By Janek                                              H.B. No. 2594
                                 A BILL TO BE ENTITLED
    1-1                                AN ACT
    1-2  relating to the disclosure of health and mental health care
    1-3  information by a provider.
    1-4        BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
    1-5        SECTION 1.  Section 241.003, Health and Safety Code, is
    1-6  amended by adding Subdivisions (12)-(16) to read as follows:
    1-7              (12)  "Directory information" means information
    1-8  disclosing the presence, nature of injury or illness, age, sex,
    1-9  occupation, municipality of residence, and general health status as
   1-10  described in terms of "critical", "poor", "fair", "good",
   1-11  "excellent", or similar terms, of a patient who is an inpatient in
   1-12  a hospital or who is currently receiving emergency care in a
   1-13  hospital.
   1-14              (13)  "Health care information" means information
   1-15  recorded in any form or medium that identifies a patient and
   1-16  relates to the history, diagnosis, treatment, or prognosis of a
   1-17  patient.
   1-18              (14)  "Health care provider" means a person who is
   1-19  licensed, certified, or otherwise authorized by the laws of this
   1-20  state to provide health care in the ordinary course of business or
   1-21  practice of a profession.
   1-22              (15)  "Institutional review board" means a board,
   1-23  committee, or other group formally designated by an institution, or
    2-1  authorized under federal or state law to review approve the
    2-2  initiation of, or conduct periodic review or research programs to
    2-3  assure the protection of the rights and welfare of human research
    2-4  subjects.
    2-5              (16)  "Legally authorized representative" means parent
    2-6  or legal guardian if the patient is a minor, a legal guardian if
    2-7  the patient has been adjudicated incompetent to manage the
    2-8  patient's personal affairs, an agent of the patient authorized
    2-9  under a durable power of attorney for health care, an attorney ad
   2-10  litem appointed for the patient, or a personal representative if
   2-11  the patient is deceased.
   2-12        SECTION 2.  Subchapter E, Chapter 241, Health and Safety
   2-13  Code, is amended by adding Section 241.105 to read as follows:
   2-14        Sec. 241.105.  DISCLOSURE OF CERTAIN HEALTH CARE INFORMATION.
   2-15  (a)  Except as authorized by Subsection (f), a hospital or an agent
   2-16  or employee of a hospital may not disclose health care information
   2-17  about a patient to any other person without the written
   2-18  authorization of the patient or the patient's legally authorized
   2-19  representative.
   2-20        (b)  A disclosure authorization to a hospital is valid only
   2-21  if it:
   2-22              (1)  is in writing;
   2-23              (2)  is dated and signed by the patient or legally
   2-24  authorized representative;
   2-25              (3)  identifies the information to be disclosed;
    3-1              (4)  identifies the person or entity to whom the
    3-2  information is to be disclosed; and
    3-3              (5)  states the purpose of the disclosure.
    3-4        (c)  A disclosure authorization is valid for 90 days after
    3-5  the date it is signed unless it provides otherwise or unless it is
    3-6  revoked.
    3-7        (d)  A patient or legally authorized representative may
    3-8  revoke a disclosure authorization to a hospital at any time.  A
    3-9  revocation is valid only if it is in writing dated with a date that
   3-10  is later than the date on the original authorization, and signed by
   3-11  the patient or legally authorized representative.  A patient may
   3-12  not revoke a disclosure that is required for purposes of making
   3-13  payment to the hospital for health care provided to the patient.
   3-14        (e)  A patient may not maintain an action against a hospital
   3-15  for a disclosure made by the hospital in good-faith reliance on an
   3-16  authorization if the hospital's medical record director did not
   3-17  have written notice of the revocation of the authorization.
