of guidelines for cooperation between Oregon healthcare providers and the news media. It is devised cooperatively to facilitate accurate, ethical, and timely news coverage of medical and other health-related events. This code balances the patient’s right to privacy and well-being with the public’s right to receive information.

In the code, all references to “hospital” or “hospitals” include individual facilities, health systems, clinics and provider organizations.

The Oregon Code of Cooperation is published by Oregon Association of Hospitals and Health Systems, with editorial contributions from member hospitals, Oregon Medical Association, Oregon Newspaper Publishers Association, and Oregon Association of Broadcasters. The code is a set of guidelines for healthcare news media relations, and should be adapted to the news media policies of individual facilities.

By agreeing with the code’s guidelines, the Oregon news media and healthcare providers acknowledge a shared responsibility to provide accurate public information and to assure patients and healthcare providers that the gathering and reporting of this information does not infringe upon patient privacy, professional medical ethics, or patient care.

In cooperation with the code, each healthcare facility will have a spokesperson available at all times to respond quickly and accurately to news media inquires. Physicians will be accessible to the news media, either directly or indirectly or through an authorized spokesperson, and will respect media deadlines to an extent consistent with patient privacy and well-being.

News media will seek information through designated spokespersons and will respect hospital regulations regarding entry into all areas of the facility, whether or not a patient has already agreed to be interviewed.

Guidelines for Hospitals and Other Healthcare Facilities:

The communications director or officers or designated staff members of Oregon Association of Hospitals and Health Systems (OAHHS) will help the news media get prompt and accurate information on health and hospital subjects.

Each facility will designate an authorized spokesperson who will be accessible to the news media at all times. A hospital spokesperson serves as the primary resource for the news media and assumes responsibility for coordinating exchange of information from and access to the hospital. When requested by a patient or a patient’s family, the hospital spokesperson will direct calls to the patient’s designated spokesperson.

Unless there are extraordinary circumstances, a written consent to release information should be obtained from the patient, a member of the patient’s family or the patient’s spokesperson.

All news media in the community served by the hospital should be informed of the hospital’s designated spokesperson(s). It is the hospital’s responsibility to keep this information current.

When a physician’s approval is necessary to release information, the hospital spokesperson will obtain it even if the reporter later speaks directly to the physician.

Before releasing an attending physician’s name, the hospital spokesperson must get the physician’s approval. However, the spokesperson may acknowledge that a patient is under the care of the hospital staff.

Hospital spokespersons and physicians should be aware that they probably will not be permitted to review or edit interviews before publication or broadcast. Although reporters and editors try to double check information whenever possible, each news organization determines what it will publish or air.

When a hospital invites the news media to cover a patient story, the hospital will provide reporters with requested follow-up information and access consistent with the guidelines in the code and according to the wishes of the patient and attending physician.

The hospital spokesperson is responsible for obtaining information about patients as rapidly as possible without interfering with the health, welfare, or privacy of patients. In compliance with ORS 192,525, 179.505, and other applicable state and federal laws, no information that violates the confidence, privacy, or legal rights of the patient should be given. (See sections on Psychiatric, Drug and Alcohol Abuse Cases, and Unusual Illnesses.)

Guidelines for Physicians:

The communications director or designated staff members of Oregon Medical Association (OMA) will be available to the news media to help get prompt and accurate information on health and medical subjects. If information is not immediately available to comply with news media deadlines, OMA will inform the news media and, depending on the nature of the request, either continue to gather the information for a later deadline, or refer the reporter to another competent authority as a resource.

Officers, committee chairpersons, or designated spokespersons of OMA are expected to agree to be quoted by name in matters of public interest for the purpose of authenticating medical information. An up-to-date list of OMA spokespersons should be maintained so that OMA can respond quickly to inquiries from the news media.

This policy is not to be construed by OMA members as a breach of the time-honored medical practice of avoiding personal publicity. It is intended only to serve the best interests of the public and the medical profession. To this end, physicians should be introduced only by those titles and credentials/affiliations that are relevant to the particular news-gathering situation.

County and regional medical societies in Oregon are urged to adopt a similar policy for their officers, committee chairpersons, and other designated representatives, and to maintain up-to-date lists of spokespersons for media contact.

