PATIENTS’ RIGHTS: Ruling Keeps Medical Records Private
An appellate court ruling last month in West Palm Beach, FL, upheld a lower-court decision that it is illegal for HMOs to have access to medical records without patient consent, the Wall Street Journal reports. The question of who controls a patient's medical records when their HMO and primary- care physician split is common. Doctors, often under pressure from HMOs and unwilling to compromise patient care by withholding records, sometimes turn records over directly to the HMOs -- an illegal procedure according to Florida state law. The test case arose in 1997 when Humana Medical Plan, Inc. of Florida terminated its contract with Dr. Charles Fischman. As part of the breakup, Humana requested the records of the 1,800 patients Dr. Fischman had in his practice, but could only provide 300 patient consent forms. Dr. Fischman withheld the remaining 1,500 patient files, mainly Medicare HMO members, citing state confidentiality law. "They have no right to know who is HIV-positive, who has been abused, who is an alcoholic, who has sexual problems. They are not going to dishonor my patients," he asserted. The paucity of case law in this area is due in part to the fact that very few physicians actually challenge HMOs, choosing to err on the side of continuity of care. While they are disciplined infrequently for improper release of medical records, the state Board of Medicine has made greater efforts to educate providers about confidentiality, especially in light of the Internet. "I think as we are seeing more doctors terminated there is greater potential for patient records to be in the wrong hands," said John Knight, general counsel for the Florida Medical Association, which represents more than half of the state's 40,000 doctors, "This opinion will put an end to that and guarantee confidentiality" (Terhune, 1/12).
Charging for Medical Records?
What happens when patients request that their records be released to another physician? An article in today's Washington Post examines the practice of charging patients for their charts. As patients become more savvy consumers, there is more willingness on their part to change doctors. This trend has persuaded some physicians to start charging for services that were traditionally free. AMA spokeswoman Brenda Craine confirmed that this practice is becoming more common, and said that the AMA's ethical policy on charging for charts is that "physicians can charge a reasonable fee for medical records." The AMA's Code of Medical Ethics states that records cannot be withheld due to lack of payment, and that "the interest of the patient is paramount in the practice of medicine." Many states have passed laws, allowing doctors to charge a "reasonable fee" for releasing medical records to patients -- anywhere from $1 per page to $75 per chart (Oldenburg, 1/12).