   3-18        (f)  A patient's health care information may be disclosed
   3-19  without the patient's authorization if the disclosure is:
   3-20              (1)  to a health care provider who is rendering health
   3-21  care to the  patient when the request is made;
   3-22              (2)  to any employee or agent of the hospital who
   3-23  requires health care information for health care education, quality
   3-24  assurance or peer review, or to assist the hospital in the delivery
   3-25  of health care or in complying with statutory, licensing,
    4-1  accreditation, or certification requirements, and the hospital
    4-2  takes appropriate action to ensure that the employee or agent:
    4-3                    (A)  will not use or disclose the health care
    4-4  information for any other purpose; and
    4-5                    (B)  will take appropriate steps to protect the
    4-6  health care information;
    4-7              (3)  to any federal, state, or local governmental
    4-8  agency or authority to the extent authorized or required by law;
    4-9              (4)  to a hospital that is the successor in interest to
   4-10  the hospital maintaining the health care information;
   4-11              (5)  for use in a research project authorized by an
   4-12  institutional review board according to federal law;
   4-13              (6)  to health care personnel of a penal or other
   4-14  custodial institution in which the patient is detained but only for
   4-15  purposes of providing health care to the patient;
   4-16              (7)  directory information, unless the patient has
   4-17  instructed the hospital not to make the disclosure or unless the
   4-18  directory information is otherwise protected by Chapter 611 or
   4-19  federal regulations concerning the confidentiality of alcohol and
   4-20  drug abuse patient records (42 C.F.R. Part 2);
   4-21              (8)  pursuant to compulsory process in accordance with
   4-22  Subsection (g);
   4-23              (9)  to facilitate reimbursement by a health benefit
   4-24  plan to a hospital, other health care provider or the patient for
   4-25  medical services or supplies; or
    5-1              (10)  to a health maintenance organization for purposes
    5-2  of maintaining a statistical reporting system as required by
    5-3  Chapter 119, Title 25, Texas Administrative Code, or regulations
    5-4  adopted under the Federal Health Maintenance Organization Act.
    5-5        (g)  Health care information may not be disclosed by a
    5-6  hospital pursuant to compulsory legal process or discovery in any
    5-7  judicial, legislative, or administrative proceeding unless:
    5-8              (1)  the patient has authorized in writing the release
    5-9  of the health care information;
   5-10              (2)  there is an attempt to recover monetary damages
   5-11  for any physical or mental conditions, including death of the
   5-12  patient, in any civil litigation or administrative proceeding, if
   5-13  relevant, brought by the patient or a person on the patient's
   5-14  behalf;
   5-15              (3)  the patient's physical or mental condition is
   5-16  relevant to the execution of a will;
   5-17              (4)  the health care information is to be used in an
   5-18  involuntary commitment proceeding for court-ordered treatment or
   5-19  for a probable cause hearing under:
   5-20                    (A)  Subtitle C, Title 7;
   5-21                    (B)  Subtitle D, Title 7; or
   5-22                    (C)  Chapter 462;
   5-23              (5)  the health care information is for use in a law
   5-24  enforcement proceeding or investigation in which a health care
   5-25  provider is the subject or a party, except that health care
    6-1  information obtained under this subdivision may not be used in any
    6-2  proceeding against the patient unless the matter relates to payment
    6-3  for the patient's health care or unless authorized under
    6-4  Subdivision (8);
    6-5              (6)  the health care information is relevant to a
    6-6  proceeding brought under Subsection (g);
    6-7              (7)  the health care information is relevant to a
    6-8  criminal prosecution where the patient is a victim, witness, or
    6-9  defendant, subject to the limitation that the records are not
   6-10  discoverable until the court in which the prosecution is pending
   6-11  makes an in camera determination as to the relevance of the records
   6-12  or communications, or any portion of the records or communications,
   6-13  and further provided that this determination does not constitute a
   6-14  determination as to the admissibility of those records or
   6-15  communications or any portion of the records or communications; or
   6-16              (8)  a court has determined that the health care
   6-17  information of a party or a person who has placed his mental or
   6-18  physical condition at issue is subject to compulsory legal process
   6-19  or discovery because the party seeking the information has
   6-20  demonstrated by clear and convincing evidence that the interest in
   6-21  access outweighs the patient's privacy interest.
   6-22        (h)  If health care information is sought under Subsection
   6-23  (g), unless the court, for good cause shown, determines that the
   6-24  notification should be waived or modified, the person seeking
   6-25  discovery or compulsory process shall mail a notice by first-class
    7-1  mail to the patient, the patient's legally authorized
    7-2  representative, or the patient's attorney of record of the
    7-3  compulsory process or discovery request not later than the 10th day
    7-4  before the date the certificate required by this subsection is
    7-5  presented to the hospital.  Service of compulsory process or
    7-6  discovery requests on a hospital must be accompanied by a written
    7-7  certification, signed by the person seeking to obtain health care
    7-8  information, or the person's legally authorized representative,
    7-9  identifying at least one subdivision under Subsection (g) under
   7-10  which compulsory process or discovery is being sought.  The
   7-11  certification must also state that the requirements for notice of
   7-12  the compulsory process or discovery request have been met.  A
   7-13  person may sign the certification only if the person reasonably
   7-14  believes that a legitimate basis for the use of discovery or
   7-15  compulsory process is provided by a subdivision under Subsection
   7-16  (g).  Production of health care information under Subsection (g)
   7-17  does not constitute a waiver of any privilege, objection, or
   7-18  defense existing under other law, rule of evidence, or procedure.
