Hostile HIPAA

Adding to my new experiences as a patient, I have now run into heretofore unforeseen side of the HIPAA monster. As a patient, it should be protecting me, right? Of course not! Legislated in part to protect privacy, HIPAA is one of the most misunderstood and abused laws by healthcare personnel, particularly clerical staff at the front lines of the patient-physician records interface who may not have much of a healthcare (or all that much educational) background to boot. 

In my case, I called wanting a report from a minor surgery a few weeks after I had it done. I had already called the surgeon’s office and they said that while they did have a copy via their electronic medical record (EMR), the actual operative report was the hospital’s property and they couldn’t give me a copy; they just had viewing privileges, I was told. In the past, I’ve received every copy of everything I’ve ever wanted. This “ownership” business was nonsense–after all, this was my surgeon and the paper copy was in my chart. As long as I was there and asked for it, a simple copy had always been made for me to walk out with said report in hand. To be clear, I’m talking about post-HIPAA, not some wistful recollection of the way things were back in the “good old days.” Said surgeon recently moved into a brand spanking new office, has a ton of new staff, and I just thought that this was just a miscommunication–escalating to a supervisor or the like should resolve the problem.

Obviously it didn’t, but the fun was just about to begin. My instructions–reasonable, I might add–were to contact the hospital’s medical records department since they “owned” the information, and they could help me further. It was speaking to the medical records (”MR” below, because I like the double-entendre) office that thing became unglued. Below is a faithful transcript of our conversation, edited only for general length and idle banter:

Me: [explain my needs] So what procedure do you have for me to get a copy of the report?
MR: You need to come by–in person only with a picture ID–fill out some paperwork and pay a processing fee that starts at $42.50 for first 10 pages.
Me: $42-what?! The report is just one page, I think–maybe 2 at most. I mean, it’s on the screen–just hit ‘Print’
Me: Doesn’t matter if it’s 1 page or 10; it’s the same price.
MR: But wait, my family doctor’s been FAXed records from here–did you charge his office too?
MR: No, we don’t charge physicians because the request is for continuation of care. If we give a copy to you it’s not for continuation of care, it’s for your personal use.
Me: But the same work is being done, you just aren’t charging the doctor but are charging the patient? So it’s not a cost recovery, you’re penalizing the patient.

MR: We give it to the doctor electronically [not true, only applies to affiliated doctors in same med center]. We charge you or an insurance company because we have to physically process the record [what, press "Print" from the screen interface?!?] If it the report is for a doctor, they can access it electronically.
Me: But the doctor is in [my home city, 35 miles away], he’s always gotten records by fax.
MR: Well, we just went live with our new system in October.
Me: But if your system wasn’t live, you’re still saying you would charge me and not him.
MR: That’s correct, but slightly less than $42.50.

Me: OK, but I’m saying my doctor I know has no login credentials to your hospital, no privileges, nothing. So how can he get a copy?
MR: I’m guessing he’ll have to apply for access, but–well–I don’t know–I’m not the one that handles that, but in the meantime if he can’t get to it online, someone will have to pull the records, process it [again, this is just a quick computer search that takes 5-10 seconds], and send him the records–
Me: –which is my point: you’ll have to send him the records manually, but you aren’t going to charge him for the same work you’re going to charge me–
MR:  –That’s right! [Proudly, as though she's won an argument b/c I'm agreeing, which was most disturbing]
Me:  –someone is going to have to physically process this–
MR: Yes sir! [again, defiantly]
Me:   –and send it to my physician without charging him.
MR: Yes, because it’s for continuation of care [emphasis theirs, spoken slowly] and that’s something very different.
Me: [previously explained about my having been in Mexico, do have a "continuation of care" issue for my own recordkeeping] I already told you, I need the records for a physician in Mexico.
MR: If you can provide us with the name and address, we can release the records to him and mail them.
Me: To Mexico?!?!
MR: Yes sir, we can mail them.

Me: You have no idea what mail is like in Mexico; it will take a month at least if at all. I doubt you’ll pay the $30 for FedEx for that one page. Besides, are you sure all these fees are consistent with HIPAA and state regulations concerning access, etc?
MR: Yes sir, I can even provide you with a fee schedule.
Me: Can you fax that to me?
MR: Of course, let me get your fax number.

And with that deliciously ironic ending, the “labor” and “pulling records” was equal to the fax of that one page which they were all too willing to perform for free so their fees could be proudly shared. The 10 minute phone converation could have pulled at least 5 records and faxed as many copies. This is robbery, plain and simple.

HIPAA was crafted for portability (change in jobs, location, etc. doesn’t make one “start over” in terms of coverage) and security/privacy above all. It is, in spirit, supposed to be protective of the insured at the unfortunate and unfunded responsibiity of the healthcare provider caught in between trying to both comply and do right by the patient. I sympathize with this, but to selectively push costs back on the patient and not a physician–or more to the point, another business entity capable of absorbing said costs as the price of doing business–is predatory and in stark contrast to the spirit of the law. Moreover, HIPAA left way too much open to vague enforcement with language like “reasonable fee.”  It’s no wonder that individual state agencies and other entities are pushing the envelope with what’s “allowable” at the patient’s (ie, the person most exploitable and vulnerable) expense.

In the end, I got my report–not by paying $42.50 to the hospital, but at my next surgeon’s visit, I simply asked him if I could get a copy.  Without hesitation, he said “Sure!” and directed his nurse to go up front and make a copy for me on my way out.  Done. Piece of cake. HIPAA be damned.

I’m a Victim of Voter “Fraud!”

I, like many others participating in early voting, welcomed the opportunity to avoid the pandemonium of Nov. 4th.  On Halloween oddly enough, I went to my local voting center to proudly cast my vote for Barack Hussein Obama/Joe Biden, etc. phone video camera in hand in case any tricky-tricky vote-flipping nonsense were to occur that I had read about. (You KNOW I would have posted it here and notified everyone I could–if it can even happen to Oprah you can’t be too sure!)

Imagine my surprise when I gave my driver’s license and after a long wait involving some phone calls I was told that I was not a registered voter.  “That’s impossible!” I said.
“Do you have your registration card?” the lady asked.
“No,” I replied. “Everyone has told me–even your signs say–you only need your driver’s license. What’s going on?”
After some hemming and hawing, a supervisor came over, review the situation and asked me, “Did you vote in the primaries?”
“No.”
“Ah well, there you go, you were probably purged from the voting rolls.”
“WHAT?! So everyone here voted in a part primary? That’s the most ridiculous thing I ever heard!”

By this time, this conversation was drawing some attention, so the supervisor lady and I stepped behind this divider where we could talk with a bit more privacy.
“When did you register, then?” she asked.
“When I renewed my license, two years ago in 2006.”
“Oh well THAT explains it. DPS [Department of Public Safety, state troopers + drivers license division] just doesn’t send the information all the time, this happens.”
Now I’m ready to punch a kitten I’m so mad. “WHAT?!?! Now this is DPS’ fault?! ‘They’ are the ones responsible right?  Why doesn’t everyone else have a problem then? Because that’s how most people register.”
“No, most people register through us [county].”  Typical small-minded “my world = everyone else’s universe” thinking.  Like the “motor voter” initiatives were small potatoes, what a laugh. “And besides,” she continued, “if you haven’t voted in the last two years, you’re purged from the rolls anyway.” [this isn't true, it SHOULD be two federal election cycles, not two years]

It was clear I was going to get nowhere with her, or even a phone call to the county voter person because, well, this is about as busy as it’s going to get outside Nov. 4th, and by the time I get through to someone, what are they going to do? I filled out a provisional ballot which may or may not be counted for the general election, depending on the mood of whomever reviews the ’cause’ of my ‘affidavit’ contained therein that in fact, I am eligible to vote.  Great.

We like to think of one person, one vote as if that makes a real difference. Without a tirade on the electoral college, the fact is Texas as a whole is as red as it gets. We’re the home of George W. Bush for crying out loud, as well as other notable figures destined for punishment in the afterlife such as Tom Delay and Phil Gramm. My vote, even in my own county, would probably diluted to the point of irrelevance, but in the end, I wanted to say I was there on this momentous election year, to feel like I was one lever-pull, touch-screen, whatever part of history. Now I won’t even know until after it’s done.

I’m just happy that while my vote may be diluted to irrelevance, hundreds of thousands of others will not. Tonight we will signal a new era in American politics, and come January, we’ll be putting this train back on the tracks. I’m tired of seeing Democrats act like simpering schoolchildren–Pelosi especially–caving to a perceived bully. With Obama in the White House, maybe Congress can not only act on initiatives that I feel are important, but restore some dignity in doing so.

I will watch events unfold today like everyone else, and whether my vote will count or not will not affect the outcome of this historic day.

Protected: Chr1s R0ck on Politics (HB0 2008)