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Consider this question. Say the mother of a 22-year old student that you have treated requests to see her daughter?s medical records. The Bursar?s office confirms that the student is listed as a dependent for tax purposes. There seems to be no urgent reason for such a release and the student does not wish to give her mother access. How would you protect the privacy of her information? Situations such as this one that require knowledge of privacy laws to resolve successfully are all too common in the average student health center, yet the acronyms HIPAA and FERPA tend to strike fear into the hearts of the staunchest of college health professionals. So much has been written anecdotally on the subject of how complicated and unspecific these laws are that some may be surprised to find that according to legal professionals, the intersections between the laws are generally clear-cut. This article aims to explain which laws apply to you and what you can do to avoid the headaches that ensue from a conflict between your principles as a care provider and the law. Six golden rules of privacy law * FERPA never applies to non-students * FERPA only applies when the student?s medical records are released * HIPAA doesn?t apply to records covered by FERPA or to student ?treatment records? * Even if you treat non-students, you?re not bound by HIPAA unless you perform electronic transactions. * Student health and counseling centers that do perform electronic transactions for non-students only have to abide by HIPAA for those transactions. * State laws are applicable whether or not other federal laws apply This is how these rules break down. RULE 1: FERPA never applies to non-students RULE 2: FERPA only applies when the student?s medical records are released The Family Educational Rights and Privacy Act (FERPA) is the older of the two federal privacy laws. Enacted in 1974, one aspect of its governance is the privacy of educational records. There is a popular myth circulating that student medical records fall under the FERPA?s umbrella term ?educational records?. In fact, FERPA specifically excludes the treatment records of students in higher education from its definition of educational records (see USC 20, 1232g for a complete definition). It also excludes employees of an educational institution if they are not students. FERPA does come into play, but only if the records are released to someone outside the health center, whether that is the student, their parents, their professors, or another health provider outside the university, at which point they become ?educational records? rather than treatment records. It is important to note that it is not the request for the release that brings FERPA into effect. Many student health professionals believe that if a request to see the records is made that is in accordance with FERPA guidelines, they have to release them or be in violation of FERPA. Not so, says Kristine Dunne, BA, EdM, JD, an associate at the Washington, D.C. office of law firm Arent Fox, LLC. ?It's the release of the records that triggers FERPA,? she explains. ?There are no rights extended under FERPA to those medical records until such time as they have been made available to someone other than the treating health professionals, at which point the FERPA protections of student records kick in.? Applying this to the example at the beginning of the article, if state law doesn?t require you to release the student?s unreleased medical records to her mother, you are under no legal obligation to do so without a court order. Similarly, even if you think a professor may have a ?legitimate educational interest? in requesting a student?s unreleased medical records, you still don?t have to release them. FERPA is just one part of the puzzle, however. The Health Insurance Portability and Accountability Act (HIPAA) of 1996 is another relevant law that seeks to be the national privacy standard in health care. It was updated in 2003 to take into account the trend toward automation and electronic record-keeping. These privacy guidelines have been well publicized and generally uphold the kind of patient confidentiality that most health care providers are comfortable with and there has therefore been a widespread trend in health centers to apply these standards to student medical records, even if they are not legally required. It is important to realize, however, that while its principles of privacy and confidentiality are excellent, in most cases, compliance is not required by law. RULE 3: HIPAA doesn?t apply to records covered by FERPA or to student medical records which are made, maintained, or used only in connection with the provision of treatment to the student, and are not available to anyone other than persons providing such treatment. RULE 4: Even if you treat non-students, you?re not bound by HIPAA unless you transmit health care information in electronic form in connection with the submission of claims for payment. HIPAA?s definition of protected health information (PHI) specifically excludes education records covered by FERPA and the treatment records of students in higher education as defined above. Dunne explains that the goal of this exclusion is simplification. ?If student