Private Lives

Protecting patient records

While recuperating from an operation for prostate cancer, a middle-aged Chicago machinist learns that a loan company is inquiring among his neighbors whether he can ever work again. In Hartford, Conn., a recent college graduate hears that she has been rejected for a teaching job by a private school because it has somehow found out that her mother is under psychiatric care. In New York City, women who have registered for abortions at a private clinic are besieged by phone calls from right-to-life advocates trying to dissuade them.

These typical cases represent violations of one of medicine's sacred trusts: the patient's right to privacy. Under a credo that goes back to the Hippocratic oath, a physician is required to keep silent about what he is told or learns of a patient's condition. But lately the tradition is being more honored in the breach.

The problem is not loose-lipped doctors but the increasing complexity of medical care. No longer is all treatment provided at home or in physicians' offices. It is administered at hospitals or clinics, where nurses, lab technicians, therapists, pharmacists and other functionaries join with doctors in building mountains of medical information about the patient. To complicate matters, the patient does not pick up the hospital tab directly. That is done by insurance companies or government agencies, so-called third parties, all of whom claim a legitimate right to look into what they are paying for.

Even if patients object to violations of their privacy, they cannot prevent them since hospitals and insurance companies commonly insist that patients sign "any and all" release forms as a precondition of treatment. These give the institutions virtually a free hand to distribute information from a patient's files. Nor do the limited restrictions that exist provide much assurance of secrecy. Information can often be ferreted out of computer memories by anyone with access to a terminal. The curious can also enter busy hospital record rooms by simply passing themselves off as doctors. Besides learning about a patient's current ailment, the snoops may pick up potentially damaging items from the past, such as a record of bouts with venereal disease, drug addiction or alcoholism, or a family history of mental illness or cancer. Easily copied by duplicating machine and then spread, this sensitive information may eventually appear on the desks of credit and loan officers, personnel chiefs or even college admissions boards.

To tighten the secrecy of medical records, Congress is now considering a number of bills, including one introduced by Republican Senator Jacob Javits of New York, another by Democratic Representative Richardson Preyer of North Carolina, and a third on behalf of the White House. All three measures cover mainly institutional records, not those kept by doctors in their private offices. Also, they would continue to allow release of information for such worthy scientific purposes as inquiries into the effectiveness of a particular drug on the course of a disease. But they would prohibit the kind of blanket, open-ended authorizations that are contained in the any-and-all forms. What is more, the patient, who is now practically the only one kept in the dark about his medical records, would finally be allowed to examine them, either directly or through an intermediary. Penalties for obtaining the information under false pre tenses would be relatively stiff: up to a year in jail, a fine of $10,000, or both.

Some doctors are afraid that easy access by patients to their records may bring a rash of malpractice suits, but the American Medical Association discounts such fears. Strongly supporting congressional action, many consumer groups and pro fessional organizations like the American Medical Record Association are convinced that without a new law medical privacy stands in mortal jeopardy. In a decision that could have legal repercussions elsewhere, the Colorado Supreme Court in April tossed out indictments against two insurance companies that hired a Denver detective agency that allegedly trained employees to impersonate doctors and bribed hospital personnel to obtain medical records. The court's reasoning: theft statutes could not be used to prosecute the firms because such information is not a "thing of value."

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