From the desk of Rabbi Yehuda (Leonard) Blank, MS, BCC
Director of Programming, Chaplaincy Commission and External Affairs
Rabbinical Alliance of America/Igud HaRabbonim
December 30, 2021
HIPAA(Health Insurance Portability and Accountability Act) –
Confidentiality and Privacy
The Agudath Israel of America and the Rabbinical Council of America versions
of their Orthodox Jewish Living Will, NASCK and the EMES Card.
Erlichkeit- Honesty- Sincerity – Compassionate-Caring- Integrity-Kiddush H
Sender Zev ben Moshe Hakohen Z”L Mr. William Finkelstein
At the Bialystoker Center for Nursing and Rehabilitation known for being a community based facility, I was the rabbi and director of pastoral care . There was also a synagogue attended by community residents and the snf patients known as the snf residents. It was not unsual for visitors to want to speak to me about assorted topics and concerns they might have. However, if the discussion would include wanting to know confidential information about a snf resident I had to gently, diplomatically, and politely explain that unless they were authorized by the snf resident or authorized family member or care giver I could not share such information. It was also not unusual for someone who attended synagogue services to notice a snf resident who was a frequent attendee of the synagogue services not present. I would be asked how that resident is feeling, or to be more blunt why hasn’t that resident been attending the synagogue services whether it be one time or more that once. If somehow a visitor or congregant found out the resident was ill or taken to the hospital, the questions to me became more intense and the person(s) asking me for information felt they had a right to know. After all“I have been visiting the resident (the patients name was told to me) for a long time” or “this patient male or female is a member of this my synagogue”. I shared my appreciation for their care and concern for that resident. There was no question the information being requested was confidential. I had to be a diplomat as to what I should say without divulging personal information. I would mention there is a regulation called HIPAA which prevents me from discussing anything of a personal nature. Of course, HIPAA sounded official and legal even though many people never heard of HIPAA. I would do my best to be polite and diplomatic. Of course, there were those who were not satisfied with the information I gave. After all, as a rabbi, or chaplain I should be sharing much more. Especially since they knew of my devotion to all the residents. To these individuals and thank goodness most were not like that. They were upset this so-called confidential information could not be shared with them. In fact, they invoked the “well he/she would definitely want me to know everything.” That might be true. I therefore mentioned as soon as I can, will enquire about gaining authorization from the patient if he/she is able to, or the authorized family member or care giver for permission to share their personal information with the visitor (by name). I would also request the social worker to join me for that discussion so that could be documented. I also would defer and advise that person(s) speak to the nursing or social service department if they felt they were not satisfied. The same held true when I was working for MJHS in hospice. I was involved with families, family meetings, clergy, and others. Observing HIPAA was of course necessary. The challenges were surmountable when anyone including family members, rabbis and other clergy requested confidential information. Often patients and care givers did not give any thought of discussing their spiritual or other concerns with their rabbi or other clergy or request having their clergy person discuss on their behalf with their medical staff or any member of the interdisciplinary team I would ask if they would like for me to contact their rabbi or other clergy person or they themselves . Especially for the Jewish patients MJHS encouraged them or their designated family and or care givers to discuss their loved ones medical conditions and any concerns al pi halacha they may have . Authorizing their designated rabbi /posek to discuss on their behalf any medical or other questions they may have and to collaborate with the medical team whenever and however possible. Especially for those patients and or family who depend on their rabbi/posek for such guidance, knowing their rabbi/posek would be able to discuss openly and freely any concerns and questions they may have. This brought great comfort to the family members. Unfortunately, there were occasions when there were disputes amongst and between family members. Vying for who is the spokes person, which rabbi will be the decider for halachic decisions and, who was the authorized health care proxy. I was often called into family meetings where I had to be the peace maker and help guide the family members to a peaceful and meaningful resolution on what was best for their loved one, usually a parent, but sometimes a sibling or a spouse. Of course, the usual question that is asked by the medical staff or social workers what would the patient have wanted in his/her treatment or perhaps no treatment at all? Which family and who would be the spokes person(s) and decision maker(s)? Most of all which rabbi would be the rabbi of choice for decisions al pi halacha? Such questions often could not be answered as the patient was unable to or not willing to. There were also many other family and legal matters that came into being. But even in the best of circumstances families often wait too long before a patient can share his/her thoughts especially about medical decisions and other concerns.
