[Med-privacy] Texas Monthly:Invasive! Who's gutting the laws that keep medical records private
DPeelMD@aol.com
DPeelMD@aol.com
Mon, 25 Oct 2004 03:25:31 EDT
-------------------------------1098689131
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=20
Texas Monthly November, 2004, Volume=20
32, Issue 11
Invasive!
Who's gutting the laws that keep your medical records private? The feds are=
=E2=80=94
and soon, Texas may too.
Christopher Keyes on the story behind the story.
=20
Since when are my medical records no longer private? Since April 14, 2003,=20
Although the concept of a patient's right to privacy dates back more than tw=
o=20
thousand years to the creation of the Hippocratic oath, the Bush administrat=
ion=20
recently made an official change to the so-called privacy rule in the Health=
=20
Insurance Portability and Accountability Act (HIPAA), a federal law governin=
g=20
the electronic exchange of patient information between doctors, hospitals, a=
nd=20
insurance companies. The original HIPAA rule, written in 19 9 6, gave patien=
ts=20
the strict right of consent before any of their records were shared; the new=
=20
rule eliminates the consent requirement, opening your records to more than=20
600,000 "covered entities" for "routine purposes." Even in Texas, which has=20=
its=20
own pri=C2=ADvacy laws, your records may no longer be yours and yours alone.
Whoa=E2=80=94who are these "covered entities," and what's a "routine purpose=
"? In=20
addition to the groups you might expect to have access to your files=E2=80=
=94doctors (for=20
treatment) and insurance companies (for payment)=E2=80=94"covered entities"=20=
include=20
the pharmaceutical industry, credit bureaus, and some employers (those with=20
privately administered health care plans). As for a "routine purpose," criti=
cs=20
say the term can be defined so broadly that it may open the door to innumera=
ble=20
privacy violations.=20
Such as? Let's say you work for one of the 600,000 "covered entities."=20
During your first few years of employment, the company looks at your re cord=
s to=20
track your medical bills on its health care plan. Concerned that you're=20
costing it too much money, the company eventually decides to lay you off. An=
other=20
scenario: In a few years, your newly indepen=C2=ADdent daughter applies for=20=
health=20
insurance. The insurance company has access to your records, discovers a=20
genetic test that shows that you and your descendants have a high risk for b=
reast=20
cancer, and then raises your child's premiums as a result. "The possibil=C2=
=ADities=20
for such violations are endless," says Austin psychiatrist Deborah Peel, a=20
plaintiff in a federal lawsuit filed last year against the new rule. "But th=
e=20
worst part is that many patients will forgo health care, especially mental h=
ealth=20
treatment and genetic test=C2=ADing, because they're afraid of who will get=20=
their=20
hands on the information."
Why was the privacy rule changed in the first place? Proponents say it=20
will help speed the transfer of our health care infor=C2=ADmation from bulky=
paper=20
records to elec=C2=ADtronic files, improving efficiency and cutting costs. B=
ut=20
opponents claim the rule was changed only after lobbyists for the health ins=
urance=20
and pharmaceutical industries put the screws to the Bush administration. The=
se=20
groups, the critics charge, want to use your records to customize their=20
market=C2=ADing, For instance, the makers of Cialis could find out that you=20=
take Viagra=20
and send you a sample of their competing drug..
Why weren't we told about this? We probably were and didn't know it. An=
y=20
of us who have visited the doctor since the new rule went into effect should=
=20
have signed a HIPAA privacy notice informing us of the rule change=E2=80=94y=
ou know,=20
one of those two-page, single-space documents written in dense legalese, the=
=20
kind of thing we can't make sense of before putting pen to paper.=20
Is there anything we can do to keep our records private? That's where=
=20
Texas comes into play. A section of HIPAA says more-stringent state laws and=
=20
regulations preempt changes made can by the new privacy rule, recent health=20
care and decisions by the state Supreme Court have recognized a strict right=
of=20
privacy in our constitution.
So there's nothing to worry about in Texas? Not exactly. In 2003 the=20
Legisla=C2=ADture passed a bill giving the state health commissioner the rig=
ht to bring=20
Texas's medical privacy regulations into compliance with HIPAA's. On Novembe=
r 1 a=20
task force headed up by the attorney general's office will issue a report on=
=20
how our privacy laws differ from federal ones. But since the task force=20
includes many repre=C2=ADsentatives from the healthcare industry, critics li=
ke Peel say=20
state laws protecting your medical privacy could be in line for an extreme=20
makeover.
