Negotiating the Secular in the Interest of the Sacred
What is HIPAA?
The Health Information Portability and Accountability
Act, or HIPAA as it is commonly known, is a federal law that went
into effect on April 14th, 2003. As its name suggests, the law is
designed to address the portability of an individual’s health
information, particularly through shared technological resources,
and the accountability of those who manage such information. In
other words, the law is designed to give an individual more immediate
control over his/her health information.
The effects of HIPAA will continue to be felt in
the private and public sector as the law is fully implemented in
stages over the next few years. Because it is a federal law, HIPAA
has been and will be interpreted by the lawyers representing the
interests of each institution directly affected by its mandates.
These institutions include, but are not limited to: hospitals, both
public and private; nursing homes and similar elderly care institutions;
pharmacies; mental health institutions; physicians’ offices;
insurance companies; financial institutions; and employers. (For
example, different hospitals in Vermont will have different interpretations
and implementations of the law with regard to security. While some
already require ID badges for local clergy, others may not consider
them until the parts of the law addressing security go into full
effect in 2005.)
How are clergy and members of religious communities
in Vermont affected?
With the granting of control to an individual comes
the potential of his/her limiting access to him/herself in an effort
to maintain privacy. Clergy’s access to an individual when
that individual is receiving medical care is a small but vital part
of the law. If HIPAA has done anything, it has raised awareness
for those wishing to give and receive spiritual support during times
of medical treatment to be intentional about communicating these
wishes. The law confirms the need for clergy to attend to two specific
relationships in pastoral ministry:
1. Develop trust-based, life-giving relationships
with parishioners. If clergy are an integral part of the support
system, members of faith communities and/or their families will
consult clergy in times of medical concern. If clergy are directly
consulted by an individual or by the immediate family, their access
to the person is fully permitted under HIPAA regulations.
2. Develop a relationship with the chaplain(s) at
local health care facilities. Clergy may need to take the first
step—a phone call or a visit to the office. Chaplains can
be a source of information for clergy about HIPAA and how it is
affecting access to parishioners. Chaplains can also be a great
bridge between clergy and parishioners who are receiving medical
In addition to these two relationships, under the
auspices of HIPAA the burden of developing the relationship between
clergy and the health care team falls more clearly upon clergy who
will need to be more proactive if they wish to have a significant
role in the care of an individual. (For example, clergy may want
to know what type of meals members of the religious community can
provide for a parishioner when s/he returns home after surgery.
HIPAA forces a medical team to be more cautious in revealing this
kind of information to anyone without the individual’s consent.)
As mentioned, HIPAA regulations are still being interpreted
and implemented in a variety of ways institution-wide and nationwide.
However, there is a basic protocol clergy can follow when wishing
to visit a parishioner in a health care facility. (For the purposes
of this discussion, it will be assumed that the person is in a local
1. If clergy hear about a parishioner being in the
hospital from that individual or his/her family, clergy have the
right to visit and offer spiritual support if requested to do so.
2. If clergy hear about a parishioner being in the
hospital from anyone other than the individual and/or the immediate
family, s/he can call the hospital and ask if the person in question
is listed in the directory as a patient.
If the answer is yes, a hospital employee will be
allowed to give the clergy the patient’s room and bed number.
Clergy may ask about the patient’s medical condition and should
be afforded by law a one-word descriptive response (stable, critical,
etc.) from either the nurse assigned to the patient or the attending
physician. This is the only information provided to clergy by law.
a. Ask to be connected to the patient’s room and ask the individual
permission to visit. If denied, clergy must honor the request.
b. Or, call the immediate family. If they wish for clergy to see
their relative while s/he is in the hospital, clergy have the right
to do so unless the patient does not grant permission.
If the answer is no and the individual is at the
hospital, s/he has elected to keep the medical care confidential.
This is his/her right. No one, including immediate family members,
will be told of the individual’s location and condition.
In some instances, clergy will be visiting a parishioner
at the hospital and, while there, will run into another member of
the community. Clergy have the right to visit this individual and
his/her family as long as they are receptive. The individual and
family likewise have the right to refuse the visit by dismissing
clergy. It is understood they will choose in the moment whether
or not they wish for clergy to have access to them.
Under HIPAA regulations, one of the most important
aspects of the ministry of spiritual care during times of medical
care is educating religious community members about the questions
they will be asked when being admitted to health care facilities.
In addition to encouraging parishioners to contact clergy directly
when anticipating or experiencing medical care, clergy can encourage
parishioners to answer in the affirmative questions regarding religious
affiliation and chaplaincy services.
1. If a person when asked at admission willingly
offers his/her religious affiliation (Baptist, Catholic, Jewish,
etc.), his/her name may be listed with this affiliation on a daily
directory maintained by the chaplain(s)’ office. In institutions
where such a directory exists and is maintained, any clergy have
access to the list and can in turn visit those identifying with
their religion or denomination even when those on the directory
have not made an initial contact.
2. If a person at admission answers in the affirmative
if asked about seeing a chaplain, the chaplain can in turn receive
permission from that individual to contact the clergyperson and
make you aware of the care being provided.
If a person denies either this information or this
care, the chaplain(s) are no longer able to help clergy connect
with parishioners. If a person gives religious affiliation information
but denies care of the chaplain, the chaplain(s) may be more limited
in their access to the patient than clergy.
There are any number of reasons why an individual,
when being admitted to a health care facility, would deny care from
a chaplain or conceal his/her religious affiliation. Here are a
Fear Am I dying?
Do I need a chaplain? Is the chaplain trying to convert me while
religious life is my own business.
Lack of knowledge
What is a chaplain? What does a chaplain do?
(A hospital employee who works in admitting may not have adequate
information to answer this question.)
Reluctance Don’t bother the chaplain. I’m only in for
a few days. (Patients do not always have an accurate sense of how
long they will have to stay.)
minister will visit. I haven’t attended in a long time but
hopefully s/he will remember me.
Medical Condition / Confusion
I feel awful. The last thing I want to do is
talk to someone. (Patient thinks the chaplain will want to talk
Concern about ecumenism / interfaith issues
/ religious identity
I’m Catholic. Is the chaplain a priest?
I don’t have a religious affiliation. How
can the chaplain help me?
Clergy can dispel people’s fears and minister
to them long before they anticipate needing health care by talking
with them about what kind of support a chaplain can offer and about
how beneficial spiritual support can be.
Privacy, healing, and clergy rights
Whether clergy conceive of the ministry of spiritual
support/pastoral care during times of medical need as a calling,
a privilege, or a burden, I hope that clergy can appreciate the
need for someone to offer and receive it. I also hope clergy and
members of religious communities can appreciate the intentions of
HIPAA—to protect the privacy of the individual by granting
the individual control over the distribution of his/her health information.
The law serves as a gentle reminder to faith communities; the distinction
between sharing information about a family member or friend for
the purpose of corporate prayer and gossiping about those we know
and love is not always clear. This law challenges clergy to define
and advocate for the right to be members of the team of people supporting
those in need of healing.
This paper was written by the Reverend
Jill C. Robinson, a United Methodist Elder and member of the
Faith and Order Commission of the Vermont Ecumenical Council, in
consultation with the Reverend Diana Scholl, Chaplain at Porter
Medical Center in Middlebury, Vermont.