There are many ramifications as to why HIPAA came into being (to lengthy for this article, but available on the internet). Aside from legal reasons of not sharing confidential information without the direct permission of the patient, or authorized care givers medical facilities, physicians and other professionals, there is great concern when well intended family members and other’s request personal information the patient or caregivers would not want to be shared nor disclosed. How often are the rabbis, the rebbitzens, chaplains, requested to give information about someone they know, perhaps mispallim of a shul, neighbors, or from the community. All well meaning and genuinely concerned. But then there are individuals who are just curious without any real purpose other than just wanting to know and maybe share what they have found out with others. Just ask members of Hatzalah how often they are asked about the well being of someone they know being taken or was taken to the hospital- wanting to know all the particulars. That is human nature to be curious and often it is based on genuinely wanting to know if they could be of assistance to the patient or family members. However, Hatzalah members know who to speak to, who to contact and for reasons they know of vital importance. Patients or their authorized caregiver can also request from the social worker or nursing department in a medical setting which visitors they wish to exclude from visiting. The same holds true with giving information when someone calls patient information if they wish not to disclose if a patient in the hospital they are in or any other information. There are more reasons than one why confidentiality, privacy and yes HIPAA is to be adhered to.
Of course, there are situations when a patient has no one other than his/her rabbi or rebbitzen to be involved making sure all needs are met and help with decision making. By the way, it is truly important for everyone not only to have a healthcare proxy, but to have an Orthodox Jewish document such as Agudath Israel of America version of a halachic living will, which they call a Halachic Medical Directive (HMD). The Rabbinical Council of America version of a halachic living will, which they call a Halachic Health Care Proxy (HHCP). The HMD comes in different versions, depending on the state. They also stipulate which rabbi or rabbis should be contacted or his organizations in the event of a medical situation where the patient is unable to make any decisions for him/herself nor the authorized caregiver or healthcare proxy. The National Association of Chevra Kaddisha (NASCK} also has information that is very useful including their Emergency Medical Education and Sign up EMES wallet card which comes with a plastic slipcover. In the EMES card there is emergency medical and post-mortem instructions including persons name, choice of Agudath Israel of America Halachic Medical Directive, Rabbinical Council of America Halachic Health Care Proxy, Health Care Proxy, /Living Will, US Living Will Registry or None of the above. Also, whoever will find the EMES card, will note the persons request for his/her designated agents and or rabbi to be contacted regarding life sustaining and emergency measures or instructions after death. There is a place for the agent, alternate agent, rabbi, and place for two witnesses and their contact information and signatures. It is also a wise idea to keep together with that card a list of medications the person takes.
The Orthodox Jewish Healthcare Chaplains are remarkable resources and can be of tremendous assistance with valuable information on halachic issues and who to seek specific and helpful information and needed assistance. Their knowledge in medical areas, their professional relationships throughout the medical facilities and hospice are phenomenal. They too have poskim they confer with and though chaplains do not have to be ordained rabbis, many are rabbi’s themselves, some with congregations. Of course, in the military, chaplains are required to be ordained as in some other disciplines where chaplains serve. Jewish chaplains in the military must have smicha.
Rabbis are held in high esteem by their congregation and community. There are many situations they are often involved in with individuals dealing with marital, financial, emotional, medical, illnesses, divorce, shalom bayis between spouses and family members, end of life and even after death issues to name just a few areas the rabbi deals with. Often the rebbitzen’s who are also held in high esteem are sought after for their advice especially from the female congregants or community residents. They both must contend with confidentiality and privacy. This is especially so when dealing with any of the above that becomes known by other congregants or community residents. When there is a situation that warrants the assistance of the synagogues bikur cholim or chesed committees, knowing what information can and should be shared with the guidance of the rav, takes a lot of wisdom and finesse. Confidentiality and privacy is of utmost importance which with the rav and the rebbitzen’s compassion, kindness, understanding, goodness and sincerity plays a tremendous role in the advice and care they impart to those who seek their guidance.