=20
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<DIV>
<DIV>
<P class=3DMsoNormal style=3D"BACKGROUND: white; MARGIN: 0in 0in 0pt"><B><SP=
AN style=3D"FONT-SIZE: 12pt; COLOR: black; LETTER-SPACING: -6.1pt"><o:p>&nbs=
p;</o:p></SPAN></B></P>
<P class=3DMsoNormal style=3D"BACKGROUND: white; MARGIN: 0in 0.95pt 0pt 0in;=
LINE-HEIGHT: 11.05pt; TEXT-ALIGN: justify; mso-line-height-rule: exactly"><=
st1:State><st1:place><B style=3D"mso-bidi-font-weight: normal"><SPAN style=
=3D"FONT-SIZE: 12pt; COLOR: black; LETTER-SPACING: -0.4pt; mso-font-width: 1=
08%">Texas</SPAN></B></st1:place></st1:State><B style=3D"mso-bidi-font-weigh=
t: normal"><SPAN style=3D"FONT-SIZE: 12pt; COLOR: black; LETTER-SPACING: -0.=
4pt; mso-font-width: 108%"><SPAN style=3D"mso-spacerun: yes"> </SPAN>M=
onthly<SPAN style=3D"mso-spacerun: yes"> </SPAN><SPAN styl=
e=3D"mso-spacerun: yes"> &nbs=
p; &n=
bsp; </SPAN=
>November, 2004,<SPAN style=3D"mso-spacerun: yes"> </SPAN>Volume 32, I=
ssue 11<o:p></o:p></SPAN></B></P>
<P class=3DMsoNormal style=3D"BACKGROUND: white; MARGIN: 0in 0in 0pt"><B><SP=
AN style=3D"FONT-SIZE: 61.5pt; COLOR: black; LETTER-SPACING: -6.1pt">Invasiv=
e!<o:p></o:p></SPAN></B></P>
<P class=3DMsoNormal style=3D"BACKGROUND: white; MARGIN: 0in 0in 0pt 0.95pt;=
LINE-HEIGHT: 11.05pt; mso-line-height-rule: exactly"><SPAN style=3D"FONT-SI=
ZE: 11pt; COLOR: black; mso-font-width: 95%">Who's gutting the laws that kee=
p your medical records private? </SPAN><SPAN style=3D"FONT-SIZE: 11pt; COLOR=
: black; mso-font-width: 91%">The feds are</SPAN><SPAN style=3D"FONT-SIZE: 1=
1pt; COLOR: black; mso-font-width: 91%; mso-bidi-font-family: 'Times New Rom=
an'">=E2=80=94</SPAN><SPAN style=3D"FONT-SIZE: 11pt; COLOR: black; mso-font-=
width: 91%">and soon, </SPAN><st1:State><st1:place><SPAN style=3D"FONT-SIZE:=
11pt; COLOR: black; mso-font-width: 91%">Texas</SPAN></st1:place></st1:Stat=
e><SPAN style=3D"FONT-SIZE: 11pt; COLOR: black; mso-font-width: 91%"> may to=
o.<o:p></o:p></SPAN></P>
<P class=3DMsoNormal style=3D"BACKGROUND: white; MARGIN: 0in 0in 0pt"><B><SP=
AN style=3D"FONT-SIZE: 10.5pt; COLOR: black; FONT-FAMILY: 'Times New Roman';=
LETTER-SPACING: -0.1pt; mso-font-width: 103%">Christopher Keyes </SPAN></B>=
<SPAN style=3D"FONT-SIZE: 10.5pt; COLOR: black; FONT-FAMILY: 'Times New Roma=
n'; LETTER-SPACING: -0.1pt; mso-font-width: 103%">on the story behind the st=
ory.</SPAN></P>
<P class=3DMsoNormal style=3D"BACKGROUND: white; MARGIN: 0in 0in 0pt 0.95pt;=
LINE-HEIGHT: 11.05pt; mso-line-height-rule: exactly"><o:p> </o:p></P>
<P class=3DMsoNormal style=3D"BACKGROUND: white; MARGIN: 11.05pt 0.95pt 0pt=20=
0.5pt; TEXT-INDENT: 0.1in; LINE-HEIGHT: 11.05pt; TEXT-ALIGN: justify; mso-li=
ne-height-rule: exactly"><SPAN style=3D"FONT-SIZE: 12pt; COLOR: #710f29; FON=
T-FAMILY: 'Times New Roman'; LETTER-SPACING: -0.3pt; mso-font-width: 108%">S=
ince when are my medical records no longer private? </SPAN><SPAN style=3D"FO=
