I am a 69-year-old clinician who is hard of hearing. My son is a 39-year-old medical school graduate who has passed all of the necessary steps but has yet to land a residency. In the meantime, he works with me at my office and has gone around with other specialists in the community. The patients love him. I would like to take him with me on my hospital rounds. This would be a great boost to his knowledge and to the patient’s care. He could be my ears as well as a mini-consultant.

The problem is that the hospital won’t allow him to accompany me because it is a violation of the Health Insurance Portability and Accountability Act (HIPAA) since he is not enrolled in an academic training program and is unlicensed.

Under HIPAA, I am a covered entity. My son has worked for me intermittently for two years. The IRS has a detailed record of the salary he has received. As employees of covered entities are allowed free access to patient records, shouldn’t he also be covered? Under the hospital’s interpretation, I should not be allowed to bring my office nurse to the hospital with me.—James Adrian, MD, Merced, Calif.

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Hospitals have broad leeway in setting their own medical staff rules through executive and medical staff committees. Though they apparently couched their decision in terms of HIPAA, they could just as easily have ruled that non-licensed employees are also excluded. My best advice would be to approach your hospital administrator and chief of staff, acknowledge that you are aware of HIPAA rules, and would formally obtain and document the consent of any patient your son accompanied you to see. Should this fail, hospital bylaws typically have a section on the appropriate path to appeal a dictation. Be certain to make and document your own independent medical findings and opinions. Allowing your son to make an independent examination not confirmed by you or to order a diagnostic test or treatment would put both you and him at legal risk for practicing medicine without a license.—John Davenport, MD, JD (134-9)