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HIPAA

“Who is protected by patient privacy laws? Hint: not patients.” [Stewart Baker, Volokh]

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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.

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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)

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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]

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Medical roundup

by Walter Olson on July 13, 2012

  • 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]

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Medical roundup

by Walter Olson on April 24, 2012

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January 9 roundup

by Walter Olson on January 9, 2012

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August 11 roundup

by Walter Olson on August 11, 2010

  • General Mills sends lawyers after local “My Dough Girl” Bakery [Consumerist via Amy Alkon]
  • But he can reapply in five years: “Lawyer Takes Plea in Case Over His Hardball Litigation Tactics, Will Be Disbarred” [ABA Journal, California]
  • “Shame on Elie Wiesel” for threatening a lawsuit over his fictionalization in a stage play [Terry Teachout]
  • State AGs dive into HIPAA and health privacy enforcement [Nicastro, Health Leaders Media]
  • More highlights from Daniel Okrent book on Prohibition [Tabarrok]
  • Denver school board investment fiasco [Popehat]
  • Russell Jackson on the Yoo-Hoo chocolate beverage class action [Consumer Class Actions and Mass Torts, earlier]
  • California court rules state’s Moscone (“little Norris-LaGuardia”) Act unconstitutional [Workplace Prof]

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February 12 roundup

by Walter Olson on February 12, 2010

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February 6 roundup

by Walter Olson on February 6, 2010

  • Wronged wife loses suit under California “Drug Dealer Liability Act” (DDLA) against mistress who supplied crack cocaine to husband [OnPoint News]
  • “D.C. Circuit to Former Judge in Pants Lawsuit: Follow the Rules” [NLJ, more, earlier]
  • “Law firm demands retailer destroy all copies of Olivia Munn comic, retailer refuses” [BoingBoing, HeavyInk, earlier on TJIC]
  • Can’t find jury for tobacco trial: “Lawyers excused a woman who said people have no right to sue over diseases that are disclosed on the warning label of a package.” [Russell Jackson, Chamber-backed W.V. Record]
  • Despite widespread misconception to the contrary, editing comments generally does not open blogger to liability over what remains [Citizen Media Law]
  • To heck with HIPAA, introduce your patients to each other if you think they’ll get along [Musings of a Dinosaur]
  • Devoted daughter vs. RSPCA: epic will contest in Britain over family farm bequest [Times Online]
  • Woman found guilty after planting dead rat in meal at upscale restaurant [Appleton Post-Crescent via Lowering the Bar and Obscure Store]

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.”

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October 14 roundup

by Walter Olson on October 14, 2009

  • Uh-huh: new report from federal Legal Services program calls for gigantic new allocation of tax money to, well, legal services programs [ABA Journal]
  • “Judge: Man’s a ‘vexatious litigator’” [Cincinnati.com]
  • Wisconsin governor signs bill requiring prescription to buy mercury thermometer [Popehat]
  • “Injured by art?” Woman sues Museum of Fine Arts Houston after fall in artist-designed light tunnel [Mary Flood, Houston Chronicle "Legal Trade"]
  • On Carol Browner and the cry of “environmental racism” (a/k/a “green redlining”) [Coyote]
  • New York: “Lawyers implicated in $9 million mortgage fraud” [Business Insider]
  • In Canada, as in the U.S., medical privacy rules hamper police investigations [Calgary Herald]
  • Stalin’s grandson loses lawsuit in Russia against newspaper that supposedly defamed the dictator [WSJ Law Blog, Lowering the Bar, Volokh]

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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]

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FERPA meets HIPAA

by Walter Olson on January 24, 2009

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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October 27 roundup

by Walter Olson on October 27, 2008

  • NYC judge tosses injury suit against Lawyers Athletic League filed by a player on Milberg’s team [NYLJ]
  • Kentucky fen-phen lawyers Gallion and Cunningham disbarred [Lexington Herald-Leader]
  • Worker’s comp doc claims he noticed abnormal lab result and told patient to check with his primary doc. Patient didn’t and harm ensued. Malpractice? [CalLaw Legal Pad, KevinMD, Happy Hospitalist]
  • Federalist Society publishes text of Judge Dennis Jacobs’s speech on pro bono, but Chemerinsky digs in rather than apologize [PoL]
  • Are HIPAA privacy rules suspended during emergencies? No, and what lovely situations that’s likely to cause [HIPAA blog, more]
  • One of the more unusual personal injury lawyer websites is “like a touchy-feely hybrid of Myst and The Office” [Above the Law]
  • Gold-collar criminal defense work? McAfee decides $12 million too rich a sum for defending CFO Prabhat Goyal [Bennett & Bennett, Greenfield]
  • Sounds promising: “Texas Supreme Court decision could end peremptory strikes in jury selection” [SE Texas Record]

