BILL ANALYSIS
S.B. 667
By: Madla (Janek)
05-09-95
Committee Report (Unamended)
BACKGROUND
In order to receive appropriate health care, a patient must often
share highly personal information with a health care provider. In
recent years, the emergence of third-party payment plans, the use
of healthcare information for non-healthcare purposes, and the
exponential increase in the use of computers and automated
information systems threatens traditional confidentiality
protections. Current law affords some protection for physician
offices, mental health, and mental retardation records, but no
similar legislation exists for hospital medical records.
Additionally, obtaining medical records can be an expensive task
that often drags on for an extensive period of time. Current law
requires the records to be provided at "reasonable" costs, yet
instances exist in which individuals have paid hundreds of dollars
for a couple of pages of information. The prices charged for
duplication and the waiting period add to the costs of litigation
when records are being sought in relation to a court case.
PURPOSE
S.B. 667 would set forth guidelines for the disclosure of certain
health care information by a provider, and would establish limits
on the amount that can be charged for reproducing a document.
RULEMAKING AUTHORITY
It is the committee's opinion that this bill expressly grants
additional rulemaking authority to the Texas State Board of
Medical Examiners under SECTION 6 (Section 5.08(o), Medical
Practice Act (Article 4495b, Vernon's Texas Civil Statutes)).
SECTION BY SECTION ANALYSIS
SECTION 1. Adds Subchapter G, Chapter 241, Health and Safety Code,
as follows:
SUBCHAPTER G. DISCLOSURE OF HEALTH CARE INFORMATION.
Sec. 241.151. DEFINITIONS. Defines "health care
information," "health care provider," "institutional review
board," and "legally authorized representative."
Sec. 241.152. WRITTEN AUTHORIZATION FOR DISCLOSURE OF HEALTH
CARE INFORMATION. (a) Prohibits a hospital, or agent or
employee of a hospital, from disclosing health care
information about a patient without the written authorization
of the patient or the patient's legally authorized
representative, except as authorized by Section 241.153.
(b) States that a disclosure authorization to a hospital is
valid only if certain requirements are met.
(c) States that a disclosure authorization is valid until
the 90th day after the date it is signed, unless it provides
otherwise or is revoked.
(d) Allows a patient or legally authorized representative to
revoke a disclosure authorization to a hospital at any time,
except as provided by Subsection (e). States that a
revocation is valid only if it is dated later than the date
on the original authorization and is signed by the patient
or authorized representative.
(e) Prohibits a patient or a legally authorized
representative from revoking a disclosure that is required
for purposes of making payment to the hospital for health
care provided to the patient.
(f) Prohibits a patient from maintaining an action against
a hospital for a disclosure made in good-faith reliance on
an authorization, if the hospital's medical record
department did not have notice that the authorization was
revoked.
(g) Prohibits a hospital from charging a fee for providing
health care information under Section 241.154(b) to the
extent the fee is prohibited under Chapter 161, Subchapter
M.
Sec. 241.153. DISCLOSURE WITHOUT WRITTEN AUTHORIZATION.
Authorizes a patient's health care information to be disclosed
without the patient's authorization, if the disclosure is made
under specific circumstances outlined in the section.
Sec. 241.154. AUTHORIZED REQUEST. (a) Requires a hospital,
not later than the 15th day after receipt of a request, to
make information available for examination and provide a copy
to the authorized requestor, if requested, or inform the
requestor if the information does not exist or cannot be
found.
(b) Authorizes the hospital to charge a reasonable fee for
providing the health care information. Declares that the
hospital is not required to permit examination or copying
until the fee is paid, unless there is a medical emergency.
Prohibits the fee from exceeding a certain sum, which is
based on several, specified factors.
(c) Requires the fee for providing health care information
as specified in this section, effective September 1, 1996,
and annually thereafter, to be adjusted accordingly based on
certain changes to the consumer price index.
Sec. 241.155. SAFEGUARDS FOR SECURITY OF HEALTH CARE
INFORMATION. Requires a hospital to adopt and implement
reasonable safeguards for the security of all health care
information it maintains.
Sec. 241.156. PATIENT REMEDIES. (a) Authorizes a person
aggrieved by a violation of this subchapter relating to the
unauthorized release of confidential information to bring an
action for appropriate injunctive relief and damages resulting
from the release.
(b) Requires an action under Subsection (a) to be brought in
the district court of the county in which the patient
resides; the district court of the county in which the
patient's legally authorized representative resides, if the
patient is deceased; or the district court of Travis County,
if the patient or a legally authorized representative is not
a resident of this state.
(c) Declares that a petition for injunctive relief under
Subsection (a)(1) takes precedence over all civil matters on
the court docket, except those matters to which equal
precedence on the docket is granted by law.
SECTION 2. Amends Section 1.03(a), Medical Practice Act (Article
4495b, V.T.C.S.), by adding Subdivisions (17) and (18), to define
"legally authorized representative" and "medical records."
SECTION 3. Amends Sections 5.08(g) and (h), Medical Practice Act
(Article 4495b, V.T.C.S.), as follows:
(g) Declares that exceptions to confidentiality or privilege
in court or administrative proceedings exist under specified
conditions, and adds the following: Subsection (7) adds that
an exception to an involuntary civil commitment proceeding,
proceeding for court-ordered treatment, or probable cause
hearing falls under specified chapters of the Health and
Safety Code, rather than certain codes in V.T.C.S, reference
to which are is deleted; and Subsections (8), (9), (11) and
(12) add certain conditions to this section on the exceptions
to confidentiality or privilege in court or administrative
proceedings.
