Bioethics Discussion Blog: Your Medical Prescription: Who Gets to See it?

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Wednesday, November 21, 2007

Your Medical Prescription: Who Gets to See it?

Do you think screening of phone calls of U.S. citizens by the U.S. government as part of the “War on Terror” is the only way you can lose your privacy? How about a doctor’s prescription? It’s not about the “War on Terror” (though see the last two statements in this posting) but many other excuses, some apparently legitimate and others with a profit or other motives.
When a physician writes a prescription for your medical condition, the class of drug prescribed can often indicate the name or nature of your medical condition.
What do you think happens to the prescription that your doctor wrote out after the pharmacy fills it? Does it stay in the pharmacy for the refill? Not at all. Your “Protected Health Information” with the implied medical condition may go out to many other people.

As an example in the United States, the CVS Pharmacy Privacy Policy is reproduced below. You may object to the revelation of your information and it might be accepted by the pharmacy but also your objection may be overruled. Is this privacy? Is this all ethical? Well, you decide. ..Maurice.

The Health Insurance Portability and Accountability Act (“HIPAA”)
NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
This Notice of Privacy Practices (the “Notice”) describes the privacy practices of CVS/pharmacy including CVS retail outlets, CVS.com, and CVS ProCare retail outlets.
CVS/pharmacy wants you to know that nothing is more central to our operations than maintaining the privacy of your health information (“Protected Health Information” or “PHI”). PHI is information about you, including basic information that may identify you and relates to your past, present, or future health or condition and the dispensing of pharmaceutical products to you. We take this responsibility very seriously.
Our Pledge Regarding Your Health Information
We are required by federal and applicable state law, regulations, and other authorities to protect the privacy of your health information and to provide you with this Notice. Our pharmacy staff is required to protect the confidentiality of your PHI and will disclose your PHI to a person other than you or your personal representative only when permitted under federal or state law. This protection extends to any PHI that is oral, written, or electronic, such as prescriptions transmitted by facsimile, modem, or other electronic device. This Notice describes how we may use and disclose your PHI. In some circumstances, as described in this Notice, the law permits us to use and disclose your PHI without your express permission. In all other circumstances, we will obtain your written authorization before we use or disclose your PHI.
This Notice also describes your rights and the obligations we have regarding the use and disclosure of your PHI. Under federal and applicable state law, we are required to follow the terms of the Notice currently in effect.
HIPAA’s standards may be pre-empted by certain state laws relating to the privacy of health information. Please see state provisions at the end of this Notice. [Moderator's note: Go to the above link to enter your state for specific state provisions.]

How We May Use and Disclose Your PHI Without Your Permission
TREATMENT, PAYMENT, OR HEALTH CARE OPERATIONS. Below are examples of how Federal law permits use or disclosure of your PHI for these purposes without your permission:
1. Treatment: Dispensing medications. PHI obtained by CVS/ pharmacy will be used to dispense prescription medications. We will document information related to the medications dispensed and services provided in your record. Patient Contacts. We may contact you to provide treatment-related services, such as refill reminders, treatment alternatives (e.g., available generic products), and other health related benefits and services that may be of interest to you.
2. Payment: We may contact your insurer, payor, or other agent and share your PHI with that entity to determine whether it will pay for your prescription and the payment amount. We may also contact you about a payment or balance due for prescriptions dispensed to you at CVS/pharmacy.
3. Health care operations: Service. Your PHI may be used to monitor the effectiveness of our services. Transfer. Your PHI may be transferred for purposes of carrying out the pharmacy services if we buy or sell pharmacy locations. Benefits/Research. We may also use your PHI to tell you about opportunities that may be of interest to you, such as benefits for preferred CVS customers or clinical research projects.

OTHER SPECIAL CIRCUMSTANCES:

We are permitted under federal and applicable state law to use or disclose your PHI without your permission only when certain circumstances may arise, as described below.
We are likely to use or disclose your PHI for the following purposes:

Business associates: We provide some services through other companies termed “business associates.” Federal law requires us to enter into business associate contracts to safeguard your PHI as required by CVS and by law.
Individuals involved in your care or payment for care: We may disclose your PHI to a friend, personal representative, or family member involved in your medical care. For example, if we can reasonably infer that you agree, we may provide prescriptions and related information to your caregiver on your behalf.
Disclosures to parents or legal guardians: If you are a minor, we may release your PHI to your parents or legal guardians when we are permitted or required under federal and applicable state law.
Worker’s compensation: We may disclose your PHI to the extent authorized and necessary to comply with laws relating to worker’s compensation or similar programs established by law.
Law enforcement: We may disclose your PHI for law enforcement purposes as required by law or in response to a court order, subpoena, warrant, summons, or similar process; to identify or locate a suspect, fugitive, material witness, or missing person; about a death resulting from criminal conduct; about crimes on the premises or against a member of our workforce; and in emergency circumstances, to report a crime, the location, victims, or the identity, description, or location of the perpetrator of a crime.
As required by law: We must disclose your PHI when required to do so by applicable federal or state law.
Judicial and administrative proceedings: If you are involved in a lawsuit or a legal dispute, we may disclose your PHI in response to a court or administrative order, subpoena, discovery request, or other lawful process.
Public health: We may disclose your PHI to federal, state, or local authorities, or other entities charged with preventing or controlling disease, injury, or disability for public health activities. These activities may include the following: disclosures to report reactions to medications or other products to the U.S. Food and Drug Administration or other authorized entity; disclosures to notify individuals of recalls, exposure to a disease, or risk for contracting or spreading a disease or condition.
Health oversight activities: We may disclose your PHI to an oversight agency for activities authorized by law. These oversight activities include audits, investigations, and inspections, as necessary for our licensure and for government monitoring of the health care system, government programs, and compliance with federal and applicable state law.
United States Department of Health and Human Services: Under federal law, we are required to disclose your PHI to the U.S. Department of Health and Human Services to determine if we are in compliance with federal laws and regulations regarding the privacy of health information.