With the support of Mr. Joel Kaplan Executive Director of the United Jewish Council of the East Side and Martha Pollack LCSW, Director of Social Work where I was also the Director of Special Programs, I spearheaded the Manhattan Coalition on Mental Health Issues of the Elderly in response to suicides that were occurring on the Lower East Side community. Partially due to my relationship with the local NYPD police, I was notified about those of the Jewish faith who were committing suicide in most cases by jumping out of windows. Later, I became knowledgeable about different methods of suicide and in most cases related to clinical depression. I was also notified and responded to those who were not Jewish. I would respond to the scene where the suicide occurred and if the person was Jewish helped to ensure proper respect given to the deceased and family. The police and the ME were quite helpful. I made sure the body was covered. However, those cases of suicide that occurred in the open and if the person was a community resident known by others especially in the Jewish community, there would often be questions how, why, who, when etc. by various individuals. Though for such an occurrence keeping confidentiality and privacy was a challenge, but had to be met. I visited family members when they were sitting shiva who shared with me history, doctor visits and other background information, never realizing how ill their loved ones were. Together with Martha Pollack LCSW who was also co-chair of the mental health coalition, we gave in services to management, security, all staff including maintenance workers to be observant of residents of their buildings for any signs out of the ordinary who to report their findings to and the importance of confidentiality. We gave all kinds of trainings, educational and informative presentations to social services organizations and agencies throughout New York City about depression signs to be aware of, other reasons that could lead to suicide and different methods of suicide. These programs were also given to frontline workers. We also did programs and collaborated with the other coalition members. We did special programs to senior groups and clergy to be more aware of the signs that might be considered depression and to bring these concerns to a professional who we gave information about or our contact information or any member of our coalition giving their presentations. Here are a few examples. An elderly woman from an Orthodox Jewish family had gone up and down an elevator in the building she lived in and was walking around her buildings lobby and then went back up to the 20th floor, then to the flight of stairs leading to the roof. She never came down. There was a crashing noise in front of the building. When security went to see what might have cause that noise found this person lying on the floor. The police were called as was I. I went quickly to the site and though it was not a pleasant sight, recognized this woman. She was known in the community. I was requested by the family to help them sought things out helped guide them with those who could assist expedite burial as well as pastoral care. Of course, there were other professionals involved as well including Martha Pollack. We were very discreet and guided the housing development management what to do. Most of all to ensure all their employees not share any information. Until this day, the family still remembers my involvement and especially how discreet about their loved one’s death. For the sake of the family especially her husband and adult children, confidentiality and privacy were so important. Another suicide took place while the wife and adult children were in one of the rooms of their apartment when they felt a draft. The husband had jumped out of their 17th floor apartment. When I arrived at the scene, notes were found in his pocket for funeral requests and other words of good by. I was also notified about other elderly suicides not just of the Jewish faith. Prior to the spearheading of the mental health coalition called the Manhattan Coalition on Mental Health Issues of the Elderly which was created in response to suicides, consisted of psychiatrists, psychologists, licensed social workers, and other professionals. I did extensive research and interviews of professionals in the field of suicide and especially of the elderly in collaboration with Martha Pollack and was invited and joined various mental health programs. Family members had to overcome many emotional heartbreaking challenges including feelings of guilt, shame and embarrassment. The need for privacy was so important. Respect and confidentiality were of the utmost importance. Unfortunately, not everyone would have the understanding when engaging family members of what to say and what not to say. Often the same holds true with visitors being necham availos. The need to know how a person died and any information individuals feel the need to know. Often, there is a lack of understanding for the need for privacy and confidentiality. For what purpose does obtaining certain information serve?
