The Rev. Karen Stevenson has warned parishioners at Trinity Episcopal Church in Washington, Pa., to call her if they're admitted to Washington Hospital. Due to new federal hospital privacy regulations, she explained, a list of Episcopal patients would no longer be available to her as has been the routine for years.
"This just increases the chance that someone will get missed," she said.
Some experts say that withdrawing such lists is an overreaction to the Health Insurance Portability and Accountability Act, which takes effect April 14.
At the heart of the issue is the hospital directory, which is used by most institutions to locate patients and includes name, room number, condition and religious affiliation. Many hospitals -- especially smaller ones -- have traditionally also used the directory to generate lists of patients who belong to a given faith, allowing visiting clergy an easy way to find hospitalized members.
In response to the new rules, however, many hospitals are either no longer offering such lists to clergy or tightening access to the lists. And now, unless a patient gives permission to be in the directory in the first place, the hospital will not tell their clergy -- or even their own children -- that they are there.
But federal regulations, like scripture, are subject to interpretation. The administrators charged with following the new rules have ranged from fundamentalist to liberal.
"The privacy regulations are meant to protect privacy in the sense that people shouldn't know certain things about the patient. But the fact that the patient is in the hospital is not the center of the HIPAA regulations," said John Horty, Pittsburgh attorney and national expert on hospital law.
The option for patients to take their name out of the directory is intended for extraordinary circumstances, such as a celebrity in hiding from the tabloids, said Janlori Goldman, director of the Health Privacy Project in Washington, D.C., which enlisted support for the new regulations.
"Most people want their relatives to be able to find them; They want people to be able to send flowers to their room," she said. "Clergy are not going to be barred from directory information."
That will hold true at Pittsburgh Mercy Health System, where visiting clergy will continue to get lists as long as the patient has identified his or her religious affiliation.
Faith concerns are integral to health care, said Phyllis Grasser, director of Mercy's Department of Spiritual Care. It is critical to have clergy available when a family must decide whether to discontinue life support or treatment, she said.
But Washington Hospital has moved from allowing clergy to check a list for their parishioners to having its chaplains' office call the congregation if a patient wants to be visited. The problem, Stevenson said, is that the hospital's pastoral care department is part-time. If a parishioner is admitted after noon Friday, Stevenson is unlikely to receive a call until Monday, when the parishioner may already have been discharged. She had relied on the list of Episcopalians at times when the chaplain's office was closed.
But so far her parishioners have responded well, she said.
"I have a couple of older people who have told me -- double told me -- about folks who had gone in to the hospital. . . People are watching out for each other."
The Rev. Lerrill White, a chaplain at St. Luke's Episcopal Hospital in Houston, Texas, and the point man on the new regulations for the Association of Professional Chaplains, believes the rules will benefit pastoral care after the bugs are worked out. Ultimately, the new act "cleans up the process in that it standardizes access to patients," he said.
For instance, it requires visiting clergy to register, so that the hospital can verify that they represent a religious group to which the patient belongs.
The act is designed so that a visiting rabbi will be given a list only of Jewish patients who have told the admissions office that they would like a rabbi to visit, he said. While the regulations do not require that all hospitals keep a religious directory, they do say that any such directory be equally accessible to all accredited clergy, White said.
His biggest concern is for emergencies, when a patient may be unable to answer questions about religious preferences. The rules allow the hospital to call a Catholic priest if, for instance, it is apparent that an unconscious patient is Catholic.
"But there are still a lot of hospital administrators who are really afraid to do that because they have very conservative attorneys," he said.
Pittsburgh hospitals have differed widely in the past on their policies, and some discontinued lists for clergy years ago, said the Rev. Leslie Reimer, a former hospital chaplain who is now associate for pastoral care at Calvary Episcopal Church in Shadyside.
"There are a lot of places where I will call same-day surgery and they will tell me everything I want to know. Others tell me that I'll have to get that information from the family," she said.
Rabbi Alvin Berkun, of Tree of Life Congregation in Squirrel Hill, has noticed a tightening of access in anticipation of the new regulations.
Previously, "I would go to the various hospitals several times a week to see the list [of Jewish patients] and they'd show me. I could look for the names of members of my congregation. That has all changed within the last few months. They restrict the lists," he said.
At one hospital, clergy who take training as hospital volunteers are now given a hospital badge and access to the lists, Berkun said. But people should no longer expect clergy to play medical detective, he said.
The Rev. Vincent Kolo, the Catholic chaplain at Allegheny General Hospital, not only urges people to call their clergy, he advises that Catholics obtain the Sacrament of the Sick from their parish priest ahead of time if the hospitalization is planned. In a large hospital it's difficult for the Catholic chaplain to anoint every Catholic, he said.
Ann Rodgers-Melnick can be reached at arodgersmelnick@post-gazette.com or 412-263-1416.
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