   7-19  A hospital is not required to seek a protective order on behalf of
   7-20  the patient to prevent or limit discovery or compulsory process of
   7-21  health care information requested under Subsection (g).
   7-22        (i)  On receipt of a written authorization from a patient or
   7-23  legally authorized representative to examine or copy all or part of
   7-24  the patient's recorded health care information, a hospital, as
   7-25  promptly as required under the circumstances, but not later than
    8-1  the 15th day after the date of receiving the request, shall:
    8-2              (1)  make the information available for examination
    8-3  during regular business hours, and provide a copy to the authorized
    8-4  requestor, if requested;
    8-5              (2)  inform the authorized requestor if the information
    8-6  does not exist or cannot be found; or
    8-7              (3)  if the information is in use or unusual
    8-8  circumstances have delayed handling the request, inform the
    8-9  authorized requestor and specify in writing the reasons for the
   8-10  delay and the earliest time for examination or copying or when the
   8-11  request will be otherwise disposed of.
   8-12        (j)  If a record of the health care information requested is
   8-13  not maintained by the hospital in the requested form, the hospital
   8-14  is not required to create a new record or reformulate an existing
   8-15  record to make the health care information available in the
   8-16  requested format.
   8-17        (k)  The hospital may charge a reasonable fee for providing
   8-18  the health care information and is not required to permit
   8-19  examination or copying until the fee is paid except in the case of
   8-20  a medical emergency.  For purposes of this subsection, a reasonable
   8-21  fee is one that does not exceed the actual cost of reproduction and
   8-22  may not include any costs that are otherwise recouped as a part of
   8-23  charges for health care.
   8-24        (l)  A hospital may deny a patient access to the patient's
   8-25  health care information if a member of the hospital medical staff
    9-1  responsible for the care and management of the patient reasonably
    9-2  concludes that access to the information would be harmful to the
    9-3  physical, mental, or emotional health of the patient and clearly
    9-4  documents that conclusion in the patient's health care information.
    9-5  The member of the hospital medical staff may delete confidential
    9-6  information about another person who has not consented to the
    9-7  release.  If a member of the hospital medical staff denies a
    9-8  patient's request for examination and copying, in whole or in part,
    9-9  the hospital shall permit examination and copying of the record by
   9-10  another health care provider, selected by the patient, who is
   9-11  licensed, certified, or otherwise authorized by state law to treat
   9-12  the patient for the same condition as the member of the hospital
   9-13  medical staff denying the request.
   9-14        (m)  A hospital may deny access to health care information if
   9-15  the health care information is made confidential by law.
   9-16        (n)  A person authorized to act for a patient shall act in
   9-17  good faith to represent the best interest of the patient and is
   9-18  immune from liability for an action taken in good faith.
   9-19        (o)  A hospital is immune from liability for a disclosure
   9-20  taken in good faith in reliance on the representations and actions
   9-21  of the patient's legally authorized representative.
   9-22        (p)  A hospital shall adopt and implement reasonable
   9-23  safeguards for the security of all health care information it
   9-24  maintains.
   9-25        (q)  A patient aggrieved by a violation of this section
   10-1  relating to the unauthorized release of confidential health care
   10-2  information may petition the district court of the county in which
   10-3  the patient resides, or if the patient is not a resident of this
   10-4  state, the district court of Travis County, for appropriate
   10-5  injunctive relief, and the petition takes precedence over all civil
   10-6  matters on the docketed court except those matters to which equal
   10-7  precedence on the docket is granted by law.  A patient aggrieved by
   10-8  a violation of this section relating to the unauthorized release of
   10-9  confidential health care information may sue for damages caused by
  10-10  that release in a district court of the county in which the patient
  10-11  resides, or if the the patient is not a resident of this state, the
  10-12  district court of Travis County.
  10-13        (r)  To the extent that this section conflicts with the Rules
  10-14  of Civil Evidence or the Rules of Criminal Evidence, this section
  10-15  controls.  The supreme court may not amend or adopt rules in
  10-16  conflict with this section.