medical records were subject to HIPAA, there would be two completely different schemes ? up until the health center released the record, it would be governed by HIPAA, and when it had been released it would be governed by FERPA,? she says. This was apparently considered unworkable by Congress, hence the blanket exception that HIPAA makes for any kind of student medical records. However, many student health and counseling centers also treat non-students, and this is where it starts to get a little bit trickier. To be considered a ?covered entity? (i.e., bound by HIPAA), your health center must electronically transmit health information in connection with a ?HIPAA transaction?. More detailed information on what constitutes a HIPAA transaction can be found in this primer released by The American Council on Education, but essentially it is any administrative or financial task carried out in the course of health care that transmits PHI. If you don?t perform electronic transactions, you don?t have to comply with HIPAA. RULE 5: Student health and counseling centers that do perform electronic transactions for non-students only have to abide by HIPAA for those transactions. Usually, every transaction of ?covered entities? has to be bound by HIPAA standards, even if they are not all electronic transactions. However, because of the intersection with FERPA, these health centers are able to be bound by HIPAA just for the non-student transactions. RULE 6: State laws are applicable whether or not other federal laws apply With all the fuss about HIPAA and FERPA, don?t forget about your state?s laws concerning privacy. In some cases, state laws are the only ones that will apply to student medical records, but even where HIPAA or FERPA apply, state law is still relevant. Despite the fact that HIPAA is a federal law, it bows to state law in those cases where state law is more stringent. Arent Fox Associate Richard Liner, BA, JD, MPH, elaborates: ?HIPAA has an enormous pre-emption problem because it sets a floor and not a ceiling for health care privacy. Congress only established a minimum for protecting patient information. If a state?s laws or regulations are more stringent than HIPAA in their protection of patient health information, then covered entities must follow state requirements.? This may conjure up ideas of conflicting laws, but Arent Fox counsels that generally, state laws are more specific and will very rarely conflict directly with HIPAA or FERPA. If more than one law is applicable, generally the more stringent requirements will apply. When in doubt, consult counsel before taking action. Knowing the theory is one thing, but applying it can be a lot more complicated. FERPA requires the student to give written, dated permission before his or her student records information is released ? even to other health care providers outside the university, which is a source of frustration for many. But the same information can be released, unauthorized, to school officials who have a ?legitimate educational interest?. Similarly, FERPA allows unauthorized disclosure in an emergency, if it is ?necessary to protect the health or safety of the student or other persons?. Dunne counsels to rely on common sense to interpret these terms, and to consult counsel early in the process. No law can specifically cover every eventuality; the burden of responsibility and interpretation must, through necessity, rest on the care provider. This responsibility weighs all the more heavy because schools are concerned about penalties for breaching FERPA. If the Family Policy Compliance Office (FPCO) found a pattern of violations of FERPA with no obvious attempts to follow the guidelines, it could result in a removal of federal funding. However, it is important to know that individuals cannot be prosecuted for a FERPA breach and individual students cannot sue for damages for such a breach. Schools should carefully develop, implement and maintain compliance oversight with regard to these important privacy laws in order to prevent unlawful release of student records. Likewise, if your school treats non-students, files electronic claims and is bound by HIPAA for those transactions, you should make sure that HIPAA protections are implemented, even though a HIPAA violation may not ? for now ? result in a fine being imposed. Liner explains: ?In the vast majority of cases where there?s found to be a violation of HIPAA, there is what?s called an ?administrative resolution?, which generally means the mistake wasn?t intentional and the organization voluntarily agrees to take appropriate remedial action.? No civil fines for violations of HIPAA have been imposed so far, although Liner warns that is likely to soon change. Although information on the triumvirate of privacy laws has always been available to those who know where to look for it, there is also a wealth of partial and incorrect information available on the Internet that has muddied the waters for those health professionals attempting to do a little research on the laws that apply to them. Dunne and Liner counsel that you should speak to a professional who knows the law in your state and the ins and outs of FERPA and HIPAA if you are worried about misinterpretation of the law. Even if you know the basics, state