“Who is protected by patient privacy laws? Hint: not patients.” [Stewart Baker, Volokh]
The internet has lit up with the story of the 20-year-old, 92-lb. history major who says she’s been battling the Yale administration over its pressure on her to eat more. [New Haven Register]. Although much of the press coverage seems unaware of the issue, it would not be surprising if changing legal pressures on universities played a role here. Efforts both regulatory and liability-driven have been under way to hold universities accountable for not preventing student suicides, and as a result, many campuses have seen a shift toward more interventionist, rules-driven policies designed to show that the institution was not standing idly by when it knew or had reason to know of early signs of self-harm. (Our file on the topic goes back a decade.) If the list of self-harm behaviors includes eating disorders, you might have a formula for interventions in which very skinny students are placed under pressure to prove they are not anorexic. Evaluating cases like the current one, of course, is difficult for outsiders because of HIPAA and other privacy laws which broadly prohibit the sharing of health-related information, even on topics of public concern.
In the season’s highest-profile case of alleged medical negligence, 13-year-old Jahi McMath, described as suffering from sleep apnea, went in to Oakland Children’s Hospital for surgery. After the surgery she began bleeding profusely, went into cardiac arrest and suffered brain death.
A hundred press accounts have described the procedure McMath underwent as a “routine tonsillectomy.” Not so, according to Brandon Peters, M.D. at About.com:
There is a paucity of known facts in this situation. The family and their lawyer have released few specific details. Oakland Children’s Hospital, bound by the privacy restrictions of the Health Insurance Portability and Accountability Act (HIPAA), has offered even less. Jahi underwent three surgical procedures for the treatment of her sleep apnea. This included a tonsillectomy, uvulopalatopharyngoplasty (UPPP), and removal of nasal turbinates. Though initially described as a “routine tonsillectomy,” this degree of surgery in children is not routine. It is extensive. When performed on a child, the risk is high.
More here and on uvulopalatopharyngoplasty (or “UP3″) and its indications and risks here. It should be apparent that with the sparsity of facts agreed on it is still extremely early to begin speculating what went wrong in McMath’s case and what kind of medical negligence if any might have been involved. (& Alkon)
When Andrew Henderson videotaped police frisking a man about to be transported by ambulance in suburban Minneapolis-St. Paul, an officer confiscated his handheld videocamera, allegedly for evidence: “If I end up on YouTube, I’m gonna be upset.” Later, when Henderson sought to get his camera back, the sheriff’s office refused and instead charged him with misdemeanors. Among the notes on the citation: “Data privacy HIPAA violation.” A Stanford law professor says it would be nonsense to regard HIPAA, the federal health privacy law, as constraining the activity of bystanders like Henderson who are not legally defined as health providers. [St. Paul Pioneer Press]
- How’d we get shortages of hospital and community sterile injectables? Check out the role of FDA Good Manufacturing Practice (GMP) regs, warning letters, and resulting plant closures [Tabarrok, with comments controversy; earlier here, here, here, etc.]
- California orthopedist sues, wins damages against medical society that took action against him based on his testimony for plaintiff in liability case [American Medical News; earlier here, etc.]
- Can’t have that: medical apology should be opposed because it “can create an emotional connection with an injured patient that makes the patient less likely to ask for compensation.” [Gabriel Teninbaum (Suffolk Law), Boston Globe]
- Feds’ war on painkillers is bad news for legit patients and docs [Reuters, Mike Riggs/Reason]
- New federal pilot project in Buffalo will provide concierge-style home care to emergency-department frequent fliers. Spot the unintended consequence [White Coat]
- Dastardly drug companies? Deconstructing Glaxo SmithKline’s $3 billion settlement [Greg Conko, MPT] More: Beck, Drug and Device Law, on suits over “what are mostly medically valid and beneficial off-label uses”. Paging Ted Frank: “HIPAA’s Vioxx toll” thesis may depend on whether one accepts that the premised Vioxx toll has been established [Stewart Baker, Ted's recent post]
- U.K.: “Lawyers seizing lion’s share of payouts in NHS negligence cases” [Telegraph]
- Silver linings in SCOTUS ObamaCare ruling? [Jonathan Adler and Nathaniel Stewart] “DNC Scientists Disprove Existence of Roberts’ Taxon” [Iowahawk humor] Did Ginsburg hint at the court’s direction on the HHS contraception mandate? [Ed Morrissey, Hot Air]
[cross-posted at Cato at Liberty]
Staying in touch with your doctor via IM? It’s more likely to happen in Mexico than here. Kevin MD quotes one doctor who “suspects that the demand that patients have to electronically talk to their doctors will force a change in privacy laws. We can only hope.”
Nearly every policy wonk in the health care debate favors faster adoption of electronic medical records, but laws passed at the urging of other policy wonks seem to be getting in the way:
Hospitals have seen a decrease in EMR adoption in states where privacy laws restrict their ability to disclose patient information, according to a study published in the journal Management Science.
The study shows that states that have enacted medical privacy laws restricting the ability of hospitals to disclose patient information have seen a reduction in EMR adoption by 11 percent over a three-year period or 24 percent overall. States with no such regulations, on the other hand, experienced a 21 percent gain in hospital EMR adoption.
[Health Care IT News via HIPAABlog]
The feds have issued guidance on the interplay of two complicated laws enacted by Congress in the name of privacy, FERPA (college students) and HIPAA (medical information). The intersection between the two was the subject of considerable attention at the time of the Virginia Tech massacre, carried out by a mentally disturbed student whose deteriorating condition had been kept a secret from many interested parties because of the laws. [HIPAA Blog]
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Following up on our discussion of HIPAA and the New York therapist murder, police have reported a break in the case, arresting a mentally disturbed man who has told investigators of having been committed to a mental institution 17 years ago by Dr. Kent Shimbach, the doctor who was injured in the rampage (and who shared offices with the therapist who was killed, Kathryn Faughey). Dr. Shinbach apparently has told investigators that he did not recognize the assailant and has no memory of any contact with him in the past.
Helen Smith (“Dr. Helen”) at Pajamas Media recalls the case of Vallejo, California psychologist Ira Polonsky, Ph.D., “who was shot and killed by what family members believe was a former patient. Unfortunately his death is still a mystery. Why? Blame the confidentiality laws in California:”
…police have been stymied in pursuing that line of investigation because of confidentiality laws protecting Polonsky’s patient records and appointment books.
Vallejo police detectives are in touch with a court-appointed attorney – a “special master” – who is working with the county court to see if there can be at least a limited review of protected records, but neither police nor court officials will comment on progress in that area.
And Hans Bader takes note of a recent Volokh thread discussing cases in which it seems Massachusetts privacy law was construed to prohibit the taping of ransom discussions with kidnappers (Commonwealth v. Jackson, 1976, mentioned in passing here) and a Florida court considered (but rejected!) the argument that a murderer’s privacy was infringed by his victim’s having tape recorded the murder.