Austin, Texas
                                   FISCAL NOTE
                               75th Regular Session
                                  February 20, 1997
      TO: Honorable Judith Zaffirini, Chair            IN RE:  Senate Bill No. 208
          Committee on Health & Human Services                              By: Haywood
          Austin, Texas
         FROM:  John Keel, Director    
In response to your request for a Fiscal Note on SB208 ( Relating 
to the disclosure of certain information regarding certain patients 
of a physician.) this office has detemined the following:
         Biennial Net Impact to General Revenue Funds by SB208-As Introduced
Implementing the provisions of the bill would result in a net 
negative impact of $(232,388) to General Revenue Related Funds 
through the biennium ending August 31, 1999.
The bill would make no appropriation but could provide the legal 
basis for an appropriation of funds to implement the provisions 
of the bill.
Fiscal Analysis
This bill amends the Health and Safety Code which currently 
allows treating physicians to disclose information pertaining 
to a patient to law enforcement or the patient's "legally authorized 
representative" (parent, guardian, person with durable power 
of attorney).  The amendments of this bill provide that the 
treating physician does not have to disclose information if 
the physician has reason to believe that disclosure would be 
harmful to the patient's physical, mental, or emotional health. 
 When these instances occur, the physician must inform the representative 
that the release of additional information would be harmful 
to the patient.  Further, the physician must report to the Department 
of Protective and Regulatory Services (DPRS) the representative's 
request for information and request that DPRS obtain a protective 
order on the patient's behalf.  If a hearing is held, the court 
shall then determine what information may be disclosed and issue 
appropriate orders.  
A physician of the Department of Mental Health and Mental Retardation 
(MHMR) will refuse to share records or information with legally 
appointed guardians of patients in their care only on very rare 
occasions.  The number of these instances is estimated to be 
approximately 50 per year.  The amount of time required for 
a physician to adhere to the requirements of this bill; meet 
with the representative; report to the Department of Protective 
and Regulatory Services (DPRS), requesting that DPRS obtain 
a protective order; and attend a hearing is estimated to be 
12 hours.  For MHMR, the average hourly salary of $65.00 plus 
estimated staff support and incidental travel places the cost 
of this bill at $900 per incident or $45,000 for 50 instances 
per year.

DPRS estimates a fiscal impact due to the addition 
of legal personnel required to process protective orders.  The 
Department of Protective and Regulatory Services (DPRS) assumes 
that one FTE attorney would be needed in the beginning followed 
by another attorney as awareness of the law increases.  Legal 
secretaries would also be needed for the production of routine 
filings, office support and development and dissemination of 
information regarding the bill's requirements. 
The probable fiscal implications of implementing the provisions 
of the bill during each of the first  five years following passage 
is estimated as follows:
Five Year Impact:
Fiscal Year Probable           Probable           Change in Number   
            Savings/(Cost)     Savings/(Cost)     of State                                                
            from General       from Federal Funds Employees from                                          
            Revenue Fund                          FY 1997                                                 
            0001               0555                                                                        
       1998        ($111,497)         ($26,768)               2.0                                    
       1998         (146,982)          (40,769)               3.0                                    
       2000         (142,517)          (38,984)               3.0                                    
       2001         (164,861)          (47,918)               4.0                                    
       2002         (160,397)          (46,132)               4.0                                    
         Net Impact on General Revenue Related Funds:
The probable fiscal implication to General Revenue related funds 
during each of the first five years is estimated as follows:
              Fiscal Year      Probable Net Postive/(Negative)
                               General Revenue Related Funds
               1998           ($111,497)
               1999            (146,982)
               2000            (142,517)
               2001            (164,861)
               2002            (160,397)
Similar annual fiscal implications would continue as long as 
the provisions of the bill are in effect.
No fiscal implication to units of local government is anticipated.
   Source:            Agencies:   503   Board of Medical Examiners
                                         655   Texas Department of Mental Health and Mental Retardation
                                         530   Department of Protective and Regulatory Services
                      LBB Staff:   JK ,BB ,AC