NT-SIZE: 12pt; COLOR: black; FONT-FAMILY: 'Times New Roman'; LETTER-SPACING:=
-0.3pt; mso-font-width: 108%">Since April 14, <I>2003, </I>Although the con=
cept of a patient's right to privacy dates back more than two thousand years=
to the </SPAN><SPAN style=3D"FONT-SIZE: 12pt; COLOR: black; FONT-FAMILY: 'T=
imes New Roman'; LETTER-SPACING: -0.4pt; mso-font-width: 108%">creation of t=
he Hippocratic oath, the Bush administration recently made an official chang=
e </SPAN><SPAN style=3D"FONT-SIZE: 12pt; COLOR: black; FONT-FAMILY: 'Times N=
ew Roman'; LETTER-SPACING: -0.05pt; mso-font-width: 108%">to the so-called p=
rivacy rule in the Health Insurance Portability and Accountability </SPAN><S=
PAN style=3D"FONT-SIZE: 12pt; COLOR: black; FONT-FAMILY: 'Times New Roman';=20=
LETTER-SPACING: -0.15pt; mso-font-width: 108%">Act (HIPAA), a federal law go=
verning the electronic exchange of patient information </SPAN><SPAN style=
=3D"FONT-SIZE: 12pt; COLOR: black; FONT-FAMILY: 'Times New Roman'; LETTER-SP=
ACING: -0.25pt; mso-font-width: 108%">between doctors, hospitals, and insura=
nce companies. The original HIPAA rule, written </SPAN><SPAN style=3D"FONT-S=
IZE: 12pt; COLOR: black; FONT-FAMILY: 'Times New Roman'; LETTER-SPACING: -0.=
35pt; mso-font-width: 108%">in 19 9 6, gave patients the strict right of con=
sent before any of their records were shared; </SPAN><SPAN style=3D"FONT-SIZ=
E: 12pt; COLOR: black; FONT-FAMILY: 'Times New Roman'; LETTER-SPACING: -0.1p=
t; mso-font-width: 108%">the new rule eliminates the consent requirement, op=
ening your records to more than </SPAN><SPAN style=3D"FONT-SIZE: 12pt; COLOR=
: black; FONT-FAMILY: 'Times New Roman'; LETTER-SPACING: -0.35pt; mso-font-w=
idth: 108%">600,000 "covered entities" for "routine purposes." Even in </SPA=
N><st1:State><st1:place><SPAN style=3D"FONT-SIZE: 12pt; COLOR: black; FONT-F=
AMILY: 'Times New Roman'; LETTER-SPACING: -0.35pt; mso-font-width: 108%">Tex=
as</SPAN></st1:place></st1:State><SPAN style=3D"FONT-SIZE: 12pt; COLOR: blac=
k; FONT-FAMILY: 'Times New Roman'; LETTER-SPACING: -0.35pt; mso-font-width:=20=
108%">, which has its own pri­vacy laws, your records may no longer be y=
ours and yours alone.</SPAN><SPAN style=3D"FONT-SIZE: 12pt"><o:p></o:p></SPA=
N></P>
<P class=3DMsoNormal style=3D"BACKGROUND: white; MARGIN: 0in 0.5pt 0pt 0.95p=
t; TEXT-INDENT: 7.7pt; LINE-HEIGHT: 11.05pt; TEXT-ALIGN: justify; mso-line-h=
eight-rule: exactly"><SPAN style=3D"FONT-SIZE: 12pt; COLOR: #710f29; FONT-FA=
MILY: 'Times New Roman'; LETTER-SPACING: -0.3pt; mso-font-width: 108%">Whoa=
=E2=80=94who are these "covered entities," and what's a "routine purpose"? <=
/SPAN><SPAN style=3D"FONT-SIZE: 12pt; COLOR: black; FONT-FAMILY: 'Times New=20=
Roman'; LETTER-SPACING: -0.3pt; mso-font-width: 108%">In addition to the gro=
ups you might expect to have access to your files=E2=80=94doctors (for treat=
ment) and </SPAN><SPAN style=3D"FONT-SIZE: 12pt; COLOR: black; FONT-FAMILY:=20=
