BILL ANALYSIS



H.B. 897
By: S. Turner
03-28-95
Committee Report (Amended)


BACKGROUND

The laws regulating the practice of podiatry in Texas do not
provide for the confidentiality of podiatric patient records or
communications between a podiatrist and a patient, but there are
laws providing this for medical doctors and chiropractors. The
Texas Podiatric Medical Association would like its profession to be
in line with the others.

Section 5.01 of the Texas Medical Practice Act allows the approval
of certain health organizations formed only by persons licensed by
the Texas State Board of Medical Examiners. This bill would
authorize podiatrists to provide podiatry services on behalf of
such health organizations.

PURPOSE

H.B. 897 provides that podiatric patient records and communications
between a podiatrist and a patient are confidential and privileged
unless otherwise specified in this Act, and that podiatrists may
provide podiatry services on behalf of a health organization
approved by the Texas State Board of Medical Examiners.

RULEMAKING AUTHORITY

It is the committee's opinion that this bill does not expressly
grant any additional rulemaking authority to a state officer,
department, agency, or institution.

SECTION BY SECTION ANALYSIS

SECTION 1. Adds Article 4575d, "CONFIDENTIALITY AND PRIVILEGE
REQUIREMENTS," to Chapter 11, Title 71 of the Revised Statutes as
follows:

     Sec. 1.   Defines patient and podiatric record.

     Sec. 2. Provides that (a) communication between a podiatrist
     and a patient and (b) the     patient's records are
     confidential and privileged except as provided by this
     Article. Subsection (c) sets conditions on the authorized
     disclosure of patient information, and (d) establishes that
     the prohibitions of this Section apply regardless of when the
     patient received the services.

     Sec. 3.   Allows a patient or a podiatrist acting on behalf of
a patient to claim the   privilege of confidentiality, and this
authority is presumed in absence of evidence to the    contrary.

     Sec. 4.   Provides exceptions to the confidentiality and
privilege requirements as follows: 

     (a) An exemption exists in a court or administrative
     proceeding if the action is brought by the patient against the
     podiatrist, the patient or another authorized person submits
     written consent on behalf of the patient, or if the action is
     brought to collect on a claim for podiatric services. 
     (b) An exemption is granted in a civil litigation or
     administrative proceeding brought on behalf of a patient if
     the plaintiff is attempting to recover monetary damages, and
     the information is discoverable under the applicable state
     rules of procedure.

     (c) In a disciplinary investigation or proceeding against a
     podiatrist, during which the identity of the patient will be
     protected by the Texas State Board of Podiatry Examiners,
     unless otherwise specified in this subsection.

     (d) In a criminal proceeding against or criminal investigation
     of a podiatrist in which the board is participating by
     providing the records of the patient. The Texas State Board of
     Podiatry Examiners is required to protect the identity of the
     patient unless otherwise specified in Subsection (a)(1) of
     this section, and this subsection does not authorize the
     release of confidential information for criminal charges
     against a patient.

     (e) In a criminal prosecution in which the patient is a
     victim, witness or defendant. The relevancy of the records or
     communications must be determined by an in camera
     determination. The ruling on relevancy does not constitute a
     determination of admissibility.

     Sec. 5.   Specifies that other than Section 4 of this Article,
an exception to the      confidentiality or privilege requirements
exists only for certain persons under specified   conditions listed
in this section, and a person receiving information for audit or
research   purposes may not disclose the patient's identity in any
way. Records reflecting charges    and services rendered may only
be disclosed for the collection of fees for services        provided. Confidential information other than the identity of the
patient, unless consented     to by the patient, may not be
disclosed in an official legislative inquiry regarding a state   school or state hospital. 

     Sec. 6.   Requires the consent for the release of the
confidential information to be     made in writing and signed by
the persons listed in this section, and the written consent      must specify the information and records to be released, the
reasons for and the person    to whom the information will be
released. The patient or other authorized person can        withdraw the consent, but this does not affect the information
disclosed before the     withdrawal.

     Sec. 7.   Allows a person who receives confidential
information to disclose this to    others only for the authorized
purposes under which the consent was obtained.

     Sec. 8.   Requires a podiatrist to release records or
summaries of records when written  consent is made, in accordance
with Sec. 6, unless the podiatrist determines that access   as
harmful to the patient. Allows the podiatrist to delete
confidential information about     another person who has not
consented to the release. Requires the information to be    released within a reasonable period of time, and requires the
patient or person on the      patient's behalf to pay reasonable
fees for the information.

SECTION 2. Adds Article 4576, "PODIATRY SERVICES FOR CERTAIN HEALTH
ORGANIZATIONS," to Chapter 11, Title 71 of the Revised Statutes,
allowing a licensed podiatrist to contract with a health
organization approved by the Texas State Board of Medical Examiners
under Section 5.01 of the Medical Practices Act (Article 4495b of
Vernon's Texas Civil Statutes) to provide podiatry services on its
behalf.

SECTION 3. Establishes that this Act applies only to those
podiatric records and information       released after the
effective date.

SECTION 4. Effective date: September 1, 1995.

SECTION 5. Emergency clause.
EXPLANATION OF AMENDMENT

The amendment changes language in SECTION 2, which adds Article
4576 to Chapter 11, Title 71, Revised Statutes. The amended article
allows a licensed podiatrist to "contract with" a health
organization approved by the Texas State Board of Medical
Examiners. As filed, the proposed article says a licensed
podiatrist "may participate in and provide podiatry services on
behalf of" any such health organization.

SUMMARY OF COMMITTEE ACTION

H.B. 897 was considered by the Public Health Committee in a public
hearing on March 28, 1995. The committee considered one amendment
to the bill. The amendment was adopted without objection.

The following persons testified in favor of the bill:
Representative Sylvester Turner, author of the bill.
Allen Horne, representing Texas Hospital Association.

The bill was reported favorably as amended, with the recommendation
that it do pass and be printed, by a record vote of 5 Ayes, 0 Nays,
0 PNV, and 4 Absent.