When I became the Executive Director of the Lower Manhattan Health Care Coalition it led to many other programs. The essence of care for all, the importance of sharing information when necessary and always with proper decorum, appropriateness, and confidentiality has always been important with personal opportunities of Kiddush H. I was truly fortunate to have as a mentor Mr. Joel Kaplan Esq who as an Executive Director at the UJC was, kind, honest, compassionate, caring with tremendous integrity and was respected for his care for men and women from all walks of life as well as the Jewish community. He has and continues to weave his frumkeit, his erlichkeit and professionalism in so many ways and his influence on me blending Ahavas Torah, Yiras Shamayim and most of all Ahavas H with professionalism remains strong and steadfast. He was always concerned of the importance of being Mekadeish H and never to make a Chilul H especially in the world of people from all backgrounds. Mr. Kaplan who is also a world renown Chazan, is the Executive Director of Yeshiva Dachei Torah in Far Rockaway, NY. Martha Pollack was an amazing professional to work with. Her pride in her Jewishness, the wonderful work she did at the UJC, as my co- chair for the Mental Health Coalition and presently as Senior Director, Elder Abuse Prevention Services & Agency Training at JASA has been phenomenal. I learned much from her and enormously proud of what we accomplished together. I was also very proud of my relationship with her who was known and still known for her expertise in the world of social work throughout New York City, amongst her peers, colleagues and other professionals. Encouragement and confidence goes a long way. One of the many attributes shared through the many stories about Rav David Feinstein ztkl was how makpid he was on respect, privacy, and confidentiality. He was careful not only about lashan harah, but not to share information of any kind about others even from the same family he had conversations with. His chachmos in knowing what to say and what not to say was acknowledge by many. The temptations of wanting to share information to one person about another is always great. The personal stories through the decades shared with Rav David of people’s sadness, happiness, challenges of all kinds could fill pages of thousands of books. Yet, except for those who gave their permission, he kept those stories to himself unless he shared examples without revealing personal information including names. Any shailos I had discussed with him was always with privacy.
There is one person who I have had tremendous hakaros hatov for all her encouragements, the inspiration’s and remarkable wisdom she gave me -my wife Keila Lutza bas Shalom Hakohain A”H. It was her encouragement for me to pursue anything of value that I did, including spearheading the coalition in response to suicides. Please let me share this with my readers. On two occasions she came with me to be necham availos a family in our community whose loved one died through suicide. My wife and I knew the families that is why we both went. I had no intentions of sharing the information about the suicide, as my wife always knew I did not share information about others that were private and surely confidential. I in turn did not ask her about private conversations or information she had with those she knew. At the shiva house, the family shared a lot of personal information. My wife saw how the family engaged with me and my responses to them. She felt so strongly about my being able to do something and instilled in me her typical care, sincerity, and encouragement. She did not give up as usual until I consented to pursue another avenue of helping people. She never shared this experience nor what she heard at the shiva house with anyone else nor did she ask me about anything I engaged in other than being proud of what I was doing. It was because of her, that I attribute any of my accomplishments and of course to the Ribono shel Olam. The same held true with my work at the snf and when I was working with hospice patients. The same held true when I was the rabbi of a shul, or any other work with individuals. She never asked me about anything of a personal nature. She was an amazing wife and a true tzedeikas. Her respect for others were admirable and in turn, she was respected by so many. In fact, Rebbitzen Malka Feinstein so zein gezundt said the same thing about her relationship with Rav David. He did not share confidential or private information, nor did she ask him for information as well.
