Clinton seeks sweeping rules to protect medical records; Proposed U.S. regulations would safeguard privacy and limit disclosure


WASHINGTON -- President Clinton will soon announce sweeping new federal rules to protect the privacy of billions of medical records and will assail Congress for failing to enact safeguards, administration officials said yesterday.

The proposed regulations would be the first comprehensive federal standards specifically intended to protect the confidentiality of medical records. They come at a time when doctors, hospitals, pharmacists and health maintenance organizations are sharing more and more data, often without the knowledge of patients, and insurance companies are demanding more information to justify the payment of claims.

The proposals would cover any medical records that are kept or transmitted electronically, as well as paper printouts of electronic transactions. Patients would generally have a right to review and copy their medical records, and to supplement the records or correct mistakes, administration officials said.

Congress has been trying to write records protections into law, but the effort has stalled. In 1996, Congress imposed a deadline on itself, requiring the secretary of health and human services to issue privacy rules if lawmakers failed to pass health privacy legislation by Aug. 21, 1999. The Clinton administration's new proposals carry out that requirement.

In offering the proposed rules, White House officials said, Clinton will try to achieve three political purposes. He will put pressure on Congress to pass legislation. He will present himself as a champion of privacy rights, a politically popular cause. And, by making aggressive use of his power, he will try to counter the perception of himself as a lame duck.

The proposed rules will probably not go far enough to satisfy psychiatrists, but may go too far for some law enforcement officials. The White House is still negotiating some details with law enforcement officials.

In general, police would need a search warrant, a subpoena or some other legal authorization to get confidential medical records under the proposed rules. Federal, state and local law enforcement officials said they wanted to preserve their ability to get immediate access to medical information without a warrant in emergencies -- when they are investigating a bomb threat or trying to rescue hostages, for example.

Experts on health privacy in and out of the government said the proposed rules also included these provisions:

Health care providers and HMOs would not have to get a patient's consent before disclosing information needed for medical treatment or payment of claims. But they would have to get the patient's consent if the information was to be used for marketing and certain types of research.

Before disclosing information, doctors would have to take reasonable steps to make sure they did not disclose more information than was needed to accomplish the purpose of the request.

A psychotherapist would not need a patient's consent to disclose information about the diagnosis of a condition, the patient's level of functioning or medications when such information was necessary for treatment or for the payment of claims. But the therapist would have to get the patient's consent before disclosing more detailed information about a patient's feelings, family relationships or sexual relationships.

The public will have an opportunity to comment on the proposed rules. Under the 1996 law, the secretary of health and human services must issue final rules by Feb. 21 of next year.

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