[Med-privacy] Psych News: HIPAA Privacy Rule Legal, Federal Court Says
DPeelMD@aol.com
DPeelMD@aol.com
Fri, 21 May 2004 16:32:59 EDT
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TABLE><!-- end of outer content box --><FONT size=3D-1><EM>Psychiatric News<=
/EM> May 21, 2004<BR>Volume 39 Number 10<BR>=C2=A9 2004 <A title=3Dhttp://pn=
.psychiatryonline.org/misc/terms.shtml href=3D"http://pn.psychiatryonline.or=
g/misc/terms.shtml">American Psychiatric Association</A><BR>p. 4 </FONT><BR>
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<H3>Legal News<BR></H3></TD></TR></TBODY></TABLE>
<H2>HIPAA Privacy Rule Legal, Federal Court Says </H2><STRONG></NOBR><NOBR>K=
en Hausman</NOBR> </STRONG>
<P><B>A judge=E2=80=99s rejection of a challenge to the constitutionality of=
a federal rule governing patients=E2=80=99 right to control access to their=
medical records has some psychiatrists worried about the future of the ther=
apist-patient relationship.</B>=20
<P>A federal judge has dismissed a lawsuit in which several organizations<SU=
P> </SUP>and individuals concerned with protecting medical-record confidenti=
ality<SUP> </SUP>sued Health and Human Services Secretary Tommy Thompson ove=
r<SUP> </SUP>the privacy rule, whose creation was mandated by the Health<SUP=
> </SUP>Insurance Portability and Accountability Act (HIPAA).<SUP> </SUP>
<P>The rule at issue governs patients=E2=80=99 right to keep third<SUP> </SU=
P>parties from having access to their medical records=E2=80=94whether<SUP> <=
/SUP>electronic or paper=E2=80=94unless the patients consent to divulge<SUP>=
</SUP>the records. The original wording required patient consent before<SUP=
> </SUP>patients=E2=80=99 confidential records could be used for "treatment,=
<SUP> </SUP>payment, and health care operations." When the Bush administrati=
on<SUP> </SUP>amended the rule, it deleted the patient-consent requirement<S=
UP> </SUP><I>(Psychiatric News,</I> January 16) and instead allowed=E2=80=
=94but<SUP> </SUP>did not require=E2=80=94consent forms to be signed before=20=
treatment<SUP> </SUP>can begin or payment initiated, for example. The consen=
t became<SUP> </SUP>an implied rather than explicit requirement, as it was i=
n the<SUP> </SUP>original rule.<SUP> </SUP>
<P>The change gives health care providers the option of having<SUP> </SUP>pa=
tients sign a consent form before initiating treatment. Once<SUP> </SUP>pati=
ents begin treatment, they should assume that they are consenting<SUP> </SUP=
>to allow others involved in their medical care or payment for<SUP> </SUP>it=
to have access to their records.<SUP> </SUP>
<P>In her April 2 ruling, Judge Mary McLaughlin of the U.S. District<SUP> </=
SUP>Court in Philadelphia stated that the privacy rule did not violate<SUP>=20=
</SUP>the plaintiffs=E2=80=99 constitutional rights "because the amended<SUP=
> </SUP>rule does not compel anyone to use or disclose the plaintiffs=E2=80=
=99<SUP> </SUP>health information for routine purposes without the plaintiff=
s=E2=80=99<SUP> </SUP>consent." That is, the Constitution doesn=E2=80=99t gi=
ve patients,<SUP> </SUP>or others, all the privacy rights they think are cru=
cial, though<SUP> </SUP>laws can be enacted that do bestow such rights, she=20=
said.<SUP> </SUP>
<P>The rule never gave patients the right to decide whether their<SUP> </SUP=
>records were to be released as part of judicial proceedings<SUP> </SUP>or f=
or public-health purposes.<SUP> </SUP>
<P>The American Psychoanalytic Association was one of the lead<SUP> </SUP>pl=
aintiffs in the case, <I>Citizens for Health v. Tommy Thompson,</I><SUP> </S=
UP>as was Texas psychiatrist and APA member Deborah Peel, M.D.<SUP> </SUP>Th=
e plaintiffs argued that the HIPAA privacy rule allows individuals<SUP> </SU=
P>in government agencies, private corporations, and even patients=E2=80=99<S=
UP> </SUP>employers to gain access to records of medical treatment.<SUP> </S=
UP>
<P><FONT size=3D+1><STRONG>Are Privacy Rights Guaranteed?</STRONG></FONT>=20
<P>Chief among the several issues on which the plaintiffs based<SUP> </SUP>t=
heir case was that the privacy rule violates privacy rights<SUP> </SUP>that=20=
patients and others are guaranteed in the First Amendment<SUP> </SUP>of the=20=
U.S. Constitution.<SUP> </SUP>
<P>When patients lack the security of knowing that what they tell<SUP> </SUP=
>their therapist will remain confidential, the plaintiffs maintained,<SUP> <=
/SUP>it is difficult to build trust and thus provide an optimal therapeutic<=
SUP> </SUP>experience. Some patients will refuse to take medications if<SUP>=
</SUP>pharmacists have access to their medical records, they claimed,<SUP>=20=
