Bush Administration Should Reconsider Medical Privacy Changes

By removing patients' right to control who has access to their medical records, the Bush administration has "short-circuited" its credibility and "severely undercut medical confidentiality," Richard Sobel, a senior research associate at Harvard Medical School, writes today in a Los Angles Times opinion piece (Sobel, Los Angeles Times, 8/23). Last week the administration made official new medical privacy rules that build on guidelines first proposed by the Clinton administration and permit personal medical files to be shared only for purposes of treating patients, paying bills and carrying out various health care operations. However, the rules omit a provision included in the Clinton regulations that would have required providers to obtain written permission from patients before their records were disclosed (California Healthline, 8/12).

"Confidentiality has been fundamental to medicine since the Hippocratic oath," Sobel writes, noting that "[u]nless patients feel their information will be safeguarded, they will not often reveal their full symptoms" for fear of losing insurance coverage or "weakening" job promotion possibilities. "The substitution of giving notice that personal patient health information, both physical and psychological, has been disclosed ... imposes a burden on the provider, who must try to get patients to sign a form acknowledging that they don't have the most basic right to consent," and on patients, who "face the choice of acquiescing to having no right of consent, trying to negotiate for that right or refusing treatment," he says. Sobel acknowledges that the Clinton administration rules also had "serious" flaws because they would have allowed medical records to be accessed without consent or court order for "national priority purposes." However, those flaws were "fixable," he says. "Abolishing consent now is not a minor modification" and "deserves full regulatory review," he writes, concluding that abolition of the rules "affects the core of what it means to have consent of the governed and due process in a nation founded on these principles" (Los Angeles Times, 8/23).