Yesterday I went to a new doctor for the first time. Along with my copy of the Patients’ Bill of Rights (NYS Hospital Code Sec. 405.7), I got a lengthy description of the “Notice of Privacy Practice” followed by the doctor’s affiliated hospital. Given what I’ve heard about HIPAA protections for a patient’s medical information, I was a little surprised to see that the notice details 24 general circumstances under which they would share personally identifiable medical information. Many of these exceptions have to do with billing issues and public health concerns. I’m curious about a couple relating to law enforcement.
First:
[QUOTE] Law Enforcement. We may disclose your health information to law enforcement officials for the following reasons:
[ul]
[li] To assist law enforcement officers with identifying or locating a suspect, fugitive, witness or missing person;[/li][li] <several other reasons snipped>[/ul][/li][/QUOTE]
Okay, it’s entirely possible that I’ve watched way too many episodes of Law & Order, but… it was my understanding that doctor/patient confidentiality would obligate a doctor not to reveal any medical information, for the reason given above, without the express written consent of the person in question or their legal guardian (if that circumstance applied). Is that sort of confidentiality actually a dramatic device only?
Second:
How is this to be interpreted - as, e.g., “we know Osama has kidney problems and we’re trying to figure out how bad/when he needs treatment/etc.”? As “we’re looking for this individual, and we want to know if he has any medical conditions that will help us flush him out, so tell us”? Both?
Doctor/patient confidentiality is nothing at all like, say, attorney/client privilege. There are rules about with whom I can share your information, but if a good enough reason is there, your records can be subpoenaed. Most docs will do what they can to make sure the request is legit and will do anything possible to prevent any release that might be damaging, but the fact that it was communication between doctor and patient doesn’t mean it can be withheld.
This is not true of mental health professionals and psychiatrists, for whom a stronger privilege exists.
Doctor J can they comb through the records looking for a match for a description? As an example, if they’re looking for a suspect they know is of Chinese heritage and from blood left at the scene, is HIV positive. Can they use your records to find him?
HIPAA is a floor for confidentiality rights, not a ceiling. If state privilege law prevents disclosure to law enforcement (and most states’ laws do, with some exceptions) then HIPAA does not change that. http://www.cdphe.state.co.us/HIPAA/Countyhealthtrain.pdf (pdf).
Interesting links, Gfactor, thanks. The outline of the privacy notice matches pretty well with the NY-HIPAA comparison chart. NYS doesn’t actually appear to restrict law enforcement access to patient health information very much at all, since compliance with a court order doesn’t seem to be required in all cases - just the approval of an “appropriate Commissioner.”
I’m still wondering what exactly is meant by the second privacy exception I mentioned in the OP - does anyone know of any concrete examples of such an exception being used? And Lissa poses an interesting question about whether law enforcement (fed or local) can essentially go fishing through health records to identify an unknown person with a particular biomedical profile… I’m curious about that as well.
Ok. Clarification. All of those exceptions are mental health related. And if you look at the code sections cited, the exceptions are really pretty limited.
General medical information is generally confidential, subject to some other common exceptions, for example: