The Substance Abuse and Mental Health Services Administration – SAMHSA – has filed notice of rule-making for such records. The proposed changes to 42 CFR Part 2- HIPPA – were published in Federal Register on Feb. 9.
It’s been 29 years since there have been any substantive updates to the Confidentiality of Alcohol and Drug Abuse Patient Records regulations. A lot has changed, especially the recent push for an integrated, continuum of care and the use of electronic medical records.
I say changes are needed because you have a bunch of 20-something-year-old newly recovered addicts owning and operating some of the HIPPA-protected treatment programs, such as intensive outpatient programs, called IOPs. They, in turn, share a patient’s health condition with their “clinical staff” – who are also newly recovered 20-something-year-old addicts who have little or no formal training and often no more than a high-school diploma.
IOPs are often the first stop for addicts who have completed inpatient treatment. These programs popped up like weeds after word got out that insurance companies would pay thousands of dollars for urinalysis tests. All you needed was a physician to say the tests were medically necessary.
And because there are no officials standards of care within the industry recommending how often recovering addicts should be drug tested, IOPs began testing addicts in their program 3-5 times a week for a smorgasbord of drugs.
In defense of the IOPs, they also offer therapy and life skills training. Some of those therapists do have degrees in behavioral health and social work. But then you have the “facilitators.” These are the folks who lead group sessions, where patients share intimate details of their recovery.
These facilitators often have no or little formal training. Many are 20-something-year old recovered addicts themselves with high school diplomas and less than two years clean. These “facilitators” are allowed to sit in on “clinical meetings” where doctors and therapists discuss a patient’s medical condition.
But say an addict has another medical condition – schizophrenia or bipolar – or is pregnant or has Hepatitis C which was disclosed during a private session with a licensed therapist and then the therapist then shares that information with the “clinical team” whose members include the “facilitators” who are not medical professionals and have not formal training.
Is that a violation of HIPPA? Perhaps no. The patient probably signed a HIPPA waiver upon admission, allowing those treating her to share information. But consider this: the patient may be a 21-year-old addict who has been using heroin, methamphetamine, crack, pot and alcohol since since age 14, dropped out of high school and has been clean for 30 days.
Is that patient competent to sign a HIPPA waiver which allows his therapist to share medical information with “facilitators?” Say that addict – still high – was put on a plane 31-days ago in New Jersey – where it was 10-degrees – and flown to a treatment center in Florida, where it is 75-degrees and the beach is a mile away.
You think that kid really understands or gives a damn about HIPPA?
The staff at the IOP also share a patient’s medical information with the operators of the sober house where the kid lives. Sober homes have no medical staff. Yet these operators – landlords who provide structured, sober living environments – discuss medical information, such as prescription drug compliance, with staff at the IOP.
Addiction is among the most stigmatized illnesses in the DSM-V. You are dealing with a patient population that has already proven their inability to make healthy, safe and rational decisions. If there was ever a patient population that needed its medical records protected, it’s addicts.
If you have any thoughts on how HIPPA should be applied to this very vulnerable patient population, you can share them with SAMHSA. The Department of Health and Human Services, which oversees SAMHSA, is accepting public on the proposed rule through April 11. Click here to offer your thoughts.
Medical records image available from Shutterstock.