  10-17        SECTION 3.  Section 1.03(a), Medical Practice Act (Article
  10-18  4495b, Vernon's Texas Civil Statutes), is amended by adding
  10-19  Subdivisions (17) and (18) to read as follows:
  10-20              (17)  "Legally authorized representative" means a
  10-21  parent or legal guardian if the patient is a minor, a legal
  10-22  guardian if the patient has been adjudicated incompetent to manage
  10-23  the patient's personal affairs, an agent of the patient authorized
  10-24  under a durable power of attorney for health care, an attorney ad
  10-25  litem appointed for the patient, or a personal representative if
   11-1  the patient is deceased.
   11-2              (18)  "Medical records" means any records pertaining to
   11-3  the history, diagnosis, treatment, or prognosis of the patient.
   11-4        SECTION 4.  Sections 5.08(g), (h), and (k), Medical Practice
   11-5  Act (Article 4495b, Vernon's Texas Civil Statutes), are amended to
   11-6  read as follows:
   11-7        (g)  Exceptions to confidentiality or privilege in court or
   11-8  administrative proceedings exist:
   11-9              (1)  when the proceedings are brought by the patient
  11-10  against a physician, including but not limited to malpractice
  11-11  proceedings, and any criminal or license revocation proceeding in
  11-12  which the patient is a complaining witness and in which disclosure
  11-13  is relevant to the claims or defense of a physician;
  11-14              (2)  when the patient or someone authorized to act on
  11-15  his behalf submits a written consent to the release of any
  11-16  confidential information, as provided in Subsection (j) of this
  11-17  section;
  11-18              (3)  when the purpose of the proceedings is to
  11-19  substantiate and collect on a claim for medical services rendered
  11-20  to the patient;
  11-21              (4)  in any civil litigation or administrative
  11-22  proceeding, if relevant, brought by the patient or someone on his
  11-23  behalf if the patient is attempting to recover monetary damages for
  11-24  any physical or mental condition including death of the patient.
  11-25  Any information is discoverable in any court or administrative
   12-1  proceeding in this state if the court or administrative body has
   12-2  jurisdiction over the subject matter, pursuant to rules of
   12-3  procedure specified for the matters;
   12-4              (5)  in any disciplinary investigation or proceeding of
   12-5  a physician conducted under or pursuant to this Act, provided that
   12-6  the board shall protect the identity of any patient whose medical
   12-7  records are examined, except for those patients covered under
   12-8  Subdivision (1) of Subsection (g) of this section or those patients
   12-9  who have submitted written consent to the release of their medical
  12-10  records as provided by Subsection (j) of this section;
  12-11              (6)  in any criminal investigation of a physician in
  12-12  which the board is participating or assisting in the investigation
  12-13  or proceeding by providing certain medical records obtained from
  12-14  the physician, provided that the board shall protect the identity
  12-15  of any patient whose medical records are provided in the
  12-16  investigation or proceeding, except for those patients covered
  12-17  under Subdivision (1) of Subsection (g) of this section or those
  12-18  patients who have submitted written consent to the release of their
  12-19  medical records as provided by Subsection (j) of this section.
  12-20  This subsection does not authorize the release of any confidential
  12-21  information for the purpose of instigating or substantiating
  12-22  criminal charges against a patient;
  12-23              (7)  in an involuntary civil commitment proceeding,
  12-24  proceeding for court-ordered treatment, or probable cause hearing
  12-25  under:
   13-1                    (A)  Subtitle C, Title 7, Health and Safety Code;
   13-2                    (B)  Subtitle D, Title 7, Health and Safety Code;
   13-3  or
   13-4                    (C)  Chapter 462, Health and Safety Code; <or>
   13-5              (8)  in any criminal prosecution where the patient is a
   13-6  victim, witness, or defendant.  Records are not discoverable until
   13-7  the court in which the prosecution is pending makes an in camera
   13-8  determination as to the relevance of the records or communications
   13-9  or any portion thereof.  Such determination shall not constitute a
  13-10  determination as to the admissibility of such records or
  13-11  communications or any portion thereof;
  13-12              (9)  when the patient's physical or mental condition is
  13-13  relevant to the execution of a will;
  13-14              (10)  when the information is relevant to a proceeding
  13-15  brought under Subsection (l); or
  13-16              (11)  when a court has determined that the medical
  13-17  records of a party or person who has placed his mental or physical
  13-18  condition at issue are subject to compulsory legal process or
  13-19  discovery because the party seeking the information has
  13-20  demonstrated by clear and convincing evidence that the interest in
  13-21  access outweighs the patient's privacy interest.
  13-22        (h)  Exceptions to the privilege of confidentiality, in other
  13-23  than court or administrative proceedings, allowing disclosure of
  13-24  confidential information by a physician, exist only to the
  13-25  following:
   14-1              (1)  governmental agencies if the disclosures are
   14-2  required or authorized by law;
   14-3              (2)  medical or law enforcement personnel if the
   14-4  physician determines that there is a probability of imminent
   14-5  physical injury to the patient, to himself, or to others, or if
   14-6  there is a probability of immediate mental or emotional injury to
   14-7  the patient;
   14-8              (3)  qualified personnel for the purpose of management
   14-9  audits, financial audits, program evaluations, or research, but the
  14-10  personnel may not identify, directly or indirectly, a patient in
  14-11  any report of the research, audit, or evaluation or otherwise
  14-12  disclose identity in any manner;
  14-13              (4)  those parts of the medical records reflecting
  14-14  charges and specific services rendered when necessary in the
  14-15  collection of fees for medical services provided by a physician or
  14-16  physicians or professional associations or other entities qualified
  14-17  to render or arrange for medical services;
  14-18              (5)  any person who bears a written consent of the
  14-19  patient or other person authorized to act on the patient's behalf
  14-20  for the release of confidential information, as provided by
  14-21  Subsection (j) of this section;
  14-22              (6)  individuals, corporations, or governmental
  14-23  agencies involved in the payment or collection of fees for medical
  14-24  services rendered by a physician;
  14-25              (7)  other physicians and personnel under the direction
   15-1  of the physician who are participating in the diagnosis,
   15-2  evaluation, or treatment of the patient; <or>
   15-3              (8)  in any official legislative inquiry regarding
   15-4  state hospitals or state schools, provided that no information or
   15-5  records which identify a patient or client shall be released for
   15-6  any purpose unless proper consent to the release is given by the
   15-7  patient, and only records created by the state hospital or school
   15-8  or its employees shall be included under this subsection; or
   15-9              (9)  any employee or agent of the physician who
  15-10  requires medical records for health care education, quality
  15-11  assurance or peer review, or to assist the physician in the
  15-12  delivery of health care or in complying with statutory, licensing,
  15-13  or accreditation requirements, and the physician takes appropriate
  15-14  action to ensure that the employee or agent:
  15-15                    (A)  will not use or disclose the information for
  15-16  any other purpose; and
  15-17                    (B)  will take appropriate steps to protect the
  15-18  information.
  15-19        (k)  A physician shall furnish copies of medical records
  15-20  requested, or a summary or narrative of the records, pursuant to a
  15-21  written consent for release of the information as provided by
  15-22  Subsection (j) of this section, except if the physician determines
  15-23  that access to the information would be harmful to the physical,
  15-24  mental, or emotional health of the patient, and the physician may
  15-25  delete confidential information about another person who has not
   16-1  consented to the release.  The information shall be furnished by
   16-2  the physician within 30 days after the receipt of the request.  The
   16-3  original medical record created and maintained or received and
   16-4  maintained by the physician remains the property of the physician.
   16-5  If a medical record requested is not maintained by the physician in
   16-6  the requested form, the physician is not required to create a new
   16-7  medical record or reformulate an existing medical record to make
   16-8  the information available in the requested format <and reasonable
   16-9  fees for furnishing the information shall be paid by the patient or
  16-10  someone on his behalf>.  If the physician denies the request, in
  16-11  whole or in part, the physician shall furnish the patient a written
  16-12  statement, signed and dated, stating the reason for the denial.  A
  16-13  copy of the statement denying the request shall be placed in the
  16-14  patient's medical records.  <In this subsection, "medical records"
  16-15  means any records pertaining to the history, diagnosis, treatment,
  16-16  or prognosis of the patient.>
  16-17        SECTION 5.  Section 5.08(j)(2), Medical Practice Act (Article
  16-18  4495b, Vernon's Texas Civil Statutes), is amended to read as
  16-19  follows:
  16-20              (2)  The patient, or other person authorized to
  16-21  consent, has the right to withdraw his consent to the release of
  16-22  any information.  Withdrawal of consent does not affect any
  16-23  information disclosed prior to the written notice of the
  16-24  withdrawal.  A patient may not maintain an action against a
  16-25  physician for a disclosure made by the physician in good-faith
   17-1  reliance on an authorization if the physician did not have written
   17-2  notice of the revocation of the authorization.