(h) Declares that exceptions to the privilege of
confidentiality, in other than court or administrative
proceedings, allowing disclosure of confidential information
by a physician, exist only to specified persons, and adds
Subsection (9), which specifies additional persons.
SECTION 4. Amends Section 5.08(j)(2), Medical Practice Act (Article
4495b, V.T.C.S.), to prohibit a patient from maintaining an action
against a physician for disclosure made in good-faith, if the
physician did not have written notice that the authorization was
revoked.
SECTION 5. Amends Section 5.08(k), Medical Practice Act (Article
4495b, V.T.C.S.), to require a physician to furnish copies of
medical records requested, including records received from a
physician or other health care provider involved in the care or
treatment of the patient, pursuant to a written request under
Subsection (j) of this section. Authorizes the physician to delete
confidential information about another patient or family member of
the patient who has not consented to the release. Deletes a
provision regarding required fees for the provision of information,
and deletes the definition of "medical records."
SECTION 6. Amends Section 5.08, Medical Practice Act, (Article
4495b, V.T.C.S.), by adding Subsections (o) and (p), as follows:
(o) Authorizes the physician to charge a reasonable fee for
copying records. Provides that the physician is not required
to permit access to the records until payment of the fee,
unless there is a medical emergency. Requires the Texas State
Board of Medical Examiners, by rule, to prescribe what
constitute reasonable fees.
(p) Prohibits a physician from charging a fee for copying
medical records under Subsection (o) to the extent that the
fee is prohibited under Chapter 161M, Health and Safety Code.
SECTION 7. Amends Section 611.004, Health and Safety Code, as
follows:
Sec. 611.004. New heading: AUTHORIZES DISCLOSURE OF
CONFIDENTIAL INFORMATION OTHER THAN IN JUDICIAL OR
ADMINISTRATIVE PROCEEDING. Authorizes a professional to
disclose confidential information only to specified persons or
under specified conditions, and adds the following: to health
care personnel of a penal or other custodial institution in
which the patient is detained if the disclosure is for the
sole purpose of providing health care to the patient; to an
employee or agent of the professional who required mental
health care information to provide mental health care services
or in complying with statutory, licensing, or accreditation
requirements under certain circumstances; or to satisfy a
request for medical records of a deceased or incompetent
person pursuant to Section 4.01(e), Article 4690i, V.T.C.S.
Deletes the condition of in a civil action or in a criminal
case or criminal law matter as otherwise allowed by law or
rule.
SECTION 8. Adds Sections 611.006-611.008 to Chapter 611, Health and
Safety Code, as follows:
Sec. 611.006. AUTHORIZED DISCLOSURE OF CONFIDENTIAL
INFORMATION IN JUDICIAL OR ADMINISTRATIVE PROCEEDING. (a)
Sets forth conditions under which a professional is authorized
to disclose confidential information in a judicial or
administrative proceeding.
(b) Requires the court, on granting an order, to impose
appropriate safeguards against unauthorized disclosure.
Sec. 611.007. REVOCATION OF CONSENT. (a) Authorizes a
patient or authorized representative to revoke a disclosure
consent at any time, except as provided by Subsection (b).
States that a revocation is valid only if it is written,
dated, and signed by the patient or representative.
(b) Prohibits a patient from revoking a disclosure that is
required for making payment for services provided to the
patient.
(c) Prohibits a patient from maintaining an action against
a professional for a disclosure made in good faith, if the
professional did not have written notice of the revocation.
Sec. 611.008. REQUEST BY PATIENT. (a) Requires a
professional, not later than the 15th day after receiving a
request from a patient to examine the patient's records, to
make the information available and provide a copy, if
requested, and inform the patient if the information does not
exist or cannot be found.
(b) Authorizes a professional to charge a reasonable fee for
copying information. States that the professional is not
required to permit access to information until payment of
the fee, unless there is a medical emergency.
(c) Prohibits a professional from charging a fee for copying
mental health care information under Subsection (b) to the
extent the fee is prohibited under Chapter 161M.
SECTION 9. States that Sections 241.152(g) and 611.008(c), Health
and Safety Code, and Section 5.08(p), Article 4495b, V.T.C.S., take
effect only if S.B. 133, 74th Legislature, Regular Session, is
enacted and becomes law. Provides that if S.B. 133 does not become
law, this Act has no effect.
SECTION 10. States that this Act applies to specified
information on or after January 1, 1996.
SECTION 11. Effective date: September 1, 1995.
SECTION 12. Emergency clause.
SUMMARY OF COMMITTEE ACTION
S.B. 667 was considered by the Public Health Committee in a public
hearing on May 9, 1995.
The following persons testified in favor of the bill:
Chet Brooks, representing self and Smart Corportation.
Teresa Benavidez, representing self and Texas Health Information
Association.
Lance Seach, representing self.
Denny O'Neill, representing self and Medical Interface, Inc.
Carol Taylor, representing Texas Trial Lawyers Assn.
Charles Bailey, representing Texas Hospital Association.
Representative Craig Eiland, representing self.
The bill was reported favorably without amendment, with the
recommendation that it do pass and be printed, by a record vote of
7 AYES, 0 NAYS, 0 PNV, and 2 ABSENT.