Independent Perspective News

Dr. David Korn, senior vice president of the Association of American Medical Colleges, said: "Community hospitals are becoming much less willing to give researchers access to medical information on their patients, including those who were treated 5, 10 or 15 years ago. Some hospitals have concluded that the burden and costs and the threat of liability are not worth it."

The rules, issued under a 1996 law, the Health Insurance Portability and Accountability Act, were written by the Clinton administration and endorsed, with changes, by the Bush administration.

Advocates of the rules cite many cases in which people were harmed or embarrassed by a breach of medical privacy. Workers with H.I.V. or mental illness have lost their jobs. Computer hackers have gained access to treatment records for thousands of patients. Drugstores have shared records with companies marketing prescription drugs.

In general, the rules say, health care providers must limit the disclosure of personal health information to the "minimum necessary" to achieve a given purpose. In practice, that means a multitude of changes.

Many doctors have changed sign-in sheets in their offices, so patients do not have to indicate the reasons for their visits. Dr. Conrad L. Flick of Raleigh, N.C., said he had removed the names of patients from the outside cover of their charts and installed a glass partition, so staff members could not be overheard as they schedule appointments on the telephone.

Many doctors, like Deborah G. Haynes in Wichita, Kan., have taken a simple precaution to conceal patients' names. When charts are placed in boxes or racks outside examining rooms, nurses make sure the names face the wall.

Elsewhere, doctors and nurses have been told to lower their voices and minimize the use of patients' names in hallway conversations. Many doctors' offices and hospitals have installed privacy screens on computers.

Montefiore Medical Center in the Bronx has put up walls in the reception area where patients are interviewed prior to admission.

Giant Food, which operates more than 100 pharmacies at its grocery stores in the Washington area, has told shoppers to "expect some delays at the pharmacy counter." Under the federal rules, Giant notes, each person filling a prescription will be given a notice of the company's privacy practices and will be asked to sign a form acknowledging receipt.

In a leaflet for customers, Giant says: "You must now pay for all prescriptions and regulated items, such as insulin and needles, in the pharmacy. This procedure keeps your health information from being shared with other store associates, who are not trained in privacy compliance." Until now, Giant customers could pay for prescriptions in the grocery checkout lines.

Many Blue Cross and Blue Shield plans will not discuss claims with the spouse of a subscriber unless the subscriber has signed a form authorizing such discussions.

At Blue Hill Memorial Hospital, on the coast of Maine, Linda O. Abernethy, director of patient care services, said the federal rules made it more difficult to arrange for meals to be delivered to people discharged from the hospital.

"In the old days," she said, "a social worker could pick up the phone and ask Meals on Wheels to deliver lunch to Mrs. Jones five days a week. Under the federal rules, we'll now have to get a release from Mrs. Jones so we can tell Meals on Wheels that, as a diabetic with cardiac problems, she has special dietary needs."

William A. Dombi, vice president of the National Association for Home Care, said the federal rules were changing the culture of home care agencies, making it impossible for nurses to tell patients about the condition of homebound neighbors. "A visiting nurse can no longer tell Mabel that Gladys, with her broken hip, is walking better than she did last month," Mr. Dombi said. "Those informal communications are no longer allowed."

Under the rules, a hospital can disclose a patient's "condition, described in general terms" — good, fair, serious or critical — but only to callers who ask for the patient by name. If a journalist asks about patients injured in an auto accident but does not know their names, the hospital is not permitted to release any information. Moreover, each patient must be given an opportunity to opt out of the hospital directory. In that case, the hospital will not confirm whether the person is a patient.

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