   17-3        SECTION 6.  Section 5.08, Medical Practice Act (Article
   17-4  4495b, Vernon's Texas Civil Statutes), is amended by adding
   17-5  Subsections (o)-(s) to read as follows:
   17-6        (o)  The physician may charge a reasonable fee for copying
   17-7  medical records and is not required to permit examination or
   17-8  copying until the fee is paid except in the case of a medical
   17-9  emergency.  For purposes of this subsection, a reasonable fee is
  17-10  one that does not exceed the actual cost of reproduction and may
  17-11  not include any costs that are otherwise recouped as a part of
  17-12  charges for health care.
  17-13        (p)  If medical records are sought under Subsection (g),
  17-14  unless the court, for good cause shown, determines that the
  17-15  notification should be waived or modified, the person seeking
  17-16  discovery or compulsory process shall mail a notice by first-class
  17-17  mail to the patient, the patient's legally authorized
  17-18  representative, or the patient's attorney of record of the
  17-19  compulsory process or discovery request not later than the 10th day
  17-20  before the date the certificate required by this subsection is
  17-21  presented to the physician.  Service of compulsory process or
  17-22  discovery requests on a physician must be accompanied by a written
  17-23  certification, signed by the person seeking to obtain medical
  17-24  records, or the person's legally authorized representative,
  17-25  identifying at least one subdivision under Subsection (g) under
   18-1  which compulsory process or discovery is being sought.  The
   18-2  certification must also state that the requirements for notice of
   18-3  the compulsory process or discovery request have been met.  A
   18-4  person may sign the certification only if the person reasonably
   18-5  believes that a legitimate basis for the use of discovery or
   18-6  compulsory process is provided by a subdivision under Subsection
   18-7  (g).  Production of medical records under Subsection (g) does not
   18-8  constitute a waiver of any privilege, objection, or defense
   18-9  existing under other law, rule of evidence, or procedure.  A
  18-10  physician is not required to seek a protective order on behalf of a
  18-11  patient to prevent or limit discovery or compulsory process of
  18-12  medical records requested under Subsection (g).
  18-13        (q)  A person authorized to act for a patient shall act in
  18-14  good faith to represent the best interest of the patient and is
  18-15  immune from liability for an action taken in good faith.
  18-16        (r)  A physician is immune from liability for an action taken
  18-17  in good faith in reliance on the representations and actions of the
  18-18  patient's legally authorized representative.
  18-19        (s)  To the extent that this section conflicts with the Rules
  18-20  of Civil Evidence or the Rules of Criminal Evidence, this section
  18-21  controls.  The supreme court may not amend or adopt rules in
  18-22  conflict with this section.
  18-23        SECTION 7.  Section 611.004, Health and Safety Code, is
  18-24  amended to read as follows:
  18-25        Sec. 611.004.  AUTHORIZED DISCLOSURE OF CONFIDENTIAL
   19-1  INFORMATION IN OTHER THAN COURT PROCEEDINGS.  (a)  A professional
   19-2  may disclose confidential information only:
   19-3              (1)  to a governmental agency if the disclosure is
   19-4  required or authorized by law;
   19-5              (2)  to medical or law enforcement personnel if the
   19-6  professional determines that there is a probability of imminent
   19-7  physical injury by the patient to the patient or others or there is
   19-8  a probability of immediate mental or emotional injury to the
   19-9  patient;
  19-10              (3)  to qualified personnel for management audits,
  19-11  financial audits, program evaluations, or research, in accordance
  19-12  with Subsection (b);
  19-13              (4)  to a person who has the written consent of the
  19-14  patient, or a parent if the patient is a minor, or a guardian if
  19-15  the patient has been adjudicated as incompetent to manage the
  19-16  patient's personal affairs;
  19-17              (5)  to the patient's personal representative if the
  19-18  patient is deceased;
  19-19              (6)  to individuals, corporations, or governmental
  19-20  agencies involved in paying or collecting fees for mental or
  19-21  emotional health services provided by a professional;
  19-22              (7)  to other professionals and personnel under the
  19-23  professionals' direction who participate in the diagnosis,
  19-24  evaluation, or treatment of the patient;
  19-25              (8)  in an official legislative inquiry relating to a
   20-1  state hospital or state school as provided by Subsection (c); or
   20-2              (9)  to any other person who requires mental health
   20-3  care information for mental health care education, quality
   20-4  assurance, or peer review, or to assist the professional in the
   20-5  delivery of mental health care services or in complying with
   20-6  statutory, licensing, or accreditation requirements, if the
   20-7  professional has taken appropriate action to ensure that the
   20-8  person:
   20-9                    (A)  will not use or disclose the information for
  20-10  any other purposes; and
  20-11                    (B)  will take appropriate steps to protect the
  20-12  information <in a civil action or in a criminal case or criminal
  20-13  law matter as otherwise allowed by law or rule>.