laws vary greatly and knowing the details of how the three laws intersect will allow you the greatest leeway to interpret them in a way that is consistent with your ethics. ?It is complicated,? sympathizes Liner. ?Talk to the privacy officer within the university, if there is one. There are also a few government Web sites that are really good in terms of user-friendly guidance to help people navigate through the more basic pitfalls.? For instance, the Office of Civil Rights, the enforcement agency for the HIPAA privacy standards, offers tremendously helpful information and FAQs on its Web site. ?Consult with your legal counsel to ensure you?re interpreting and applying the law correctly,? adds Dunne. ?And be clear to those who use student health center services, especially students, about the laws that apply.?

What is Acne? People have differing opinions as to what acne really is. So, what exactly is acne? Do a couple of occasional but recurring zits qualify as a case of acne or do you have to have a lot of zits? Believe it or not, the answer is that occasional pimples or zits do not constitute a true case of acne. Although zits do seem to have the ability to appear almost instantaneously and at the most inopportune times like picture day, prom night, spelling bees, sporting events, dates, and special award ceremonies, they are not a true acne outbreak. The dictionary defines acne as "an inflammatory disease of the sebaceous glands, characterized by comedones and pimples, especially on the face, back, chest, and, in severe cases, by cysts and nodules resulting in scarring." The anatomical definition of sebaceous glands is: "small subcutaneous glands usually connected with hair follicles. The follicles secrete an oily semi-fluid matter, composed in great part of fat, which softens and lubricates the hair and skin." Real acne outbreaks are actually a disease of the skin. However, the great news is that acne is treatable. Although it can be very embarrassing, cause great emotional distress, and lower your personal self-esteem for a period of time, acne is not fatal. There are new and effective treatments being sought by researchers and great advances have been made in the treatment of acne in the last few years. Years ago, when a person had acne, they were pretty much stuck with the problem. There were very few treatments available and the medical profession didn't even consider acne a disease. It was long thought that acne was the direct result of a diet that was too high in fat and/or sweets. That is no longer the case. Acne is most often associated with puberty and the onset of pre-teen and teenage years but it can and does develop in adults as well. When acne does finally heal, there can be permanent scars left (from picking and popping) that are unsightly and cause patients to suffer long term emotional distress and low self- esteem. New and very effective skin resurfacing treatments have been developed over the last several years that have, if not completely removed acne scars, at least diminished their appearance and severity. Acne Fact or Fiction: You can hear a lot of tall tales about acne today, so let's take a look at the fact or fiction of acne. It is always better to be well armed with factual information so that you don't get fooled by the fictional facts that surround acne. Fictional Fact #1: Acne is caused by a lack of sexual activity. Factual Fact: Acne and sexual activity are two entirely separate issues. One has no bearing on the other. Hormones secreted during puberty and young adulthood does have a bearing on acne. They also have a bearing on sexual arousal and activity. However, acne has no bearing on sexual activity nor does sexual activity have any bearing on acne. Fictional Fact #2: People have acne because they are dirty. Factual Fact: Dirt has no part in acne. Dirt is dirt. Acne is acne. One has nothing to do with the other. Acne is a build up of oil, dead skin cells, and bacteria. Dirt isn't involved. Keeping the face clean can and will help to prevent clogged pores but dirt does not cause acne. Fictional Fact #3: Dermatologists can cure acne. Factual Fact: Dermatologists can TREAT acne. They can help to alleviate the symptoms and help to clear up the pimples, black-heads, and white heads. They can prescribe antibiotics and topical ointments, lotions, and creams that will help but there is no cure at this time for acne. Fictional Fact #4: Acne is simply a skin problem. Factual Fact: It's true that acne affects the skin but it can also affect the way a person sees himself or herself. Acne and the scarring it can leave behind may cause a sufferer to become depressed and develop low self-esteem, both of which can lead to larger and more complex life socialization problems. Acne sufferers need the loving support and reassurance from their family and friends. Acne and Stress: Can stress actually cause acne? There is ample evidence available to suggest that stress can most assuredly cause an acne breakout or make an existing breakout worse. Our bodies are highly developed chemical laboratories that produce all sorts of stuff. At puberty, our body begins to produce an abundance of male hormones and this happens in both boys and girls. This overproduction of male hormones can happen at other