http://www.nytimes.com/2001/02/12/politics/12PRIV.html?pagewanted=all
February
12, 2001
Medical
Industry Lobbies to Rein In New Patients Privacy Rules
By
ROBERT PEAR
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Hospitals, insurance companies,
health maintenance organizations and medical researchers said the rules, issued
in the final weeks of the Clinton administration, would impose costly burdens.
But members of Congress said the privacy protections, while they went further
than many lawmakers expected when Congress asked to have them written, were
immensely popular with consumers and would be hard to reverse at this point.
Bush administration officials,
caught in the middle, said they were looking for ways to revise and simplify the
Clinton rules, which are scheduled to take effect on Feb. 26. Since taking
office, the Bush administration has embarked on a major review of many rules
issued in the waning days of the Clinton administration.
Industry groups had raised some
of their objections earlier, while the rules were being drafted. But in their
final form the new rules were even more protective of consumers' privacy than
the Clinton administration had at first proposed, prompting the industry to
increase its objections.
Consumer advocates describe the
rules as a milestone in the history of American medicine, the first
comprehensive federal standards for medical privacy.
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 will affect virtually every
doctor, patient, hospital, pharmacy and insurance plan in the country.
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 P. Houston, a lawyer at
the 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, Mr. Houston 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 situations. 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 the CVS
Corporation, which filled 300 million prescriptions at 4,100 drugstores in 31
states last year.
Senator Jack Reed, Democrat of
Rhode Island, said the rules were causing "lots of unanticipated
difficulties." Senator Pat Roberts, Republican of Kansas, said he was
"stunned and terribly worried" by the rules. In many parts of Kansas,
Mr. Roberts 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 Senator Christopher J.
Dodd, Democrat of Connecticut, said voters would punish politicians who
weakened privacy protections. "The public cares about this issue very,
very much," Mr. Dodd said.
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 were 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 industry.
"People in the industry
should get on with the business of carrying out the rules, but instead they
want to keep talking forever," Mr. 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."
Ms. Goldman said the rules met
a genuine need. Millions of Americans, she said, withhold information from
doctors or provide inaccurate information in an effort to avoid the stigma or
discrimination that might result from the disclosure of medical secrets.
"Astonishing breakthroughs
in genetics cannot go forward without the full trust of the American people,
who want an assurance that their privacy will be protected," Ms. Goldman
said.
Health insurance executives
said concerns about security and privacy had slowed the use of the Internet by
their industry.
Shannah R. Koss, an expert on
health information technology at I.B.M., 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."
Ms. Koss 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."
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