'Times New Roman'; LETTER-SPACING: -0.1pt; mso-font-width: 108%">insurance c=
ompanies (for payment)=E2=80=94"covered entities" include the pharmaceutical=
</SPAN><SPAN style=3D"FONT-SIZE: 12pt; COLOR: black; FONT-FAMILY: 'Times Ne=
w Roman'; LETTER-SPACING: -0.25pt; mso-font-width: 108%">industry, credit bu=
reaus, and some employers (those with privately administered health </SPAN><=
SPAN style=3D"FONT-SIZE: 12pt; COLOR: black; FONT-FAMILY: 'Times New Roman';=
LETTER-SPACING: -0.3pt; mso-font-width: 108%">care plans). As for a "routin=
e purpose," critics say the term can be defined so broadly that </SPAN><SPAN=
style=3D"FONT-SIZE: 12pt; COLOR: black; FONT-FAMILY: 'Times New Roman'; LET=
TER-SPACING: -0.25pt; mso-font-width: 108%">it may open the door to innumera=
ble privacy violations. <o:p></o:p></SPAN></P>
<P class=3DMsoNormal style=3D"BACKGROUND: white; MARGIN: 0in 1.9pt 0pt 0in;=20=
LINE-HEIGHT: 11.05pt; TEXT-ALIGN: justify; mso-line-height-rule: exactly"><S=
PAN style=3D"FONT-SIZE: 12pt; COLOR: #710f29; FONT-FAMILY: 'Times New Roman'=
; LETTER-SPACING: -0.35pt; mso-font-width: 108%"><SPAN style=3D"mso-spacerun=
: yes"> </SPAN>Such as? </SPAN><SPAN style=3D"FONT-SIZE: 1=
2pt; COLOR: black; FONT-FAMILY: 'Times New Roman'; LETTER-SPACING: -0.35pt;=20=
mso-font-width: 108%">Let's say you work for one of the 600,000 "covered ent=
ities." During your first few years of employment, the company looks at your=
re cords to track your medical bills </SPAN><SPAN style=3D"FONT-SIZE: 12pt;=
COLOR: black; FONT-FAMILY: 'Times New Roman'; LETTER-SPACING: -0.25pt; mso-=
font-width: 108%">on its health care plan. Concerned that you're costing it=20=
too much money, the company </SPAN><SPAN style=3D"FONT-SIZE: 12pt; COLOR: bl=
ack; FONT-FAMILY: 'Times New Roman'; LETTER-SPACING: -0.3pt; mso-font-width:=
108%">eventually decides to lay you off. Another scenario: In a few years,=20=
your newly indepen­</SPAN><SPAN style=3D"FONT-SIZE: 12pt; COLOR: black;=20=
FONT-FAMILY: 'Times New Roman'; LETTER-SPACING: -0.2pt; mso-font-width: 108%=
">dent daughter applies for health insurance. The insurance company has acce=
ss to your </SPAN><SPAN style=3D"FONT-SIZE: 12pt; COLOR: black; FONT-FAMILY:=
'Times New Roman'; LETTER-SPACING: -0.3pt; mso-font-width: 106%">records, d=
iscovers a genetic test that shows </SPAN><SPAN style=3D"FONT-SIZE: 12pt; CO=
LOR: black; FONT-FAMILY: 'Times New Roman'; LETTER-SPACING: -0.25pt; mso-fon=
t-width: 106%">that you and your descendants have a high </SPAN><SPAN style=
=3D"FONT-SIZE: 12pt; COLOR: black; FONT-FAMILY: 'Times New Roman'; LETTER-SP=
ACING: -0.15pt; mso-font-width: 106%">risk for breast cancer, and then raise=
s your </SPAN><SPAN style=3D"FONT-SIZE: 12pt; COLOR: black; FONT-FAMILY: 'Ti=
mes New Roman'; LETTER-SPACING: -0.35pt; mso-font-width: 106%">child's premi=
ums as a result. "The possibil­</SPAN><SPAN style=3D"FONT-SIZE: 12pt; CO=
LOR: black; FONT-FAMILY: 'Times New Roman'; LETTER-SPACING: -0.15pt; mso-fon=