General links

by Walter Olson on May 16, 2008

*Blogroll, cont’d*

Other sites by our authors: Point of Law (Ted Frank, Walter Olson and others) / Ted Frank’s AEI Legal Center / Walter Olson home page / Our Facebook group

Law:

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And more law: AdamSmithEsq / ACSBlog / AJP / AGWatch / ArmsLaw / Bay / BLT / Bluestone / Cal Wage & Hr / Comm for Just / Complex Lit / Concur Op / Conglom / Counterfeit Chic / EmpirLS / Ernie the Atty / Friable Thts / Justia / Kranenburg / LawSites / LegalJuice / Legal Rdr / Legal Scholarship / Low’g the Bar / NAM / Ninomania / Ohio Employment / Opinio Juris / Petit / Pop Tort / Proof & Hrsy / QuizLaw / Sports Law / StonePosts / TrollTracker (now underground) / WAC?

Med: Cut to Cure / Dr. Wes / GruntDoc / HIPAA blog / MedProgToday / MedPundit (RIP) / MedRants / Orac / Pipeline / RangelMD / Seidel / SymTym / Throckmorton

General interest:

Discr’ns / Empire Center / Gawker / Jay P. Greene / Haspel / Housing Bubble / IRB / Dan Kennedy / Manh Inst / David Nieporent’s Jumping to Conclusions and Likelihood of Success / MindingCampus / NYObserver / NYT Board, Freak’cs, Lede, Opin’tor, Tierney / Pratie Place / Rauch / SalonBlogRep / Siegel on tobacco / Truth on the Mkt / Tushnet

Right:

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Odd:

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Hoax / Snopes / Myers / Unoff Dawkins / Free Inq / Rowe / Lehmann / Quackwatch / Secular Right Skept Inqr / Skeptic.com

This site’s reprinted articles library, with articles by authors Michael Fumento, Peter Huber, Walter Olson, and Jonathan Rauch.

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.

More HIPAA madness? On Wednesday, in a crime that cast a chill through the mental health community, a Manhattan therapist was brutally slaughtered in her office by a man whose actions seemed consistent with those of a current or former patient with a grudge. The assailant escaped on foot, and although his image had been captured on surveillance tape, police were nowhere near beginning to know where to start looking for him: “Because of privacy laws, police hadn’t been able to access patient records as of late yesterday, sources said.” (New York Post, Feb. 14)(via Bader). On medical privacy laws and the Virginia Tech rampage of Seung Hui Cho, see Jun. 16, 2007.

More: Commenter Supremacy Claus says not to blame HIPAA, which has an exemption for police reports.

Friday morning sequel: This morning’s New York Post sticks with the original story and fleshes out the HIPAA role somewhat:

The hunt for the savage beast who butchered an Upper East Side therapist has hit a roadblock – because detectives can’t access her patients’ medical records under federal privacy laws, The Post has learned.

Police believe the meat-cleaver-wielding psycho who killed Kathryn Faughey on Tuesday night inside her office on East 79th Street could be the doctor’s patient – and need access to her records to identify him.

But police sources said because of the Health Insurance Portability and Accountability Act, signed by President Bill Clinton in 1996, investigators are having a hard time gaining access to those records.

“A case like this gets complicated because of medical privacy protections,” a source close to the investigation told The Post yesterday.

The federal law states that doctors, hospitals and health-insurance companies must protect the privacy of patients – even in a murder investigation – and that only through the use of subpoenas can authorities hope to obtain such information.

Police sources said investigators have applied for a subpoena, but have yet to receive it. Even if the subpoena is issued, patients can sue to keep their records private. …

[D]etectives have tried to get around the law by tracking down patients through sign-in sheets at the building’s front desk and through surveillance cameras in the lobby, sources said.

(Murray Weiss, Jamie Schram and Clemente Lisi, “Vexed by ‘Slay File’ Madness”, New York Post, Feb. 15). My Times (U.K.) article on the problems posed by health privacy laws is here.

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