Re: Rel. of Information - Secondary release (fwd)

[James Brady <jbrady@freenet.columbus.oh.us>]

  Bernice typing at all (politely pinning Jim's ears back - Jim was typing
  first post on line w/o benefit of Bernice's input).
  
  ---------- Forwarded message ----------
  Date: Tue, 6 Aug 1996 12:55:16 -0500
  From: Bernice Childs <102366.1174@CompuServe.COM>
  To: jbrady@freenet.columbus.oh.us
  Subject: Re: Rel. of Information - Secondary release
  
  Jim,
  
  I read your reply with interest and some concern.  I do not know your
  background in medical records or your actual experience in responsibility
  for release of information.  Have you had responsibility to your
  institution for ROI or has your experience been more theoretical?  I have
  in my CV eleven years as a hospital administrator, including a large
  municipal hospital, in addition to 40+ years of responsibility for
  ROI--often when I was busy with other things and had to rely on a policy
  that would serve the institution well and, at the same time, not create
  the havoc of confrontation with a patient.  My comments were made because
  while philosophy and theory are fine, practical solutions are usually more
  productive in a busy workplace. 
  
  Let me respond to your "what ifs".  If the record at the original facility
  (hospital, HMO, ambulatory care, physician's office, etc.) is lost,
  obviously the next best record (legal, too) is what you (the second
  faclity)have. Certainly that record can be released, but only after the
  original facility has been notified--as I put in my memo yesterday. 
  
  Can you imagine that if I sent a copy of pages anywhere (another provider,
  insurance company, attorney, etc.) and these pages were re-released
  without my knowledge, and someone in my facilty proceeded to continue to
  write on the progress notes or find on error which is then corrected--or
  who knows what--so a change is made.  If, for some reason, those
  re-released pages show up in court and you show up with pages that are
  different--guess whose record is in jeopardy?  On the other hand, if I had
  been notified someone wanted to re-release the pages, I could have
  consulted the record, seen a marker on the page that it had been
  photocopied and checked to be sure that no new entries or changes had been
  made.  Then, I certainly would have approved the re-release of these
  pages.  Suppose the patient plans to sue the first facility, cannot or
  won't pay for the copies and doesn't want to alert the first facility, and
  then uses your copies as a basis for his/her suit, and, to make matters
  worse, your pages come up different in court!  I can give you a number of
  real life horror stories that I have been made aware of--and I am sure you
  have,too. 
  
  My primary concern would always be to protect the facility for whom I work
  by having my staff follow a protocol that leaves little room for the
  imagination. Of equal concern is fulfilling the patient's needs. 
  Sometimes this requires careful thought, consideration and negotiation. 
  It has worked for me for all these years--my last position was as
  consultant for 62 Group Model HMOs.  This policy worked for them, too and
  was drafted with corporate legal staff.  What can we do for our employer
  other than play it safe?  The patient's needs are paramount and can be
  handled many different ways without jeopardizing your own facility. 
  Lawsuits generally start at seven figures--and I never wanted to be
  responsible for an outcome that could have been avoided. 
  
  By the way, there are some Federal regs about re-disclosure of
  information.  I have them somewhere, but folks should be mindful and look
  for them--they are about alcohol, drug abuse and certain sensitive
  diagnoses. 
  
  As you do, Jim, I am writing for myself and trying to share my many years
  of experience.  There is no need for my younger colleagues to have to
  re-invent the wheel, unless they want to. What is fun for me now, is very
  serious when you are the person faced with the problem.  Safe is very
  good. 
  
  Bernice Childs, RRA