Pubdate: Fri, 19 Apr 2002
Source: Richmond Times-Dispatch (VA)
Copyright: 2002 Richmond Newspapers Inc
Contact:  http://www.timesdispatch.com/
Details: http://www.mapinc.org/media/365
Author: Susan Atkins
Note: Richmonder Susan Atkins is a pediatric orthopedic surgeon.
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RECORDS AT RISK: 'PRIVACY' LAWS WOULD END HIPPOCRATIC MEDICINE

Hippocratic medicine is technically illegal, and will be so in reality, 
assuming the current "privacy" laws are implemented as scheduled (stepwise, 
April, 2003 and 2004). Before managed care, the Hippocratic Oath was the 
gold standard for integrity in Western medicine. It stood the test of time 
for more than 2,000 years. Noble ideals from the oath, such as "prescribe 
regimen for the good of my patients, according to my ability and judgment, 
and never do harm" and "all that may come to my knowledge . . . I will keep 
secret and never reveal" are now under fire.

Many describe these lofty goals as impractical, wasteful, and unfair - for 
society, at least. Revised guidelines already have been written 
(www.professionalism.org) by the Medical Professionalism Project (MPP), a 
collaboration of three established organized medicine groups. The MPP 
charter puts care rationing right into the patient-physician relationship. 
Compromised patient advocacy, leaving patients to fend for themselves, is 
not my idea of compassionate care. In contrast, the Hippocratic Oath can be 
found at www.aapsonline.org under medical ethics.

Once the so-called privacy rules are enforced, Hippocratic medicine is 
gone. The regulations exempt the Deparment of Health and Human Services 
(HHS) from age-old patient consent standards - and leave the door open for 
potential updates to further undermine confidentiality.

Come next April, most physicians (all physicians in 2004) will be required 
to give individualized patient information - without the patient's consent 
or knowledge - to HHS. Additionally, records may be distributed for the 
following broadly defined purposes, though details and safeguards are 
vague: Oversight of the health care system, FDA monitoring, public health 
surveillance and activities, foreign governments (collaborating with U.S. 
public health officials), research (with limitations), law enforcement, 
judicial and administrative proceedings, and licensure and disciplinary 
actions. Honest. For more, check out www.For- HealthFreedom.org.

ONCE THESE groups have the data, they can use or share it according to 
their own standards, not necessarily medical standards (foreign states 
avoid all U.S. legal protections). The approved regulations include paper 
records, not just electronic ones. From April, 2003, forward, your entire 
medical record, not just numerical billing data, is at risk. Believe me, it 
makes a huge difference for mental health patients.

These regulations do not require law enforcement or the courts to get a 
subpoena for personal medical rec-ords. Detailed psychiatric and genetic 
information can be shared with the federal government without a patient's 
consent. There is nothing in the law to prevent Child Protective Services 
from reviewing medical charts, including sensitive family matters shared 
with their used-to-be-trusted family doc. Reams of data could become 
available - conveniently in computerized form - on those seeking help for a 
drug problem.

HHS, which recently proposed a national medical database for Medicare 
patients, will soon be able to expand its horizons. Once these laws take 
effect, HHS gets patient-consent-bypassed access to privately insured and 
self-pay patient data, too. Gone will be the restrictions that limit 
tracking to Medicare patients, or just taxpayer-subsidized patients.

THERE ARE a few bright spots. Congress has not approved funding for the 
unique health identifier for patients that would make tracking easier - yet 
it refused to cancel the 1996 Health Insurance Portability and 
Accountability Act (HIPPA) requiring its development. A few determined 
patients have managed to keep their Social Security numbers off their 
medical records. Someone got the banks off the original proposed list, at 
least for now.

Medical privacy may not be convenient, but there are good reasons for it. 
Employer discrimination is real - at least one EEOC case involves a woman 
who was fired after testing positive for a genetic predisposition. Janiori 
Goldman, director of Georgetown University's Health Privacy Project, noted 
that almost 20 percent of Americans either pay out of pocket or lie to 
their doctors, when they get treatment for mental health, sexually 
transmitted diseases, reproductive health, or genetic counseling.

Expect the genetics revolution, with its vast potential, to suffer. Genetic 
information is specifically excluded from even the limited protection 
offered by the regulations. Researchers may have to find another country 
that respects privacy.

DOCTORS ARE caught in the middle. The first time a (pediatric) patient's 
mother told me she needed to tell me something, but only if I would promise 
not to put it in the chart, I was at a complete loss. This issue is not 
going away.

Proposed "solutions" sound like the unrealized utopia promised by managed 
care. Dr. Arthur Derse, a senior AMA consultant, describes the new pledge 
as "a vision of the physician as a balancer of resources." Supporters claim 
that socially responsible physicians can both advocate for patients and 
focus on resource distribution. When HMOs tried to do both, unsuccessfully, 
those pesky doctors and patients just wouldn't give up.

Unfortunately, the federal government isn't giving up either. HHS is 
accepting public comments about changes in the regulations until April 26 
(see www.ForHealthFreedom.org, or you can write your Congressman). 
Patients, not HHS or Congress, should decide who has access to their 
personal medical records.
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MAP posted-by: Beth