Although we may not engage in the following activities, under federal or applicable state law, we are allowed to use or disclose your PHI without your permission for these purposes:

Research: Under certain circumstances, we may use or disclose your PHI for research purposes. However, before disclosing your PHI, the research project must be approved by an institutional review board or privacy board that has reviewed the research proposal and established protocols to ensure the privacy of your PHI.
Coroners, medical examiners, and funeral directors: We may release your PHI to assist in identifying a deceased person or determine a cause of death.
Administrator or executor: Upon your death, we may disclose your PHI to an administrator, executor, or other individual so authorized under applicable state law.
Organ or tissue procurement organizations: Consistent with applicable law, we may disclose your PHI to organ procurement organizations or other entities engaged in the procurement, banking, or transplantation of organs for the purpose of tissue donation and transplant.
Notification: We may use or disclose your PHI to assist in a disaster relief effort so that your family, personal representative, or friends may be notified about your condition, status, and location.
Correctional institution: If you are or become an inmate of a correctional institution, we may disclose to the institution or its agents PHI necessary for your health and the health and safety of others.
To avert a serious threat to health or safety: We may use and disclose your PHI to appropriate authorities when necessary to prevent a serious threat to your health and safety or the health and safety of another person or the public.
Military and veterans: If you are a member of the armed forces, we may release your PHI as required by military command authorities. We may also release PHI about foreign military personnel to the appropriate military authority.
National security and intelligence activities: We may release your PHI to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.
Protective services for the President and others: We may disclose your PHI to authorized federal officials so that they may provide protection to the President, other authorized persons, or foreign heads of state, or conduct special investigations.

6 Comments:

At Thursday, November 22, 2007 2:09:00 AM, Anonymous teqjack said...

On the other hand...
It may be apocryphal [but I think it is true] that several years ago a victim of hit-and-run was reported to his family only after he died, using ID found on him: for four days, phone calls to area hospitals and morgues by family and even police were not met with success because HIPAA regs were [incorrectly?} interpreted as not allowing divulging the status [or even existence] of a patient without the patient`s consent.

 
At Thursday, November 22, 2007 7:58:00 AM, Anonymous js md said...

To a large extent HIPAA laws do little more than enable corporations to distribute your medical information to all their business associates, which could be nearly anyone. They can use this information to have telemarketeers call you. Insurance claims can get back to potential employers and you can be rejected for a job based on your medical history that you thought was private. In many ways, the average patient would be more secure without HIPAA laws.
My website Patient Privacy has links to detailed information about HIPAA privacy abuses.

 
At Thursday, November 22, 2007 9:03:00 AM, Blogger MY OWN WOMAN... said...

Sounds like we have a privacy act that isn't worth the paper that it's written on. Might as well have said, "we can tell anybody whatever we want, unless we don't want to." Blah

 
At Thursday, November 22, 2007 9:44:00 AM, Blogger Maurice Bernstein, M.D. said...

For those interested in doing something about patient privacy rights and abuse of prescription information, you may wish to go to the website of "Patient Privacy Rights". Click on their video, amusing but so true! ..Maurice.

 
At Wednesday, November 28, 2007 3:37:00 AM, Anonymous Mike said...

Very recently I came across a very interesting webcast event that is going to be held on December 11, 2007 9 am PT/12 pm ET on subject “How Information Governance and Compliance Pay”. I think this webcast could be useful for your website visitors.
This webcast is based on recent research conducted by the IT Policy Compliance Group, focuses on fact-based insight into how improving information governance, risk and compliance, reduces costs, financial risk and the loss of sensitive data.
You website visitor who are interested in this webcast can learn about the steps should be taking to:
• Reduce labor costs
• Mitigate and avoid significant financial risk and loss
• Improve information governance results
• Improve regulatory compliance results
More information about this webcast is available at here How Information Governance and Compliance Pay http://www.compliancehome.com/symantec/

 
At Thursday, August 14, 2008 1:18:00 PM, Blogger Maurice Bernstein, M.D. said...

Lily wrote the following today but I have removed a commercial link that had been inserted since as best as possible I don't want this blog to turn commercial but strictly deal with communication about ethical issues. ..Maurice.

It is possible that your employer is aware of the prescription medications you are taking and the health conditions associated with them. Even though there are confidentiality laws in place to protect you, these laws are rarely enforced as it is difficult to prove that an employment decision has been made based on a health condition. The only real way to guard your privacy is to not use your company’s health plan to purchase medications for questionable or embarrassing conditions.

 

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