Minutes of October 7, 1998 Meeting

A meeting of the Law Revision Commission Committee on Confidentiality of Medical Records was held commencing at 4:00 p.m. on Wednesday, October 7, 1998 in Hearing Room 2B in the Legislative Office Building in Hartford, Connecticut. Those attending were: Commission members Committee Chairman Joseph J. Selinger, Jr., William R. Breetz, Mary Anne O’Neill, and Joel I. Rudikoff; advisors Charlotte Acquaviva, Lawrence Berliner, Carolyn Brady for Jeannette C. Schreiber, Mary H. Hess, Stephen Lewis, Richard J. Lynch, Michael Meacham for Marybeth Reinhardt, Marcia Noll, David W. Parke, Donald L. Roll for Robert Scalettar, Nadine Schwab, and Patricia Shea; and Commission staff David Hemond.

Mr. Selinger called the meeting to order.

The minutes of the September 23 meeting were approved.

The committee then reviewed section 2-104 of the Uniform Health-Care Information Act and the following issues were raised:

Under the introduction to subsection (a), who is to be authorized to disclose without authorization requires further review (Hemond). Language should be limited to person who holds or legitimately obtained information.

Under subsection (a)(1), advisors asserted that the provision allowing disclosure of information to any person providing health-care to the patient was too broad in that it violated current rules with respect to mental health, HIV, and alcohol and drug treatment. Mr. Hemond agreed to provide further details on the conflicting provisions of current law.

Under subsection (a)(2), it was again asserted that the provision could not apply with respect to mental health, HIV, and alcohol and drug treatment. Advisors suggested that a balance be drawn between the need for providers and others to carry on business in a reasonable manner and the need to protect patient expectation of privacy. The matter will be revisited after review of the applicable current provisions.

Under subsection (a)(2), advisors questioned the adequacy of language requiring a reasonable belief that the person will not use or disclose the information and will protect the information. It was suggested that written protocols might be required.

Under subsection (a), advisors questioned the extent to which disclosures could be made through obtaining consents. Mr. Roll agreed to provide a copy of a current authorization for disclosure.

Under subsection (a)(3), advisors again noted that an exception was required for mental health, HIV, and alcohol and drug treatment. Some advisors questioned why these disclosures could not be made pursuant to authorizations.

Under subsection (a)(4), advisors questioned limiting the exception to cases of "imminent" danger to health or safety.

Under subsection (a)(5), advisors again questioned the release of sensitive information to immediate family members and noted that consent for such a release was clearly preferable if practical. Questions were raised as to what circumstances would require allowing such a disclosure without authorization. The concept was raised of limiting the exception to circumstances where consent might be implied – for example to the spouse of an unconscious patient or where the spouse and the patient were both present and no objection was raised. Such circumstances might, also, allow reduction of formality, allowing, for example, verbal, rather than written, authorization.

Under subsection (a)(6), advisors questioned whether the provision was intended to apply to successors in interest other than health-care providers. Given the open-endedness of the provision and the value of health care information, concern was expressed that the provision might be too broad if extended beyond the context of health care providers.

Under subsection (a)(7), advisors questioned the drafting of subparagraphs (iv) and (v) (Selinger) and whether a showing should be required that obtaining authorizations is impractical. It was noted that disclosure authorization requirements, such as a limitation on the period of disclosure, might limit their usefulness in the research context.

Under subsection (a)(8), concern was expressed that a patient did not necessarily consent to the use of his health information for audit purposes. On the other hand, advisors expressed concern that those agencies charged with a regulatory role be properly empowered to carry out that role.

Under subsection (a)(9), advisors cautioned that there may exist a custodial institution that should not automatically obtain access to the detainee’s health-care information. For example, a pre-trial detainee held without bail has not necessarily consented to release of his heath-care information (Hemond).

Under subsection (b), advisors expressed concern that the provision be sufficiently broad to cover regulatory agencies in addition to law enforcement.

Mr. Hemond noted the possible use of a subsection (c) to provide insurers complying with the Connecticut Insurance Information and Privacy Act with license to disclose where in compliance with that act.

It was agreed that the committee would undertake a review of disclosure authorization requirements, sections 2-102 and 2-103, at the next meeting.

The next meeting was set for October 21, 1998 at 4:00 p.m. in the Legislative Office Building in Hartford, Connecticut.

The meeting adjourned at 6:15 p.m.

Respectfully submitted,

 /S/ 

David L. Hemond
Reporter/Drafter

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