LEGISLATIVE BUDGET BOARD 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 Senate 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. Methodolgy 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 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