CONFIDENTIALITY: Psychologist Sues HMO for Privacy Breach
New Jersey psychologist Russell Holstein, who refused to divulge details of his patient's treatment and condition to an HMO and subsequently was ejected from the managed care network, is suing Human Affairs International, Inc., Aetna U.S. Healthcare and Magellan Health Services. The Asbury Park Press reports that the case pits "the confidentiality that psychologists and their patients hold sacred against the requirements of managed care companies that say they need information to help keep a lid on health care costs." Holstein argues that "he's bound by New Jersey law to keep such details confidential." For all patients in state-regulated plans, according to the state Board of Psychological Examiners, "psychologists must refuse to disclose confidential information to an employer or insurance company on the basis of the Peer Review Act" and cannot disclose information without a written waiver from the patient. Holstein said his patient was covered by a state-regulated plan. Under the act, psychologists are permitted to release case identification numbers, whether patients are being treated as inpatients or outpatients, duration and frequency of treatments, diagnoses and prognoses and whether levels of function and distress are mild, moderate, severe or extreme. But the HMO requested the following: whether the patient was a threat to himself or others; a medical evaluation of the patient's prescribed medication; a detailed list of symptoms and medications; details regarding chemical abuse and dependency; a detailed clinical synopsis and treatment goals and progress toward those goals; treatment criteria and community resources. In a statement, Magellan officials said Holstein's complaint was "without merit," adding, "We believe we are in full compliance with New Jersey's Peer Review Act. We believe that his concerns are capable of being resolved through collaboration and dialogue in a collegial manner that ultimately considers patient needs first." Holstein said he wants "to establish the confidentiality protected under law in New Jersey that is an effective ingredient in what we (psychologists) do (and) should not be given up." He added, "Do you want your doctor to violate his licensing law? Do you want to tell your doctor something very personal, and he's going to tell someone else? The managed care company (would be) stronger than any licensing law. That's what they want."
Karen Shore, president of the National Coalition of Mental Health Professionals and Consumers, said, "There are clinicians who have either been pushed out (of networks) or, in more subtle ways, deprived of ways to gain business" because they are reluctant to divulge confidential information. But American Managed Behavioral Association Executive Director Pamela Greenberg defended the practice, saying, "A part of managed behavioral health care is looking at a patient's record to insure they're getting the most appropriate and proper care from their providers. ... We can't do that without access to components of the medical record. That doesn't mean we need the psychotherapy notes. ... We don't want anybody to have more information than they need to accomplish their job." Pennsylvania psychologist Richard Small called the case "huge," adding, "To me, the stakes are the right of people to get help without their dirty laundry aired in any way a managed care company might choose to air it, including that it not get back to their employer" (Silvestrini, 10/24).