t-width: 106%">ities for such violations are endless," says </SPAN><st1:City=
><st1:place><SPAN style=3D"FONT-SIZE: 12pt; COLOR: black; FONT-FAMILY: 'Time=
s New Roman'; LETTER-SPACING: -0.15pt; mso-font-width: 106%">Austin</SPAN></=
st1:place></st1:City><SPAN style=3D"FONT-SIZE: 12pt; COLOR: black; FONT-FAMI=
LY: 'Times New Roman'; LETTER-SPACING: -0.15pt; mso-font-width: 106%"> psych=
iatrist Deborah Peel, a plain</SPAN><SPAN style=3D"FONT-SIZE: 12pt; COLOR: b=
lack; FONT-FAMILY: 'Times New Roman'; LETTER-SPACING: -0.4pt; mso-font-width=
: 106%">tiff in a federal lawsuit filed last year against </SPAN><SPAN style=
=3D"FONT-SIZE: 12pt; COLOR: black; FONT-FAMILY: 'Times New Roman'; LETTER-SP=
ACING: -0.45pt; mso-font-width: 106%">the new rule. "But the worst part is t=
hat many </SPAN><SPAN style=3D"FONT-SIZE: 12pt; COLOR: black; FONT-FAMILY: '=
Times New Roman'; LETTER-SPACING: -0.1pt; mso-font-width: 106%">patients wil=
l forgo health care, especially </SPAN><SPAN style=3D"FONT-SIZE: 12pt; COLOR=
: black; FONT-FAMILY: 'Times New Roman'; LETTER-SPACING: -0.15pt; mso-font-w=
idth: 106%">mental health treatment and genetic test­</SPAN><SPAN style=
=3D"FONT-SIZE: 12pt; COLOR: black; FONT-FAMILY: 'Times New Roman'; LETTER-SP=
ACING: -0.2pt; mso-font-width: 106%">ing, because they're afraid of who will=
get </SPAN><SPAN style=3D"FONT-SIZE: 12pt; COLOR: black; FONT-FAMILY: 'Time=
s New Roman'; LETTER-SPACING: -0.25pt; mso-font-width: 106%">their hands on=20=
the information."<o:p></o:p></SPAN></P>
<P class=3DMsoNormal style=3D"BACKGROUND: white; MARGIN: 0in 1.45pt 0pt 0.5p=
t; LINE-HEIGHT: 11.05pt; TEXT-ALIGN: justify; mso-line-height-rule: exactly"=
><SPAN style=3D"FONT-SIZE: 12pt; COLOR: black; FONT-FAMILY: 'Times New Roman=
'; LETTER-SPACING: -0.25pt; mso-font-width: 106%"><SPAN style=3D"mso-spaceru=
n: yes"> </SPAN></SPAN><SPAN style=3D"FONT-SIZE: 12pt; COLOR: #7=
10f29; FONT-FAMILY: 'Times New Roman'; LETTER-SPACING: -0.35pt; mso-font-wid=
th: 106%">Why was the privacy rule changed in the </SPAN><SPAN style=3D"FONT=
-SIZE: 12pt; COLOR: #710f29; FONT-FAMILY: 'Times New Roman'; mso-font-width:=
115%">first place? </SPAN><SPAN style=3D"FONT-SIZE: 12pt; COLOR: black; FON=
T-FAMILY: 'Times New Roman'; mso-font-width: 115%">Proponents say it will he=
lp <SPAN style=3D"LETTER-SPACING: -0.6pt">speed the transfer of our health c=
are infor­</SPAN><SPAN style=3D"LETTER-SPACING: -0.5pt">mation from bulk=
y paper records to elec­tronic files, improving efficiency and cut</SPAN=
><SPAN style=3D"LETTER-SPACING: -0.65pt">ting costs. But opponents claim the=
rule was </SPAN><SPAN style=3D"LETTER-SPACING: -0.5pt">changed only after l=
obbyists for the health </SPAN><SPAN style=3D"LETTER-SPACING: -0.35pt">insur=
ance and pharmaceutical industries </SPAN><SPAN style=3D"LETTER-SPACING: -0.=
55pt">put the screws to the Bush administration. </SPAN><SPAN style=3D"LETTE=
R-SPACING: -0.65pt">These groups, the critics charge, want to use </SPAN><SP=