</SUP>while many others will shun all mental health treatment out<SUP> </SUP=
>of fear of who may be able to read their medical records.<SUP> </SUP>
<P>The amended rule does not, however, permit disclosure of patient<SUP> </S=
UP>medical information that was prohibited before the original<SUP> </SUP>ru=
le was written.<SUP> </SUP>
<P><FONT size=3D+1><STRONG>Thompson Says Rules Followed</STRONG></FONT>=20
<P>Thompson, who was named as the defendant because he heads the<SUP> </SUP>=
agency that promulgated the privacy rule, argued that amending<SUP> </SUP>th=
e rule was done according to required procedures=E2=80=94a charge<SUP> </SUP=
>the plaintiffs disputed=E2=80=94and was the result of a substantial<SUP> </=
SUP>amount of public comment protesting "unintended consequences"<SUP> </SUP=
>of the original rule=E2=80=99s patient-consent requirement, according<SUP>=20=
</SUP>to Thompson. Many of the comments suggested that allowing patients<SUP=
> </SUP>to keep their records from certain third parties could "substantiall=
y<SUP> </SUP>impair delivery of health care" by depriving those parties of<S=
UP> </SUP>"information necessary for quality assurance, accreditation,<SUP>=20=
</SUP>and fraud and waste detection."<SUP> </SUP>
<P>The judge ruled that Thompson had met federal rule-making requirements<SU=
P> </SUP>by considering "the relevant factors Congress intended the agency<S=
UP> </SUP>to consider, namely, the efficiency and effectiveness of the<SUP>=20=
</SUP>health care system and the privacy of health information."<SUP> </SUP>
<P>She pointed out that Thompson "took the privacy interests of<SUP> </SUP>p=
atients into account by permitting health care providers to<SUP> </SUP>obtai=
n prior consent" for limited release of medical records.<SUP> </SUP>
<P>As for the constitutional violation charges, the judge ruled<SUP> </SUP>f=
or Thompson, saying that "the amended rule does not compel<SUP> </SUP>anyone=
to use or disclose the plaintiffs=E2=80=99 health information<SUP> </SUP>fo=
r routine purposes without the plaintiffs=E2=80=99 consent."<SUP> </SUP>
<P>She continued, "Even assuming that the plaintiffs have a constitutional<S=
UP> </SUP>right to privacy over their medical records and to patient=E2=80=
=93health<SUP> </SUP>care provider communications, the amended rule does not=
violate<SUP> </SUP>those rights," since it is "wholly permissive" regarding=
whether<SUP> </SUP>an entity covered by HIPAA "should seek consent from a p=
atient<SUP> </SUP>before using his or her information for routine purposes.=20=
The<SUP> </SUP>amended rule neither requires nor prohibits that practice."<S=
UP> </SUP>Moreover, the rule does not "place obstacles in the paths of<SUP>=20=
</SUP>patients seeking to have confidential communications with their<SUP> <=
/SUP>health care providers," since it does not require that clinicians<SUP>=20=
</SUP>breach confidentiality.<SUP> </SUP>
<P>In giving strong weight to Thompson=E2=80=99s argument, the judge<SUP> </=
SUP>stated, "To the extent the amended rule mandates any actions,<SUP> </SUP=
>it protects the plaintiffs=E2=80=99 putative rights. For example,<SUP> </SU=
P>[it] prohibits covered entities from disclosing and using health<SUP> </SU=
P>information for reasons unrelated to health care without proper<SUP> </SUP=
>authorization."<SUP> </SUP>
<P>Peel, who is president of the organization Appeal for Patient<SUP> </SUP>=
Privacy, called McLaughlin=E2=80=99s ruling "very disturbing."<SUP> </SUP>
<P>"In the end," she said, "somehow the judge came to the tortured<SUP> </SU=
P>conclusion that every citizen=E2=80=99s constitutional rights<SUP> </SUP>t=
o privacy were <I>not</I> violated."<SUP> </SUP>
<P>Peel said that the battle over the HIPAA privacy rule is not<SUP> </SUP>o=
ver. Appeal for Patient Privacy has already raised $35,000<SUP> </SUP>to fun=
d an appeal, which must be filed by June 2. It will take<SUP> </SUP>a legal=20=
victory "to wake up Congress" about the need to undo<SUP> </SUP>parts of the=
privacy rule, she said.<SUP> </SUP>
<P><B><I>Additional information about the appeal of the HIPAA ruling,<SUP> <=
/SUP>including how to contribute to the appeal, is posted online<SUP> </SUP>=
at <A title=3Dhttp://www.patientprivacyrights.org/ href=3D"http://www.patien=
tprivacyrights.org/">www.patientprivacyrights.org</A>. McLaughlin=E2=80=99s=20=
ruling is<SUP> </SUP>posted at <A title=3Dhttp://www.paed.uscourts.gov/docum=
ents/opinions/04d0102p.pdf href=3D"http://www.paed.uscourts.gov/documents/op=
inions/04d0102p.pdf">www.paed.uscourts.gov/documents/opinions/04d0102p.pdf</=
A>.<SUP> </SUP></I></B><IMG title=3D"" alt=3D"" src=3D"http://pn.psychiatryo=
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