In matters relating to the practice of medicine, physicians are encouraged to give information to the news media, as long as it does not jeopardize the physician-patient relationship or violate the confidentiality and privacy of the patient’s medical records or legal rights. The physician may choose, however, to provide information through a hospital or OMA spokesperson.

Notifying news media of an event implies that coverage will be welcome. Therefore, speakers at publicized medical meetings should expect to make themselves available to the news media on request, providing that their schedules and commitments to the sponsoring organization are not compromised.

Physicians are not authorized to participate in controversial public discussions as spokespersons for OMA without prior OMA approval.

Guidelines for News Media:

The first obligation of physicians and hospitals is to safeguard each patient’s life and health. Therefore, representatives of all news media are expected to cooperate by refraining from any action or demand that might jeopardize the patient’s health or interfere with orderly operation of the healthcare facility.

On all matters pertaining to hospitals and physicians in the community, representatives of the news media are expected to make every reasonable effort to obtain information from authorized sources before proceeding to publication or broadcast. The news media should not use the name of an attending physician without the physician’s consent.

In the case of legal charges against a physician, hospital, or clinic, the reporter is expected to make every effort to verify the charges and offer the accused an opportunity to reply before publication or broadcast.

When using a tape recorder, the reporter must advise the hospital spokesperson, patient, or physician prior to questioning, according to ORS 165.540.

Reporters and photographers are expected to obtain hospital permission and to abide by individual hospital rules regarding media access before entering a healthcare facility for interviews and/or photographs. Access will be arranged if the patient or patient’s guardian is willing and his or her condition permits. The hospital will assist by obtaining written consent from the patient or a responsible family member before videotaping, photographing, or interviewing is permitted.

When seeking information about a trauma patient, reporters will make every effort to obtain the patient’s full name and age from police, fire, or other public officials before calling the hospital for a condition report.

Access Restrictions:

Hospitals are bound by state and federal laws, and regulations (including Oregon Administrative Rules Chapter 333), and hospital policies that restrict public access to certain service areas and departments in hospital buildings. These sensitive areas include labor and delivery rooms, nursery, operating rooms, intensive care unit, cardiac care unit, emergency treatment rooms, infection control areas, and psychiatric facilities. In emergencies, access to other hospital areas that are normally available to the news media also may be restricted temporarily.

Advance notice of visits by reporters, video crews, or photographers will enable hospital staff to secure space clearance and make arrangements necessary to ensure that electronic equipment used by the news media will not impede patient care. In some areas of the hospital, news people may be required to wear special clothing and have their equipment disinfected or protected.

Release of Information to News Media:

All news media inquiries should be directed to the hospital spokesperson.

Information reported over public airwaves (commercial radio and television channels, and police/emergency radio frequency bands) is considered public information. In cases reported by fire or police departments, sheriff, medical examiner, or other public authority, the hospital spokesperson may confirm or respond to inquiries about the following without obtaining the consent of the patient: name, city of residence, sex, age, general description of injuries (as ascertained by medical personnel) within the guidelines described below. If the patient is a minor, names of parents also may be given. No statement may be made as to whether a patient is intoxicated or under the influence of drugs.

In cases not reported by a public authority, the same facts outlined above will be made available if permission has been given by the patient, the patient’s designated representative who has power of attorney for healthcare, or a responsible member of the patient’s family. The release of information about certain patient situations and conditions is controlled by state and federal law. (See Psychiatric, Drug and Alcohol Abuse Cases.)

A prognosis for a specific patient should never be given to the news media or the public.

Patient Conditions Defined:

Oregon hospitals agree to use the following standard definitions when describing a patient’s condition:

Good: Vital signs such as pulse, temperature, and blood pressure are stable and within normal limits. Patient is conscious, comfortable, and there are not complications.

Fair: Vital signs are stable and within normal limits. Patient is conscious and alert although may be uncomfortable or in pain and may have minor complications.

Serious: Vital signs may be unstable or outside normal limits. The patient is acutely ill or injured and may have major complications.

Critical: Vital signs are unstable or outside normal limits. There are major complications. (Most patients in an intensive care unit are considered critical until ready to be moved to a regular nursing unit.)

Note: “Stable” is not a condition.