  20-14        (b)  Personnel who receive confidential information under
  20-15  Subsection (a)(3) may not directly or indirectly identify or
  20-16  otherwise disclose the identity of a patient in a report or in any
  20-17  other manner.
  20-18        (c)  The exception in Subsection (a)(8) applies only to
  20-19  records created by the state hospital or state school or by the
  20-20  employees of the hospital or school.  Information or records that
  20-21  identify a patient may be released only with the patient's proper
  20-22  consent.
  20-23        (d)  A person who receives information from confidential
  20-24  communications or records may not disclose the information except
  20-25  to the extent that disclosure in consistent with the authorized
   21-1  purposes for which the person first obtained the information.  This
   21-2  subsection does not apply to a person listed in Subsection (a)(4)
   21-3  or (a)(5) who is acting on the patient's behalf.
   21-4        SECTION 8.  Chapter 611, Health and Safety Code, is amended
   21-5  by adding Section 611.006-611.012 to read as follows:
   21-6        Sec. 611.006.  AUTHORIZED DISCLOSURE OF CONFIDENTIAL
   21-7  INFORMATION IN COURT PROCEEDINGS.  (a)  A professional may disclose
   21-8  confidential information in a court proceeding:
   21-9              (1)  when the proceedings are brought by the patient
  21-10  against a professional, including malpractice proceedings;
  21-11              (2)  In a license revocation proceeding in which the
  21-12  patient is a complaining witness and in which disclosure is
  21-13  relevant to the claim or defense of a professional;
  21-14              (3)  When the patient waives the patient's right in
  21-15  writing to the privilege of confidentiality of any information, or
  21-16  when a representative of the patient acting on the patient's behalf
  21-17  submits a written waiver to the confidentiality privilege;
  21-18              (4)  when the purpose of the proceeding is to
  21-19  substantiate and collect on a claim for mental or emotional health
  21-20  services rendered to the patient;
  21-21              (5)  when the judge finds that the patient after having
  21-22  been previously informed that communications would not be
  21-23  privileged has made communications to a professional in the course
  21-24  of a court-ordered examination relating to the patient's mental or
  21-25  emotional condition or disorder, except that those communications
   22-1  may be disclosed only with respect to issues involving the
   22-2  patient's mental or emotional health;
   22-3              (6)  when the disclosure is relevant in a suit
   22-4  affecting the parent-child relationship;
   22-5              (7)  in any criminal proceeding;
   22-6              (8)  in any proceeding regarding the abuse or neglect,
   22-7  or the cause of abuse or neglect, of a resident of an institution,
   22-8  as that term is defined by Chapter 242;
   22-9              (9)  when the patient's physical or mental condition is
  22-10  relevant to the execution of a will;
  22-11              (10)  when the information is to be used in an
  22-12  involuntary commitment proceeding for court-ordered treatment or
  22-13  for a probable cause hearing under:
  22-14                    (A)  Subtitle C;
  22-15                    (B)  Subtitle D; or
  22-16                    (C)  Chapter 462; or
  22-17              (11)  when a court has determined that the information
  22-18  of a party or person who has placed his mental or physical
  22-19  condition at issue is subject to compulsory legal process or
  22-20  discovery because the party seeking the information has
  22-21  demonstrated by a preponderance of the evidence that the interest
  22-22  in access outweighs the patient's privacy interest.
  22-23        (b)  On granting an order under Subsection (a)(5), the court,
  22-24  in determining the extent to which any disclosure of all or any
  22-25  part of any communication is necessary, shall impose appropriate
   23-1  safeguards against unauthorized disclosure.
   23-2        Sec. 611.007.  DISCOVERY OR COMPULSORY PROCESS.  (a)  If
   23-3  mental health care information is sought under Section 611.006,
   23-4  unless the court, for good cause shown, determines that the
   23-5  notification should be waived or modified, the person seeking
   23-6  discovery or compulsory process shall mail a notice by first-class
   23-7  mail to the patient or the patient's attorney of record of the
   23-8  compulsory process or discovery request not later than the 10th day
   23-9  before the date the certificate required by this section is
  23-10  presented to the professional.
  23-11        (b)  Service of compulsory process or discovery requests on a
  23-12  professional must be accompanied by a written certification, signed
  23-13  by the person seeking to obtain information, or the person's
  23-14  authorized representative, identifying at least one subdivision of
  23-15  Section 611.006 under which compulsory process or discovery is
  23-16  being sought.  The certification must also state that the
  23-17  requirements for notice of the compulsory process or discovery
  23-18  request have been met.