AN style=3D"LETTER-SPACING: -0.35pt">your records to customize their market&=
shy;</SPAN><SPAN style=3D"LETTER-SPACING: -0.65pt">ing, For instance, the ma=
kers of Cialis could find out that you take Viagra and send you<SPAN style=
=3D"mso-spacerun: yes"> </SPAN>a </SPAN><SPAN style=3D"LETTER-SPACING:=
-0.6pt">sample of their competing<SPAN style=3D"mso-spacerun: yes"> <=
/SPAN>drug..<o:p></o:p></SPAN></SPAN></P>
<P class=3DMsoNormal style=3D"BACKGROUND: white; MARGIN: 0in 1.45pt 0pt 0in;=
LINE-HEIGHT: 11.05pt; TEXT-ALIGN: justify; mso-line-height-rule: exactly"><=
SPAN style=3D"FONT-SIZE: 12pt; COLOR: #710f29; FONT-FAMILY: 'Times New Roman=
'; LETTER-SPACING: -0.35pt; mso-font-width: 106%"><SPAN style=3D"mso-spaceru=
n: yes"> </SPAN></SPAN><SPAN style=3D"FONT-SIZE: 12p=
t; COLOR: #710f29; FONT-FAMILY: 'Times New Roman'; LETTER-SPACING: -0.4pt; m=
so-font-width: 115%">Why weren't we </SPAN><SPAN style=3D"FONT-SIZE: 12pt; C=
OLOR: #710f29; FONT-FAMILY: 'Times New Roman'; LETTER-SPACING: 0.3pt; mso-fo=
nt-width: 115%">told</SPAN><SPAN style=3D"FONT-SIZE: 12pt; COLOR: #710f29; F=
ONT-FAMILY: 'Times New Roman'; mso-font-width: 115%"> <SPAN style=3D"LETTER-=
SPACING: -0.4pt">about </SPAN><SPAN style=3D"LETTER-SPACING: 0.15pt">this?</=
SPAN> </SPAN><SPAN style=3D"FONT-SIZE: 12pt; COLOR: black; FONT-FAMILY: 'Tim=
es New Roman'; LETTER-SPACING: -0.4pt; mso-font-width: 115%">We </SPAN><SPAN=
style=3D"FONT-SIZE: 12pt; COLOR: black; FONT-FAMILY: 'Times New Roman'; LET=
TER-SPACING: -0.65pt; mso-font-width: 115%">probably were and didn't know it=
. Any of us </SPAN><SPAN style=3D"FONT-SIZE: 12pt; COLOR: black; FONT-FAMILY=
: 'Times New Roman'; LETTER-SPACING: -0.5pt; mso-font-width: 115%">who have=20=
visited the doctor since the new rule went into effect should have signed a=20=
</SPAN><SPAN style=3D"FONT-SIZE: 12pt; COLOR: black; FONT-FAMILY: 'Times New=
Roman'; LETTER-SPACING: -0.15pt; mso-font-width: 115%">HIPAA privacy notice=
informing us of </SPAN><SPAN style=3D"FONT-SIZE: 12pt; COLOR: black; FONT-F=
AMILY: 'Times New Roman'; LETTER-SPACING: -0.5pt; mso-font-width: 115%">the=20=
rule change=E2=80=94you know, one of those </SPAN><SPAN style=3D"FONT-SIZE:=20=
12pt; COLOR: black; FONT-FAMILY: 'Times New Roman'; LETTER-SPACING: -0.55pt;=
mso-font-width: 115%">two-page, single-space documents written </SPAN><SPAN=
style=3D"FONT-SIZE: 12pt; COLOR: black; FONT-FAMILY: 'Times New Roman'; LET=
TER-SPACING: -0.6pt; mso-font-width: 115%">in dense legalese, the kind of th=
ing we can't </SPAN><SPAN style=3D"FONT-SIZE: 12pt; COLOR: black; FONT-FAMIL=
Y: 'Times New Roman'; LETTER-SPACING: -0.55pt; mso-font-width: 115%">make se=
nse of before putting pen to paper. <o:p></o:p></SPAN></P>
<P class=3DMsoNormal style=3D"BACKGROUND: white; MARGIN: 0in 0.95pt 0pt 1.45=
pt; TEXT-INDENT: 7.7pt; LINE-HEIGHT: 11.05pt; TEXT-ALIGN: justify; mso-line-=
height-rule: exactly"><SPAN style=3D"FONT-SIZE: 12pt; COLOR: black; FONT-FAM=
