BILL ANALYSIS S.B. 548 By: Madla Health and Human Services 03-15-95 Committee Report (Amended) BACKGROUND Persons who practice podiatry in Texas are required to be licensed by the Texas State Board of Podiatry Examiners. However, the laws regulating the practice of podiatry do not provide for the confidentiality of podiatric patient records or communications between podiatrist and patient. In addition, Section 5.01, Medical Practice Act (Article 4495b, V.T.C.S.), authorizes the approval of health organizations formed solely by persons licensed by the Texas State Board of Medical Examiners; however, current law does not authorize podiatrists to provide podiatry services on behalf of such health organizations. PURPOSE As proposed, S.B. 548 sets forth confidentiality and privilege requirements relating to the regulation of podiatry and authorizes a podiatrist to provide services for certain health organizations authorized under Section 5.01, Medical Practice Act. RULEMAKING AUTHORITY It is the committee's opinion that this bill does not grant any additional rulemaking authority to a state officer, institution, or agency. SECTION BY SECTION ANALYSIS SECTION 1. Amends Chapter 11, Title 71, V.T.C.S., by adding Article 4575d, as follows: Art. 4575d. CONFIDENTIALITY AND PRIVILEGE REQUIREMENTS Sec. 1. Defines "patient" and "podiatric record." Sec. 2. (a) Makes confidential, privileged, and not to be disclosed except as provided by this article a communication, relating to podiatric services, between a podiatrist and a patient. (b) Makes confidential, privileged, and not to be disclosed except as provided by this article records of a podiatrist concerning the identity, diagnosis, evaluation, or treatment of a patient. (c) Prohibits a person, other than one listed under Section 5 or 6 of this Article, from disclosing confidential information beyond the extent to which disclosure is consistent with the authorized purposes of its obtainment. (d) Makes the prohibitions of this section continually applicable irrespective of when the patient received the services. Sec. 3. (a) Authorizes the privilege of confidentiality to be claimed by the patient or a podiatrist acting on the patient's behalf. (b) Authorizes the podiatrist to claim the privilege of confidentiality only on behalf of the patient. Provides that the authority to claim the privilege is presumed in the absence of contrary evidence. Sec. 4. (a) Provides that an exception to the confidentiality and privilege requirements exists in a court or administrative proceeding if the proceeding is brought by the patient against a podiatrist, the patient or person authorized to act on the patient's behalf submits a written consent to the release of confidential information, or the purpose of the proceeding is to substantiate and collect on a claim for services. (b) Provides that an exception to the confidentiality and privilege requirements exists in a civil litigation or administrative proceeding brought on the patient's behalf if the plaintiff is attempting to recover monetary damages for any physical or mental condition, including the patient's death. Makes information discoverable in a court or administrative proceeding if the information is relevant to the proceeding and the court or administrative body has jurisdiction over the subject matter. (c) Provides that an exception to the confidentiality and privilege requirements exists in a disciplinary investigation or proceeding conducted against a podiatrist under this chapter. Requires the Texas State Board of Podiatry Examiners (board) to protect the identity of any patient except those covered under Subsection (a)(1) or those who have submitted written consent to the release of their records. (d) Provides that an exception to the confidentiality and privilege requirements exists in a criminal investigation of, or criminal proceeding against, a podiatrist in which the board is providing records obtained from the podiatrist. Requires the board to protect the identity of any patient, except those covered under Subsection (a)(1) or those who have submitted written consent to the release of their records. (e) Provides that an exception to the confidentiality or privilege requirements exists in a criminal prosecution in which the patient is a victim, witness, or defendant. Provides that records or communications are not discoverable until the court makes an in camera determination as to their relevancy. Sec. 5. (a) Provides that an exception to the confidentiality or privilege requirements exists only for, and authorizes disclosure of confidential information by a podiatrist only to a governmental agency or to medical or law enforcement personnel under specific circumstances. (b) Prohibits a person who receives information under Subsection (a)(3) from disclosing a patient's identity directly or indirectly. (c) Authorizes records reflecting charges and services rendered to be disclosed only when necessary in the collection of fees for services. (d) Authorizes confidential information other than that which identifies a patient or client, unless the patient gives consent to release the information, to be disclosed in an official legislative inquiry regarding a state hospital or state school. Sec. 6. (a) Sets forth the parties required to grant consent for the release of confidential information. (b) Sets forth the required specifications of the written consent. (c) Gives the patient or other person authorized to consent the right to withdraw the consent. Provides that the withdrawal of consent does not affect information disclosed before the written notice of withdrawal. Sec. 7. Authorizes the person who receives confidential information to disclose the information only to the extent consistent with the authorized purposes for which consent was obtained. Sec. 8. (a) Requires the podiatrist to furnish copies, summaries, or narratives of records requested under a written consent unless the podiatrist determines that access to the information would be harmful to the physical, mental, or emotional health of the patient. Authorizes the podiatrist to delete confidential information about another person who has not consented to the release. (b) Requires the podiatrist to furnish the information within a reasonable period of time and requires the patient or another person acting on the patient's behalf to pay reasonable fees for furnishing the information. SECTION 2. Amends Chapter 11, Title 71, V.T.C.S., by adding Article 4576, as follows: Art. 4576. PODIATRY SERVICES FOR CERTAIN HEALTH ORGANIZATIONS. Authorizes a licensed podiatrist to contract with a health organization approved by the Texas State Board of Medical Examiners under Section 5.01, Medical Practice Act (Article 4495b, V.T.C.S.), to provide podiatry services on its behalf. SECTION 3. Makes application of this Act prospective. SECTION 4. Effective date: September 1, 1995. SECTION 5. Emergency clause.