Police and Accident Cases:

Information about police and accident situations is the most frequent request a hospital receives from the news media. Release of patient information in these situations should follow the guidelines for cases reported by a public authority. The general nature of the accident may be described, such as injury by automobile, explosion, shooting, etc. However, the hospital spokesperson should not enter into any discussion of the circumstances of the accident or its cause. (See Interviews and Photographs.)

No information should be given that violates the confidence, privacy or legal rights of the patient. For example, the hospital should not make a statement as to whether a patient was intoxicated, whether injuries were the result of assault or an attempted suicide, whether a patient is suspected of being a drug addict, the circumstances in which a patient was shot or stabbed, or the details relating to an automobile accident and whether there was an arrest.

Specific Injuries:

Further medical information dealing with specific injuries in police and accident cases may be given by hospital spokespersons as follows:

Fractures (except head injuries): Indicate the part of the body involved and whether the fracture is simple or compound. The words “possible” or “probable” should be used when X-ray diagnosis is not available.

Injuries to the head (except fractures): A simple statement may be made that there are injuries to the head. However, it may not be disclosed that the skull is fractured. No opinion may be given regarding severity of the head injury until the condition is definitively determined by a physician.

Trauma and internal injuries: Trauma cases usually involve injuries to more than one body location. A statement may be made that there are multiple trauma injuries. It may be stated that there are internal injuries, and the general site of such injuries may be given.

Unconsciousness: If the patient is unconscious when brought to the hospital, this fact may be stated. However, the cause of unconsciousness may not be given.

Shooting or stabbing: A statement may be made that there is a gunshot or stabbing wound and its position indicated. The hospital spokesperson may not state how the accident occurred (i.e., accidental, suicidal, homicidal, etc.), nor describe the situation under which it took place.

Paralysis, loss of limb: No statement may be made without permission from the family or the patient’s designated healthcare representative. Hospitals and the news media recognize that in cases of paralysis or loss of limb, there is great emotional turmoil for the patient and family. Often the family opts to wait for a short time to tell the patient of the extent of his or her injuries. In such cases, both hospital personnel and the news media will cooperate to ensure that the patient’s privacy is protected.

Burns: A statement may be made that the patient is burned and the hospital spokesperson may identify the area of the body involved. A statement as to the severity and extent of burns may be made if indicated by the physician.

Poisoning: A statement may be made that the patient is being treated for a suspected poisoning. The cause of the poisoning may not be described (such as suicidal, homicidal or accidental). However, when poisoning is proven to be accidental and reported to public authorities, the hospital spokesperson may confirm the nature of the poisoning. The product ingested should be described generically (such as “weed killer” or “detergent”) and not by trade name. When the ingested material has not been identified, this fact should be so stated.

Battered children: No statement shall be made that a child’s injuries appear to be the result of child abuse, even if an official report has been filed. The nature and extent of injuries may be released according to the above guidelines for cases of public record.

Rape: Every effort will be made to protect the privacy of an alleged rape victim. Names will not be released. No statement will be made concerning the nature of the incident or injuries without the specific written consent of the patient. Once a case is reported to the police, further news media questions should be directed to law enforcement authorities.

Outpatient and Emergency Care:

In facilities where outpatient care is provided by medical staffs, hospitals may choose to release information on patients consistent with the guidelines established in this document.
When a patient is brought to the emergency department but is not admitted to the hospital, the hospital spokesperson should respond to inquiries consistent with guidelines established for cases of public record. The statement, “The patient is being evaluated in the ER,” or the “The patient was treated and released,” may be used in place of a condition report.

Psychiatric, Drug and Alcohol Abuse Cases:

State and federal laws prohibit the disclosure of any information about psychiatric, alcohol and drug abuse cases (42 USC Section 290; 42 CFR Section 2.1; ORS Chapter 426). This includes confirmation of the patient’s admission to or discharge from a psychiatric, drug or alcohol treatment facility.
When reporters have information from the police or other sources concerning persons who are being treated at psychiatric, drug or alcohol abuse facilities, it is recommended that all such media inquiries be answered, “We cannot, under federal or state law, comment on such a case.”

Organ Transplants:

In the case of organ recipient, the hospital spokesperson will confirm or respond to inquiries about the following if permission has been given by the transplant recipient or a responsible adult member of the family: name, city of residence, sex, age, date of transplant, and condition.
In cases of public fund-raising for organ transplants, the hospital should follow the code guidelines for Newsworthy Persons.
In the case of organ donors, a potential organ donation will not be discussed by the hospital spokesperson. When a potential organ donor dies, as determined by the attending physician, the disposition of the body will not be revealed. The hospital spokesperson shall refer questions on definition of death to the attending physician. The hospital performing the transplant will not release information about the donor that might ultimately reveal the donor’s identity.

Maternity:

Policies on the publication of births vary from hospital to hospital. Hospitals should obtain written consent from the parent before permitting photographs or release of information about newborns.
Questions about drug-affected newborns (babies born to drug-addicted mothers) should be directed to a physician.

Unusual Illnesses:

Healthcare facilities will confirm any unusual illnesses or potential epidemics after such illnesses and conditions have been reported to local health authorities. Names of patients will not be released without permission. HIV patient confidentiality is protected by federal law. The identity of a person tested for HIV or the results of an HIV-related test are confidential (OAR 333-12-270(1)).

Death:

While announcement of a death usually is not made by a hospital, such news is public information after next of kin has been notified. If next of kin has not been notified, the news media shall be so advised and asked to refrain from release of news for a reasonable time, as determined in cooperation with the attending physician.
When the patient is of significant prominence, the hospital spokesperson should facilitate timely release of information to the news media. (See Newsworthy Persons.)
Information on the cause of death may be given by the hospital spokesperson after receiving approval from the attending physician and members of the patient’s family.
If a death becomes the object of a medical examiner’s investigation, news media inquiries as to the cause and circumstances of death will be directed to the medical examiner’s office.
The name of the funeral home receiving a body may be released to the news media.
Determination of whether a death is a suicide is not within the province of the hospital. A medical examiner is usually the qualified authority for rendering such a judgment. The hospital spokesperson should never release statements asserting suicide or attempted suicide as a reason for hospitalization or death of a patient.

Interviews and Photographs: Media-requested photographs, videotapes, or interviews can be granted with the patient’s written consent. When the patient is a minor, permission of a parent or guardian must be obtained.
The patient’s physician should be informed of news media requests. For each request, the hospital should obtain in advance a completed, dated and signed patient consent form for photography and videotaping. This consent form should be filed as a permanent part of the patient’s record in accordance with individual hospital or health system policy.
Requests to interview or photograph a patient under arrest or in custody are to be referred to the police department or government agency holding jurisdiction.
A hospital may refuse permission to interview or photograph a patient if such actions would interfere with the patient’s well-being or the delivery of patient care. However, such circumstances are often temporary and approval may be given when conditions change.
The hospital spokesperson may stay with the news media and the patient throughout the session to provide assistance and to protect the patient’s rights as well as the rights of other hospital patients.
News media coverage of unconscious patients, or patients suffering from severe illness or injury, will be permitted only with permission of the patient’s family or designated healthcare representative.

Patient Discharges: Once a patient is discharged, the hospital no longer will disclose information about him or her to the news media. All further inquiries should be directed to the patient or the family. However, a hospital may confirm a patient’s dates of admission and discharge.

Newsworthy Persons: A person whose activity is a matter of public interest or whose livelihood or success depends on being kept in the public eye (i.e., a sports figure, an elected official, an actor) forfeits some right of privacy.
When a prominent person is hospitalized, the hospital will coordinate with the patient, family, and physician to provide information about the patient’s illness in a manner that is consistent with maximum possible protection of the individual’s privacy.
The prominent person may elect to name his or her own spokesperson, to whom all requests for information will be directed. When a newsworthy person is in serious or critical condition, the hospital should arrange for medical bulletins to be issued on a regular basis. These bulletins should be issued by the hospital spokesperson in cooperation with the attending physician, the family and/or designated healthcare representative.

The above practices also may apply to the patient who, whether willingly or not, has been involved in an occurrence of public or general interest and, as a result, becomes hospitalized.

If a patient is hospitalized due to an occurrence that draws public attention, information should be provided by the hospital spokesperson for the duration of the hospital stay, according to the guidelines described in the code under Police and Accident Cases.