Dissemination of Medical Information

Questions concerning the release of medical information have plagued physicians for years. The issue as to what information may be released and to whom it may be released seems like a web created to trap the unwary practitioner. However, there are legal concepts, statutes and case law which have established basic guidelines for the physician. These are generally divided into two main categories: the patients' right to information and the rights of others.

To begin with, the patient, obviously, has the right to information concerning his own care. Although the physician owns the medical records, both he and the patient own the information contained therein. Should a patient request copies of his records, the physician is required to provide those to the patient. The release may not be conditioned upon the payment of a disputed fee. The patient may also authorize another, in writing, to procure copies on his behalf. If he does so, that individual has the same rights as the patient. Without such an authorization or court subpoena, this information should not be divulged to others unless a legal exception exists.

In understanding the release of such information to persons other than the patient, one starts with the premise that there is no doctor/patient privilege in Florida. Does the absence of such a privilege mean that a physician may, without restriction, make public the affairs of his patients? No. Each physician has taken an Oath which binds him morally to keep private the affairs of his patients. In addition, a patient might assert that he has contracted with his physician not only for care and treatment, but for confidentiality. Under what circumstances then, do exceptions to confidentiality exist?

One of the most common exceptions concerns requests by attorneys for medical information. If an attorney has the written authorization of a patient, he is entitled to records and to conferences with the physician. Even without such an authorization, an attorney for either side has the right to discuss a patient's medical care and treatment as it relates to a pending lawsuit. Physicians are considered in the same category as fact witnesses and no subpoena is necessary to discuss a patient's treatment with them. There is, however, a quirk in the law in this regard. Although the physician is free to discuss the litigant's medical care with either side, he should not release a copy of the medical records without written authorization or subpoena.

Another area of concern is the release of information to family members. The law does not provide for the release of medical information to the relatives of a competent adult patient. Each individual has the right to make his own decisions regarding medical care and to decide what information is disseminated. Although this does not usually cause a problem, if the physician is aware that information may be sensitive, he should use discretion in providing it to the spouse or other family member. However, this does not apply in a situation where the patient has become incompetent. In such circumstances where there is no legally appointed guardian, the next of kin may have the right to consent to medical care and would have the right to receipt of information.

The law is more complex with regard to minors. A parent or legal guardian who has the responsibility to care for a minor until age eighteen generally has the right to all information with regard to that child. Florida Statutes recognize the right of minors to consent to certain medical treatment without their parents' authority (pregnancy other than abortion, drug abuse and alcoholism); however, the statutes that create these rights do not specifically provide that the information regarding the treatment may be kept from the natural parent or guardian. As a result, it would appear that the parent would have a right to such information. As with the above conditions, a minor alone may also consent to treatment for venereal disease. In this circumstance, however, the physician has the discretion to decide whether or not to divulge information concerning the medical care to the parents.

There are circumstances under which a physician must disclose medical information to others. These primarily consist of reports to various state agencies and include the following:

1. Termination of a pregnancy.
    
2. Reports of diagnosis or treatment of venereal disease.
    
3. Reasonable suspicion that a child has been abused or neglected.
    
4. Reasonable suspicion that an aged or disabled person has been abused, neglected or exploited.
    
5. Treatment of a person suffering from a gunshot wound or other wound indicating violence or a receipt of a request for such treatment.
    
6. Births and deaths.

Interestingly, Florida does allow the physician to provide data concerning treatment to certain research groups to be used in the course of any study of reducing morbidity or mortality.

It is often necessary for a physician to disseminate medical information to his staff, other practitioners or hospital personnel during the course of care and treatment. Beyond this purpose, however, and in spite of the fact that there is no doctor/patient privilege in the State of Florida, medical information should be kept confidential. This article is not meant to be exhaustive or provide answers to specific situations. When in doubt, the physician should withhold the information and consult his attorney.