The health-care industry is lobbying the Bush administration to delay,
change or kill regulations protecting the privacy of medical records.
Hospitals, insurance companies, health maintenance organizations and
medical researchers say the rules, issued in the final weeks of the Clinton
administration, would impose costly new burdens.
Members of Congress say privacy protections are immensely popular with
Bush administration officials say they are looking for ways to revise and
simplify the Clinton rules, scheduled to take effect on Feb. 26.
Consumer advocates describe the rules as a milestone in the history of
American medicine, the first comprehensive federal standards for medical
Under the rules, health care providers must obtain written consent from
patients for the use or disclosure of information in their medical records.
The rules would affect virtually every doctor, patient, hospital, pharmacy
and insurance plan in the United States.
Critics say the Clinton administration went overboard in pursuing a worthy
goal. The rules, they say, are too prescriptive and, in many ways, unworkable.
Health-care providers of all types have flooded the new administration with
requests to shelve the rules or reopen the rule-making process to solicit
public comment on the need for major changes.
John Houston, a lawyer at UPMC Health System, affiliated with the
University of Pittsburgh, said hospitals would have to buy expensive
information technology, hire and train employees and rewrite contracts with
hundreds of suppliers to comply with the rules. The rules, he said, are so
restrictive that they "could impede patient care and disrupt essential
operations" of hospitals.
Pharmacists say the consent requirement would be impractical in many
How, they ask, can they obtain written consent from a patient whose doctor
phones in a prescription that is picked up by a neighbor or a relative?
"Thirty-five to 40 percent of all prescriptions are picked up by someone
other than the patient, in most cases a family member," said Todd Andrews, a
spokesman for CVS Corp., which filled 300 million prescriptions at 4,100
drugstores in 31 states last year.
Sen. Jack Reed (D-R.I.) said the rules are causing "lots of unanticipated
Sen. Pat Roberts (R-Kan.) said he was "stunned and terribly worried" by the
rules. In many parts of Kansas, he said, hospitals are short of doctors and
nurses and are "struggling to keep their doors open," so they cannot cope with
the new regulations.
But Sen. Christopher Dodd (D-Conn.) said voters would punish politicians
who weaken privacy protections.
Under the rules, every health-care provider must appoint a "privacy
official" to develop privacy policies and procedures. Patients would, for the
first time, have a federal right to inspect and copy their medical records and
could propose corrections. A health-care provider would have to keep track of
everyone who received medical information from the files, and a patient could
demand that doctors and hospitals provide an accounting of all disclosures in
the last six years.
A person who violates the rules would be subject to civil and criminal
penalties, including a $250,000 fine and 10 years in prison if the offense was
committed for commercial advantage. But no penalties would be imposed for
violations committed during the first two years that the rules are in effect.
Doctors had pleaded with the government for strong privacy protections, but
some have criticized the final rules.
"The rules miss the mark," said Dr. Donald J. Palmisano, a trustee of the
American Medical Association. "They will increase costs and paperwork for
physicians without improving patient care. The rules will not accomplish what
they set out to do, because of loopholes for marketing, law enforcement and
loosely defined `health care operations."'
Gary Claxton, the Clinton administration official who led efforts to write
the rules, said he was dismayed by the recalcitrance of the health care
"People in the industry should get on with the business of carrying out the
rules, but instead they want to keep talking forever," Claxton said. "They are
not interested in giving patients control or even a say over how their
personal medical information is used."
Congress, unable to agree on a comprehensive health privacy law, directed
the secretary of health and human services to issue rules. But many lawmakers
said they never expected the standards to be as far-reaching as those issued
by President Bill Clinton in December.
Janlori Goldman, director of the Health Privacy Project at Georgetown
University, said, "The industry's proposals to weaken or withdraw the rules
represent a hysterical reaction."
Goldman said the rules met a genuine need. Millions of Americans, she said,
withhold information or provide inaccurate information to avoid the stigma or
discrimination that might result from the disclosure of medical secrets.
Shannah Koss, an expert on health information technology at IBM, said: "It
will be a real loss if these standards are significantly delayed or severely
watered down. It would be better to try to fix the problems, because there's
real value in privacy."
She added: "It will be incredibly difficult for any politician to stand up
and say, `I don't support the public's right to health-care privacy.' That's
not a winning proposition."
Copyright 2001 Chicago Tribune