  23-19        (c)  A person may sign the certification only if the person
  23-20  reasonably believes that a legitimate basis for the use of
  23-21  discovery or compulsory process is provided by a subdivision of
  23-22  Section 611.006.
  23-23        (d)  Production of information under Section 611.006 does not
  23-24  constitute a waiver of any privilege, objection, or defense
  23-25  existing under other law, rule of evidence, or procedure.
   24-1        (e)  A professional is not required to seek a protective
   24-2  order on behalf of the patient to prevent or limit discovery or
   24-3  compulsory process of mental health care information requested
   24-4  under Section 611.006.
   24-5        Sec. 611.008.  REVOCATION OF CONSENT.  (a)  A patient or
   24-6  legally authorized representative may revoke a disclosure consent
   24-7  to a professional at any time.  A revocation is valid only if it is
   24-8  written, dated, and signed by the patient or legally authorized
   24-9  representative.  A patient may not revoke a disclosure that is
  24-10  required for purposes of making payment to the professional for
  24-11  mental health care services provided to the patient.
  24-12        (b)  A patient may not maintain an action against a
  24-13  professional for a disclosure made by the professional in
  24-14  good-faith reliance on an authorization if the professional did not
  24-15  have written notice of the revocation of the consent.
  24-16        Sec. 611.009.  REQUEST BY PATIENT.  (a)  On receipt of a
  24-17  written request from a patient to examine or copy all or part of
  24-18  the patient's recorded mental health care information, a
  24-19  professional, as promptly as required under the circumstances, but
  24-20  not later than the 15th day after the date of receiving the
  24-21  request, shall:
  24-22              (1)  make the information available for examination
  24-23  during regular business hours and provide a copy to the patient, if
  24-24  requested:
  24-25              (2)  inform the patient if the information does not
   25-1  exist or cannot be found; or
   25-2              (3)  if the information is in use or unusual
   25-3  circumstances have delayed handling the request, inform the patient
   25-4  and specify in writing the reasons for the delay and the earliest
   25-5  time for examination or copying or when the request will be
   25-6  otherwise disposed of.
   25-7        (b)  If a record of the information requested is not
   25-8  maintained by the professional in the requested format, the
   25-9  professional is not required to create a new record or reformulate
  25-10  an existing record to make the information available in the
  25-11  requested format.
  25-12        (c)  Unless provided for by other state law, the professional
  25-13  may charge a reasonable fee for copying mental health care
  25-14  information and is not required to permit examination or copying
  25-15  until the fee is paid except in the case of a medical emergency.
  25-16  For purposes of this subsection, a reasonable fee is one that does
  25-17  not exceed the actual cost of reproduction and may not include any
  25-18  costs that are otherwise recouped as a part of charges for care.
  25-19        Sec. 611.010.  DENIAL OF ACCESS; INFORMATION MADE
  25-20  CONFIDENTIAL BY LAW.  A professional may deny access to mental
  25-21  health care information if the information is made confidential by
  25-22  law.
  25-23        Sec. 611.011.  RIGHTS OF OTHERS.  (a)  A person authorized to
  25-24  act for a patient shall act in good faith to represent the best
  25-25  interest of the patient and is immune from liability for an action
   26-1  taken in good faith.
   26-2        (b)  A professional is immune from liability for an action
   26-3  taken in good faith in reliance on the representations and actions
   26-4  of the mental health care representative.
   26-5        Sec. 611.012.  EFFECT ON RULES OF CIVIL EVIDENCE AND CRIMINAL
   26-6  EVIDENCE.  To the extent that this Chapter conflicts with the Rules
   26-7  of Civil Evidence or the Rules of Criminal Evidence, this Chapter
   26-8  controls.  The supreme court may not amend or adopt rules in
   26-9  conflict with this Chapter.
  26-10        SECTION 9.  This Act applies to the disclosure of health care
  26-11  information, medical records, and mental health care information on
  26-12  or after January 1, 1996.
  26-13        SECTION 10.  This Act takes effect September 1, 1995.
  26-14        SECTION 11.  The importance of this legislation and the
  26-15  crowded condition of the calendars in both houses create an
  26-16  emergency and an imperative public necessity that the
  26-17  constitutional rule requiring bills to be read on three several
  26-18  days in each house be suspended, and this rule is hereby suspended.