ILY: 'Times New Roman'; LETTER-SPACING: -0.55pt; mso-font-width: 115%"><SPAN=
style=3D"mso-spacerun: yes"> </SPAN></S=
PAN><SPAN style=3D"FONT-SIZE: 12pt; COLOR: #710f29; FONT-FAMILY: 'Times New=20=
Roman'; LETTER-SPACING: -0.5pt; mso-font-width: 115%">Is there anything we c=
an do to keep our </SPAN><SPAN style=3D"FONT-SIZE: 12pt; COLOR: #710f29; FON=
T-FAMILY: 'Times New Roman'; LETTER-SPACING: -0.4pt; mso-font-width: 108%">r=
ecords private? </SPAN><SPAN style=3D"FONT-SIZE: 12pt; COLOR: black; FONT-FA=
MILY: 'Times New Roman'; LETTER-SPACING: -0.4pt; mso-font-width: 108%">That'=
s where </SPAN><st1:State><st1:place><SPAN style=3D"FONT-SIZE: 12pt; COLOR:=20=
black; FONT-FAMILY: 'Times New Roman'; LETTER-SPACING: -0.4pt; mso-font-widt=
h: 108%">Texas</SPAN></st1:place></st1:State><SPAN style=3D"FONT-SIZE: 12pt;=
COLOR: black; FONT-FAMILY: 'Times New Roman'; LETTER-SPACING: -0.4pt; mso-f=
ont-width: 108%"> comes </SPAN><SPAN style=3D"FONT-SIZE: 12pt; COLOR: black;=
FONT-FAMILY: 'Times New Roman'; LETTER-SPACING: -0.3pt; mso-font-width: 108=
%">into play. A section of HIPAA says more-</SPAN><SPAN style=3D"FONT-SIZE:=20=
12pt; COLOR: black; FONT-FAMILY: 'Times New Roman'; LETTER-SPACING: -0.05pt;=
mso-font-width: 108%">stringent state laws and regulations </SPAN><SPAN sty=
le=3D"FONT-SIZE: 12pt; COLOR: black; FONT-FAMILY: 'Times New Roman'; LETTER-=
SPACING: -0.3pt; mso-font-width: 108%">preempt changes made </SPAN><SPAN sty=
le=3D"FONT-SIZE: 12pt; COLOR: black; FONT-FAMILY: 'Times New Roman'; LETTER-=
SPACING: -0.05pt; mso-font-width: 108%">can</SPAN><SPAN style=3D"FONT-SIZE:=20=
12pt; COLOR: black; FONT-FAMILY: 'Times New Roman'; LETTER-SPACING: -0.3pt;=20=
mso-font-width: 108%"> by the new privacy </SPAN><SPAN style=3D"FONT-SIZE: 1=
2pt; COLOR: black; FONT-FAMILY: 'Times New Roman'; LETTER-SPACING: -0.1pt; m=
so-font-width: 108%">rule, recent health care and decisions by </SPAN><SPAN=20=
style=3D"FONT-SIZE: 12pt; COLOR: black; FONT-FAMILY: 'Times New Roman'; LETT=
ER-SPACING: -0.2pt; mso-font-width: 108%">the state Supreme Court have recog=
nized </SPAN><SPAN style=3D"FONT-SIZE: 12pt; COLOR: black; FONT-FAMILY: 'Tim=
es New Roman'; LETTER-SPACING: -0.3pt; mso-font-width: 108%">a strict right=20=
of privacy in our constitution.<o:p></o:p></SPAN></P>
<P class=3DMsoNormal style=3D"BACKGROUND: white; MARGIN: 0in 0.95pt 0pt 1.45=
pt; TEXT-INDENT: 7.7pt; LINE-HEIGHT: 11.05pt; TEXT-ALIGN: justify; mso-line-=
height-rule: exactly"><SPAN style=3D"FONT-SIZE: 12pt; COLOR: #710f29; FONT-F=
AMILY: 'Times New Roman'; LETTER-SPACING: -0.1pt; mso-font-width: 108%">So t=
here's </SPAN><SPAN style=3D"FONT-SIZE: 12pt; COLOR: #710f29; FONT-FAMILY: '=
Times New Roman'; LETTER-SPACING: 0.75pt; mso-font-width: 108%">nothing </SP=
AN><SPAN style=3D"FONT-SIZE: 12pt; COLOR: #710f29; FONT-FAMILY: 'Times New R=
oman'; LETTER-SPACING: -0.1pt; mso-font-width: 108%">to worry about in </SPA=
