Pubdate: Sat, 25 Sep 1999
Source: New York Times (NY)
Copyright: 1999 The New York Times Company
Contact:  http://www.nytimes.com/
Forum: http://www10.nytimes.com/comment/
Author: Nina Bernstein

WELFARE OFFICIALS TO SEARCH RECORDS ON DRUG TREATMENT

The Giuliani administration is planning to search thousands of medical
billing records for evidence it can use to place welfare applicants in
mandatory drug and alcohol treatment programs as a condition of
receiving public assistance, city welfare officials say.

The information will be culled from computerized Medicaid insurance
bills submitted in the past on behalf of applicants who have
voluntarily sought treatment for drug and alcohol problems. The record
search is for the applicants' own good, welfare officials said this
week, and will be used to push them to finish treatment and to get
jobs faster.

Officials say that record checks are needed because the city's current
system of drug screening and testing is finding unrealistically low
rates of substance abuse among welfare mothers who need help.

But privacy experts and lawyers for the poor say the record search may
violate a Federal law protecting the confidentiality of drug and
alcohol treatment records. They contend that the city's plan will
frighten poor people from seeking treatment or benefits and will send
a chilling message to anyone considering help for drug or alcohol problems.

The issue, privacy experts say, is a classic example of the conflict
between public concern over the loss of privacy, especially in health
care records, and public support for using computer databases to
monitor or track suspect groups, like welfare recipients, illegal
immigrants and parents who fail to pay child support.

Federal officials said they had no official notification of the plan.
"But there are confidentiality provisions in New York's Medicaid plan,
and we expect them to be followed," said Christopher H. Peacock,
spokesman for the Federal Health Care Financing Administration, which
oversees Medicaid records.

Jason A. Turner, Commissioner of the city's Human Resources
Administration, said no breach of confidentiality would be involved
because the billing records to be checked are submitted by drug and
alcohol treatment providers to the city's Medicaid office, and both
Medicaid and public assistance fall under his agency. "These are our
own records," he said. "We are not interfering with the doctor-patient
relationship. We're helping poor people here."

But advocates of the poor who support treatment as a condition of aid
say the record search crosses the line.

"If people go into treatment thinking their records are confidential
and then, lo and behold, the information is illegally disclosed, that
will upset just about everybody," said Paul N. Samuels, a lawyer and
the director of the Legal Action Center, a nonprofit advocacy
organization that specializes in substance abuse issues and has
offices in New York and Washington. "Violating confidentiality is an
ambush that will drive many people away from treatment."

No date has been set to start searching applicants' records. The plan
is one of several new measures introduced by Turner to meet a deadline
set by Mayor Rudolph W. Giuliani, who vowed last year that by the year
2000, "New York will be the first city in the nation, on its own, to
end welfare."

Giuliani, whose welfare overhaul is expected to be a centerpiece of
his likely campaign for the United States Senate, did not mean an end
to public assistance, Turner said. The Mayor meant that all adult
recipients would be moving from welfare to work through a variety of
assignments, including treatment for drug and alcohol abuse that is a
barrier to employment, Turner said.

The Mayor has cited one estimate that 20 percent of all people on
public aid have such substance abuse problems. Ten percent is the
figure more commonly accepted by substance abuse experts. But among
mothers, who are the bulk of adult recipients, only 2 percent have
been identified as substance abusers through a system of screening and
testing put in place two years ago, Turner said.

In several other jurisdictions around the country, including Florida
and Los Angeles County, officials have also identified
lower-than-expected rates of welfare mothers as substance abusers, for
reasons that remain unclear. But no other state is known to be
contemplating a record search like New York's, according to the
Washington office of the Legal Action Center, which represents many
treatment centers nationwide.

Brian J. Wing, Commissioner of the State Office of Temporary and
Disability Assistance, which oversees city and county welfare
operations, approved the city's record search plan, said Daniel D.
Hogan, his deputy. Hogan added that some upstate counties have already
conducted such searches case by case.

Marc Rotenberg, executive director of the Electronic Privacy
Information Center, a civil liberties advocacy group based in
Washington, said: "Welfare recipients are among the first to lose
their privacy.

But the unfortunate consequences of these tracking and matching
technologies tend to make their way up the line."

A Federal law passed in the 1970's makes it a crime, with few
exceptions, to disclose information about patients in drug and alcohol
treatment programs without the patients' narrowly defined written
consent. That consent does not allow redisclosure for any other
purposes. Experts on privacy law call the measure unique and
exemplary, and contrast it to the blanket consent forms allowed in the
gathering of other types of health care information.

Corinne Carey, a lawyer who has studied drug testing and welfare
reform nationwide, said that instead of searching records, the city
should be asking why more mothers on public assistance are not being
identified by the city's current screening system for substance abuse.

As tougher rules and a strong economy have combined to shrink New York
City's welfare rolls to about 670,000 from 1.1 million in 1994,
including children, fewer substance abusers are applying for public
assistance because they cannot deal with the hurdles or meet the work
requirements, said Ms. Carey, who works for the Urban Justice Center,
an advocacy organization opposed to the record search.

Others hide their problems from caseworkers because they fear losing
their children.

And some advocates suggest drug use may actually be lower than experts
thought in the younger generation of poor mothers who saw crack
devastate parents or older siblings.

A different kind of explanation was offered by Bill Panepinto, an
administrator in the State Office of Alcohol and Substance Abuse
Services. The substance abuse screening form used by the city was
intended to be the framework for a personal interview by a trained
worker, he said, but for the last two years it has instead been handed
out to welfare applicants as a nine-question paper test. Those who
answer yes to two or more questions are referred to certified alcohol
and substance abuse counselors for further assessment, including a
drug test.

Seven out of 10 welfare applicants referred to mandatory residential
treatment end up cut from all assistance, said Michael Kink,
legislative counsel to Housing Works, one of about 30 advocacy, legal
services and provider organizations that met yesterday because of
concern about the city's plan. "The sanction rate shows that this
program is designed more to drive people off the rolls than to get
people help," he said.

Turner vigorously defends the program's intentions. Now, he said,
mothers are known to coach each other in the waiting room on how to
answer the questionnaire to avoid being assigned to mandatory
treatment. But treatment billing records may show they have been in
and out of care many times, he said.

"If you're sick and your children are at risk because you're a
substance abuser," he said, "we believe it's not compassionate to
ignore that fact."

Like most states, New York considered but rejected a requirement that
all public assistance applicants submit to drug tests. Instead, it
asks drug-use questions of all applicants, but uses physical tests
only on those whose answers or behavior raise a reasonable suspicion
of abuse.

Universal testing is permitted under the Federal welfare overhaul, but
only Michigan is planning to use that approach, which has been widely
criticized as expensive, ineffective and vulnerable to constitutional
challenge.
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