Forgive me if I heard this wrong. The other day I was flipping through the channels and I turned on Law and Order:CI when I heard an exchange between Chris Noth and another character. During the questioning the character invoked doctor patient confidentiality. He was told that doesn’t apply to Chiropractors. Is that true? Seems to me that most prople who go to a chiropractor would assume that it applies. As far as I know being a medical doctor is not required because nonmedical doctor therapists are covered. Where is the line drawn? How about nurses, physical therapist, acupuncture, psychic healing? Is it a different standard from state to state? So actual case law would be nice. Thanks.
I’m not sure where Chiropractors fall in the definition of “Medical Professional” but all medical professionals are mandated to protect patient confidentiality.
I’m fairly sure, that since chiropractors are paid by medical insurers, the HIPPA laws apply, so they too would be mandated to protect confidentiality.
Well, I’ve been beating my head against a fucking wall trying to find a site somewhere that I can plug in the relevant information and get the actual fucking law of the actual fucking state of fucking New York, but as close as I can get to a definition of what constitutes a medical professional und NYS law is that under “CPL section 4504” psychiatrists are. Presumably 4504 or other adjacent sections would also define what other professions would fall under medical privilege, but I’ll be goddamned if I can get a site to turn up that specific section of NYS laws, which in every web-based incarnation are the most impenetrable state statutes it has ever been my misfortune to even attempt to deal with.
Privilege in general is I believe set on the state level, so different states may have different professions and different levels of privilege. AFAIK all states require doctors to report suspected child abuse and gunshot wounds.
According to most of my training, the law isn’t exactly clear. However, as a matter of course, anyone with access to protected health information is required to keep it confidential. This includes nurses, physical therapists, billing and records clerks, clerical staff, insurance company staff, and anyone else who has access to medical or financial records.
HIPAA, by the way, is federal. Here is a summary of information available about the privacy provisions. The law is vague on some points, and so some things are still being defined. Generally speaking, though, anyone who submits claims for services to insurers is covered, which would include chiropractors but not psychic healers or (maybe) acupuncturists. I’ve never seen a claim for acupuncture, but that doesn’t mean anything.
Robin
Check at your state’s Medical licensing boards. Doctors and nurses are licensed in every state. Some states license respiratory therapist, physical therapists, massage therapists and others. There are also state medical certifications which, while different from licensing carry certain obligations, like ethics and confidentiality.
Oh, and HIPAA is specific on one point: State law can only supersede the privacy provisions if they’re more stringent than the federal law. So unless the law in NYS is more stringent than HIPAA, HIPAA applies.
Robin
I saw that episode. I thought it was pretty clear that the detectives were just bluffing the chiropractor to get the information they wanted. Like telling the suspect that confessing is in his best interest.
There’s also a difference between “confidentiality” and “privilege”. They mean different things.
I’m hoping a lawyer or doctor will amble along soon to explain the difference.
Robin
I thought it may have been something like that. Like I said I came in the middle of it. Since they were getting information about the victim rather than the suspect maybe they thought it would be less likely to ruin any case they built. Still it would be sloppy police work. Fruit of the poisonous tree and all that. I’ll keep it away from CS territory and not comment any more about bad writing.
Still curious about the underlying question. Along with that I’m curious, under HIPA is a court order needed before a health care professional can release any information to the police?
Here is the relevant New York provision. It clearly covers chiropractors. I’m not sure that all state’s privilege laws do.
HIPAA has an exception for disclosures pursuant to legal process, which includes warrants.
http://www.oahhs.org/issues/hipaa/law_enforcement_general.htm
So the chiropractor would probably violate HIPAA by voluntarily disclosing the information. OTOH, HIPAA would not apply if the police showed up with a warrant.
A chiropractor who submits insurance claims electronically is a covered health care provider. http://www.hhs.gov/ocr/regtext.html
The issue, then, is whether the privilege law applies to the information in question.
The basic difference between HIPAA privacy law and privilege law is that HIPAA is intended to prevent those who possess medical information from disclosing it accidentally (or on purpose) to the general public. Anyone with a need for the information pretty much fits into an exception. Privilege law, on the other hand, prevents access to the information by those who need it (specifically courts and police). Here is a discussion of the relationship between HIPAA and state privilege law
S4504 Quoted above is pretty clear. Unless the patient waives it, a chiropractor can’t reveal any information.
Were I the prosecutor, I would argue that whatever was sought by the police was not necessary for the chiropractor to attend the patient in a professional capacity. But I did not see the episode, so I don’t know what kind of information the police sought.
If a chiropractor falls in the forest and no one is around to find the subluxation, does it exist?
As noted above, there’s a difference between a duty to keep patient records confidential and a privilege to do so. A duty means that you must keep them confidential unless you’re ordered to disclose by the proper authorities (usually via a court-issued subpoena or similar process). A privilege means that when the court orders you to disclose, you can tell the judge to fuck off. (Don’t actually say this!) It’s not clear from context which one the chiropractor invoked in the episode; either way, he shouldn’t have breached the confidences. In either case, the chiropractor had an obligation not to disclose. The only question is whether Noth cold have gotten a court order to make him do so.
–Cliffy
Nitpick: It’s HIPAA, not HIPPA (Health Insurance Portability Assurance Act). And HIPAA is a statute, so “HIPAA laws” is redundant. The regulations that were promulgated pursuant to HIPAA give the details of patient privacy, so the correct phrase would be “HIPAA regulations.”
[Extreme nitpick]In the case of most privileges, the owner of the privilege is the client (patient, confessor, etc.) so as a witness, a doctor has no option but to invoke the privilege. Of course, if the judge orders the doctor to provide the information anyway, “fuck off” lands her in jail. Once the court has ruled on the privilege objection, the doctor can disclose the info. [/Extreme nitpick]
Damn, I already sent that brief out, too! 
Thanks Gfactor, that’s pretty much what I was looking for. I thought the statement in the show didn’t sound right.
You are welcome. Law and order gets a lot of legal issues wrong.
Isn’t it set in Baltimore?