Rabbis confront HIPAA restrictions

When the Health Insurance Portability and Accountability Act took effect in ‘003 — guaranteeing the right of hospital patients to have their medical information kept private and confidential — it had at least one unintended consequence.

According to Rabbi Ephraim Simon, director of the Marcus Chabad House in Teaneck, the law has made it "much more difficult" to find out which members of the community are ill and might appreciate a visit.

"Before [HIPAA] we visited about ’00 people a week in all the hospitals in the area. Now, we see about 1’5," he said, noting that some hospitals are easier to work with than others in locating Jewish patients.

While Simon understands the policy, he thinks it is unfortunate that people without family — or "who would simply appreciate receiving a visit" — may now fall through the cracks.

"It has negative repercussions," he said, adding that he would like to see the old system restored and believes that patients would like to see it changed back as well. In the past, hospitals notified clergy when members of their congregations were hospitalized or made lists of names available at the visitor’s desk.

"We never had any negative responses," he said. "If people didn’t want a visit, we’d simply wish them a ‘refuah shlemah’ and leave. People let you know if they don’t feel like having a visitor."

Simon said he now spends a lot of time reminding people to call when they are in the hospital or others are in the hospital. "Now it’s done by word of mouth," he said.

Rabbi Kenneth Brickman of Temple Beth-El in Jersey City told The Jewish Standard that he’s "retraining people to notify him" when congregants are ill, and that his members have "pretty well adapted." He acknowledges, however, that the law, together with the fact that hospital stays tend to be briefer, is changing the profile of clergy visits.

"It changes [the work of] bikkur cholim as well," he said, noting that follow-up visits may now need to be done at home.

"I’ve been on both ends and I understand the right of individuals to determine whether they want a visit," said Brickman. "[HIPPA] leaves it up to the individual, who can choose to call the rabbi."

"Patients lose enough privacy," he said. "This leaves them the final dignity of deciding if they want to see someone."

Rabbi Neal Borovitz, religious leader of Temple Sholom in River Edge and head of the North Jersey Board of Rabbis, said that before the law took effect, "hospitals would even fax [him] the list" of hospitalized congregants. Now, he keeps a running notice in the synagogue bulletin, reminding members to let him know if someone is in the hospital.

"Every hospital interprets the law differently," said Borovitz. Some will allow registered clergy to obtain a list of Jewish patients, "but only when the office is opened. You can’t call ahead to get the information," he noted. Some hospitals also make a list available to trained volunteers, he said.

At least one hospital gives patients the option of providing the name of their synagogue when they first register. A code for that congregation is then entered into the hospital computer, and rabbis can request a list of patients under that code. Still, said Borovitz, "if they don’t enter the code, we can’t get their names."

According to Borovitz, not being able to get names in advance, coupled with the increased difficulty of parking at hospitals, has reduced the amount of time rabbis now spend doing hospital visits. This, he said, "has created a greater burden on the limited resources of the community chaplain, Rabbi Avrohom Marmorstein."

Judy Beck, director of the Synagogue Leadership Initiative of UJA Federation of Northern New Jersey — who supervises Marmorstein’s chaplaincy work at Englewood and Valley hospitals — agreed that the chaplain’s caseload has increased. She also pointed out that the job is only part-time.

"Ironically," said Borovitz, "as the Jewish community is aging and more people go into the hospital, there are fewer resources to deal with this."

Borovitz recalled a recent incident where a congregant/patient at Valley Hospital learned that the rabbi had been to the hospital visiting another congregant. "He was upset," said Borovitz. "People are upset that the rabbi doesn’t come."

On the other hand, he noted, "there is a real privacy issue… and people should determine whether they want a visit, and from whom." Patients should not have to be "set upon" by untrained volunteers, he added.

"We have to clarify HIPAA," he said, "so there are uniform policies for all the hospitals." In addition, he noted, "As a Jewish community, we need to fulfill the mitzvah of bikkur holim in a positive, professional way, training our volunteers and clergy" in how best to bring comfort to the patient.

"My colleagues want to be able to better serve our congregants in times of illness," said Borovitz. "The system here seems to be working against us."

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