N><st1:State><st1:place><SPAN style=3D"FONT-SIZE: 12pt; COLOR: #710f29; FONT=
-FAMILY: 'Times New Roman'; LETTER-SPACING: -0.2pt; mso-font-width: 108%">Te=
xas</SPAN></st1:place></st1:State><SPAN style=3D"FONT-SIZE: 12pt; COLOR: #71=
0f29; FONT-FAMILY: 'Times New Roman'; LETTER-SPACING: -0.2pt; mso-font-width=
: 108%">? </SPAN><SPAN style=3D"FONT-SIZE: 12pt; COLOR: black; FONT-FAMILY:=20=
'Times New Roman'; LETTER-SPACING: -0.2pt; mso-font-width: 108%">Not exactly=
. In 2003 the Legisla­</SPAN><SPAN style=3D"FONT-SIZE: 12pt; COLOR: blac=
k; FONT-FAMILY: 'Times New Roman'; LETTER-SPACING: -0.05pt; mso-font-width:=20=
108%">ture passed a bill giving the state health commissioner the right to b=
ring </SPAN><st1:State><st1:place><SPAN style=3D"FONT-SIZE: 12pt; COLOR: bla=
ck; FONT-FAMILY: 'Times New Roman'; LETTER-SPACING: -0.05pt; mso-font-width:=
108%">Texas</SPAN></st1:place></st1:State><SPAN style=3D"FONT-SIZE: 12pt; C=
OLOR: black; FONT-FAMILY: 'Times New Roman'; LETTER-SPACING: -0.05pt; mso-fo=
nt-width: 108%">'s </SPAN><SPAN style=3D"FONT-SIZE: 12pt; COLOR: black; FONT=
-FAMILY: 'Times New Roman'; LETTER-SPACING: -0.25pt; mso-font-width: 108%">m=
edical privacy regulations into compli</SPAN><SPAN style=3D"FONT-SIZE: 12pt;=
COLOR: black; FONT-FAMILY: 'Times New Roman'; LETTER-SPACING: -0.4pt; mso-f=
ont-width: 108%">ance with HIPAA's. On November 1 a task </SPAN><SPAN style=
=3D"FONT-SIZE: 12pt; COLOR: black; FONT-FAMILY: 'Times New Roman'; LETTER-SP=
ACING: -0.15pt; mso-font-width: 108%">force headed up by the attorney genera=
l's </SPAN><SPAN style=3D"FONT-SIZE: 12pt; COLOR: black; FONT-FAMILY: 'Times=
New Roman'; LETTER-SPACING: -0.2pt; mso-font-width: 108%">office will issue=
a report on how our pri</SPAN><SPAN style=3D"FONT-SIZE: 12pt; COLOR: black;=
FONT-FAMILY: 'Times New Roman'; LETTER-SPACING: -0.05pt; mso-font-width: 10=
8%">vacy laws differ from federal ones. But </SPAN><SPAN style=3D"FONT-SIZE:=
12pt; COLOR: black; FONT-FAMILY: 'Times New Roman'; LETTER-SPACING: -0.25pt=
; mso-font-width: 108%">since the task force includes many repre­</SPAN>=
<SPAN style=3D"FONT-SIZE: 12pt; COLOR: black; FONT-FAMILY: 'Times New Roman'=
; LETTER-SPACING: -0.1pt; mso-font-width: 108%">sentatives from the healthca=
re industry, </SPAN><SPAN style=3D"FONT-SIZE: 12pt; COLOR: black; FONT-FAMIL=
Y: 'Times New Roman'; LETTER-SPACING: -0.15pt; mso-font-width: 108%">critics=
like Peel say state laws protecting your medical privacy could be in line f=
or </SPAN><SPAN style=3D"FONT-SIZE: 12pt; COLOR: black; FONT-FAMILY: 'Times=20=
New Roman'; LETTER-SPACING: -0.3pt; mso-font-width: 108%">an extreme makeove=
r.</SPAN></P>
<P class=3DMsoNormal style=3D"BACKGROUND: white; MARGIN: 0in 0.95pt 0pt 1.45=
pt; TEXT-INDENT: 7.7pt; LINE-HEIGHT: 11.05pt; TEXT-ALIGN: justify; mso-line-=
height-rule: exactly"><SPAN style=3D"FONT-SIZE: 12pt"><o:p><FONT size=3D2></=
FONT></o:p></SPAN> </P></DIV></DIV></BODY></HTML>
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