Speaking about being erlich, honest, sincere, compassionate, caring, integrity, Kiddush H, I want to shift gears to my brother-in-law whose yartzeit was this past Sunday Chaf Beis Teves. He was a CPA, a truly loving husband, son, father, son in law and brother-in-law. He was loved by many in the shuls he served, in his neighborhoods, by many Rabbonim and yes, Gedolim. He was a true ben Torah. He was erlich and many requested his Birkas Kehuna as he was a Kohen whose love of H, his love of Torah, his love of Yiddishkeit was immense. He was admired for his integrity and honesty by his clients. During his many years as an accountant, he turned down lucrative accounts and client who he felt were not honest in their dealings or requested he find loopholes that were not appropriate, with many sheilos and in some cases might lead to Chilul H. Gaining income from such clients no matter how lucrative they might have been to him was not gaining anything of value. It would be the opposite to all of his beliefs, love of H, the Torah and halacha. In his last years of life, when walking became difficult, he refused to use a walker to shul on Shabbos and instead when he was up to it, there were men and boys in the neighborhood (and his family as well) who took pride in holding on to him walking to shul. He spent many of his free time learning and would make every effort going to shiurim even the nightly one no matter how difficult it might have been for him. He was such a kind person. The respect he gave his father and mother- in- law my parents was magnificent just as he gave to his own parents. With him there was never such a thing as mother- in law jokes. The respect and love he gave them, and all of his family was immense. Every opportunity he had to discuss Torah with Rabbonim, talmidei chachamim and anyone who would enjoy discussing what he was learning, brought him such joy. His most beloved chavrusa was his wife my dear sister A” H. He shared so much with her and together their lives were filled with Torah, Avoda and Gemilus Chasadim. He took such pride in making a siyum whenever he completed learning any parts of gemaras, mishnayos, chumash and so much more. They had such a close relationship with their sons and their wives. There is so much to share about him and his beloved wife my sister, I could write pages and pages, but once again, I want to stress his tremendous integrity, his honesty, his compassion and kindness to others. His influence on others to also be honest, erhlich and love H, the importance of being Mekadeish H as he did was truly spectacular. I also want to mention he like Aharon HaKohen was a peace maker helping to bring shalom amongst and between people, family members and others. He showed a gave much concern to others. He was truly a role model to all of Klal Yisrael. May Sender Zev ben Moshe Hakohen be a meilirz Yashar to his family and to Klal Yisrael.
We are living in challenging times with plagues, nationwide crime of all sorts that has become rampart in practically every state, an uprise of antisemitism, a tremendous disregard for respect of humanity. Where are we headed to? When will this stop or at least take a turn for the better? People are fearful of stepping out of their apartments and homes due to health reasons due to the spreading of different COVID variants, and now the flu and respiratory viruses. But people all over are fearful for the terrible crimewave. There are many reasons we can attribute to for the crime wave, and as far as the spread of the COVID, variants, flu and other viruses- it is true. Just the flu itself and the various viruses are causing havoc in schools and places of work all over. Vaccines and precautions are important. But there are so many thoughts on how to deal with all of the above with so many different opinions, it is mind boggling. We cannot brush any of the above under the rug. The crime wave must be addressed. So much effort and time is wasted on issues the public is tired of hearing about rather than facing the realities of the causes and how they can and should be addressed. Regarding the various causes of illness- appropriate effort must be taken to ensure the safety, health and well being of all our populations, children through adulthood. What is vital and important is the need for achdus, for every effort to be Mekadeish H and not Chilul H. We must never forget our responsibilities to the Ribono shel Olam to be Mekadeish H in every way possible and to be mispallel to Him. In the Vehu Rachum tefilos recited every Monday and Thursday, Rav David ztkl said in the past all of the parts of this tefila is collectively for Klal Yisrael, I will mention only a few passages from this tefila. The translation from the Artscroll Siddur Mesorah Publications Ltd. “Let Your great Name stand up for us in time of distress. We know that there are not any worthy deeds; with charity deal with us for the sake of Your Name. As merciful as a father is toward his children, so have mercy H on us, and save us for the sake of Your Name. Have compassion on Your people; have mercy on Your heritage; have pity we beg You, according to the abundance of Your mercy. Be gracious with us and answer us, for Yours, H is the righteousness, You Who do wonders at all times. (skip some sentences) Save us for the sake of Your Name; have mercy on us for the sake of Your covenant. Look and answer us in time of distress, for Yours, H is salvation. In You, is our hope, O G of forgiveness; please, forgive now, O G Whi is good and forgiving, for G King, Who is gracious and compassionate are You.
May we be zoche the coming of Moshiach, may we be zoche His forgiveness, His kindness, His love, His guidance, His compassion. Instill in us the ability and the strength to bring achdus, with hope, faith, emunah, simchas hachayim, good health, happiness, joy and many simchas. Amein. Thank you. Sincerely, Rabbi Yehuda Blank