times in life besides puberty; for example, when a girl or woman starting or stops taking birth control pills. These male hormones cause the bodies sebaceous glands to shift into overdrive and begin producing sebum. The sebum then travels up hair follicles, clogs the pores and begins the acne development cycle. However, male hormones are not the only cause for the sebaceous glands to begin producing an overabundance of sebum. When we become extremely stressed or overly emotional, our bodies react by causing the adrenal glands to produce a substance known as Cortisol, which is released directly into the bloodstream. Then the chemical chain reaction continues as the sebaceous glands release sebum, the sebum travels up the same hair follicles, clogs the pores and acne develops. The physical changes in the body can cause exactly the same chemical chain reaction as the emotional changes in the mind. The mind/body connection is very real. Maybe some of it really IS in your head. If that's the case, there is help available to help people deal with the acne that is caused by stress. Reducing stress will just naturally reduce sebum production by the sebaceous glands and reducing sebum production will help to alleviate an acne breakout. Therefore, when you learn to reduce and control you stress levels, this part of the chemical chain reaction is minimized. It really it isn't any different than restoring a hormonal balance to your body that reduces sebum production. So, in the final analysis, both factors that cause excessive sebum production should be addressed. Solving one problem might help; however, solving both problems could eliminate acne altogether. Acne Facials: If you are part of the 95 of the population who suffer from acne, you have more than likely seen TV or print media advertisements for acne facials. Have you ever wondered if there is anything to the claims that their manufacturers make? In general, the answer is yes! Most acne facials are very effective, pretty much worth the price, and can be used in conjunction with your usual acne fighting regime. They won't necessarily replace any part of what you are already doing; but, rather enhance the overall effects. You can find acne facials in most health stores, at many cosmetic counters, and online. As a matter of fact, you can probably complete a better comparison of available products online than you can anywhere else. Most of these acne facial products provide for a three-step program. The first step is a complete facial cleansing. The next step is a steam massage. The final step is a facial mask. The first two steps are designed to prepare the face. The steam massage softens the black heads and the white heads to remove toxins from your skin. The facial mask serves to remove the dead skin cells from the face and to moisturize it as well. The overall effect of the acne facial is a very relaxing, calming, and cleansing experience. It just plain feels good. Anything that helps to calm and sooth your stress can't be bad because we all know that acne is aggravated by high stress levels. Acne facial masks can be used in addition to other parts of your acne prevention and treatment regime or you may find that the facial can, in fact, actually replace some things that you are currently doing. Acne Concealer's: One of Newton's laws of physics laws says that, "For every action, there is an equal and opposite reaction." That law of physics spills over into a lot of our life situations. For example: A young woman gets a zit and wants to cover it up. The cosmetics industry has a multitude of products designed to do just that. Okay, that's a little far out there but you get my point. The acne pimples, whether they are white heads or black heads should never be picked at or popped. If they are popped or picked, it can and normally does result is a scar that is much harder to get rid of than the actual pimple, black head or white head. Popping a pimple is not going to make it go away. In fact, popping a pimple is only going to make the acne worse. Still when you get a zit, you have to go out and face the world so you are looking for ways to make your skin look clear. You want to disguise the zit and make it as unnoticeable as possible. Here is where the cosmetic industry can help. There are a multitude of products designed to make a zit less noticeable. You don't want to use a product that just adds to the problem by adding additional oil to already oily skin. So, you do need to remember, that when you use a cover product to make the zit less noticeable, you need to totally clean the product from your skin immediately when you return home. Some of the better known as well as more effective cosmetic concealer's on the market today are: 1. Dermablend Smooth Indulgence Concealer: This product produces a smooth matte appearance and was designed specifically for covering acne blemishes as well as for covering Rosacea and dark circles under the eyes. 2. Flawless Skin by Prescriptives: This product will not aggravate acne but will supply a medium to full coverage and it contains SPF 25 for protection from the sun. Don't let acne control you; but rather, become smart and learn how to control the negative influences in your life that create a positive situation for acne to develop!