AN ACT Relating to public health; and amending
RCW 70.02.010, 70.02.020, 70.02.030, 70.02.050, 70.02.080, 71.05.390, and
71.05.400; adding a new section to chapter 71.05 RCW; providing an effective
date; and declaring an emergency.
BE
IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:
Sec. 1.
RCW 70.02.010 and 1991 c 335 s 102 are each amended to read as follows:
As used in this chapter, unless the context
otherwise requires:
(1) "Audit" means an assessment,
evaluation, determination, or investigation of a health care provider by a
person not employed by or affiliated with the provider to determine compliance
with:
(a) Statutory, regulatory, fiscal, medical, or
scientific standards;
(b) A private or public program of payments to
a health care provider; or
(c) Requirements for licensing, accreditation,
or certification.
(2) "Directory information" means
information disclosing the presence, and for the purpose of identification,
the name, residence, sex, and the general health condition of a particular
patient who is a patient in a health care facility or who is currently
receiving emergency health care in a health care facility.
(3) "General health condition" means
the patient's health status described in terms of "critical,"
"poor," "fair," "good," "excellent," or
terms denoting similar conditions.
(4) "Health care" means any care,
service, or procedure provided by a health care provider:
(a) To diagnose, treat, or maintain a patient's
physical or mental condition; or
(b) That affects the structure or any function
of the human body.
(5) "Health care facility" means a
hospital, clinic, nursing home, laboratory, office, or similar place where a
health care provider provides health care to patients.
(6) "Health care information" means
any information, whether oral or recorded in any form or medium, that
identifies or can readily be associated with the identity of a patient and
directly relates to the patient's health care. The term includes any record of
disclosures of health care information.
(7) "Health care provider" means a
person who is licensed, certified, registered, or otherwise authorized by the
law of this state to provide health care in the ordinary course of business or
practice of a profession.
(8) "Institutional review board"
means any board, committee, or other group formally designated by an
institution, or authorized under federal or state law, to review, approve the
initiation of, or conduct periodic review of research programs to assure the
protection of the rights and welfare of human research subjects.
(9) "Maintain," as related to health
care information, means to hold, possess, preserve, retain, store, or control
that information.
(10) "Patient" means an individual
who receives or has received health care. The term includes a deceased
individual who has received health care.
(11) "Person" means an individual,
corporation, business trust, estate, trust, partnership, association, joint
venture, government, governmental subdivision or agency, or any other legal or
commercial entity.
(12) "Reasonable fee" means the
charges for duplicating or searching the record ((specified in RCW 36.18.020
(8) or (16), respectively)), but shall not exceed sixty-five cents per
page for the first thirty pages and fifty cents per page for all other pages.
In addition, a clerical fee for searching and handling may be charged not to
exceed fifteen dollars. These amounts shall be adjusted biennially in
accordance with changes in the consumer price index, all consumers, for
Seattle-Tacoma metropolitan statistical area as determined by the secretary of
health. However, where editing of records by a health care provider is
required by statute and is done by the provider personally, the fee may be the
usual and customary charge for a basic office visit.
(13) "Third-party payor" means an
insurer regulated under Title 48 RCW authorized to transact business in this
state or other jurisdiction, including a health care service contractor, and
health maintenance organization; or an employee welfare benefit plan; or a
state or federal health benefit program.
Sec. 2.
RCW 70.02.020 and 1991 c 335 s 201 are each amended to read as follows:
Except as authorized in RCW 70.02.050, a health
care provider, an individual who assists a health care provider in the delivery
of health care, or an agent and employee of a health care provider may not
disclose health care information about a patient to any other person without
the patient's written authorization. A disclosure made under a patient's
written authorization must conform to the authorization.
Health care providers or facilities shall chart
all disclosures, except to third-party ((health care)) payors, of health
care information, such chartings to become part of the health care information.
Sec. 3.
RCW 70.02.030 and 1991 c 335 s 202 are each amended to read as follows:
(1) A patient may authorize a health care
provider to disclose the patient's health care information. A health care
provider shall honor an authorization and, if requested, provide a copy of the
recorded health care information unless the health care provider denies the
patient access to health care information under RCW 70.02.090.
(2) A health care provider may charge a
reasonable fee((, not to exceed the health care provider's actual cost))
for providing the health care information((,)) and is not required to
honor an authorization until the fee is paid.
(3) To be valid, a disclosure authorization to
a health care provider shall:
(a) Be in writing, dated, and signed by the
patient;
(b) Identify the nature of the information to
be disclosed;
(c) Identify the name, address, and
institutional affiliation of the person to whom the information is to be
disclosed;
(d) Except for third-party payors, identify
the provider who is to make the disclosure; and
(e) Identify the patient.
(4) Except as provided by this chapter, the
signing of an authorization by a patient is not a waiver of any rights a
patient has under other statutes, the rules of evidence, or common law.
(5) A health care provider shall retain each
authorization or revocation in conjunction with any health care information
from which disclosures are made. This requirement shall not apply to
disclosures to third-party ((health care)) payors.
(6) Except for authorizations given pursuant
to an agreement with a treatment or monitoring program or disciplinary
authority under chapter 18.72 or 18.130 RCW or to provide information to
third-party ((health care)) payors, an authorization may not permit the
release of health care information relating to future health care that the
patient receives more than ninety days after the authorization was signed.
Patients shall be advised of the period of validity of their authorization on
the disclosure authorization form. If the authorization does not contain an
expiration date, it expires ninety days after it is signed.
(((7) Except for authorizations to provide
information to third-party health payors, an authorization in effect on July
28, 1991, remains valid for six months after July 28, 1991, unless an earlier
date is specified or it is revoked under RCW 70.02.040. Health care
information disclosed under such an authorization is otherwise subject to this
chapter. An authorization written after July 28, 1991, becomes invalid after
the expiration date contained in the authorization, which may not exceed ninety
days. If the authorization does not contain an expiration date, it expires
ninety days after it is signed.))
Sec. 4.
RCW 70.02.050 and 1991 c 335 s 204 are each amended to read as follows:
(1) A health care provider may disclose health
care information about a patient without the patient's authorization to the
extent a recipient needs to know the information, if the disclosure is:
(a) To a person who the provider reasonably
believes is providing health care to the patient;
(b) To any other person who requires health
care information for health care education, or to provide planning, quality
assurance, peer review, or administrative, legal, financial, or actuarial
services to the health care provider; or for assisting the health care provider
in the delivery of health care and the health care provider reasonably believes
that the person:
(i) Will not use or disclose the health care
information for any other purpose; and
(ii) Will take appropriate steps to protect the
health care information;
(c) To any other health care provider
reasonably believed to have previously provided health care to the patient, to
the extent necessary to provide health care to the patient, unless the patient
has instructed the health care provider in writing not to make the disclosure;
(d) To any person if the health care provider
reasonably believes that disclosure will avoid or minimize an imminent danger
to the health or safety of the patient or any other individual, however there
is no obligation under this chapter on the part of the provider to so disclose;
(e) Oral, and made to immediate family members
of the patient, or any other individual with whom the patient is known to have
a close personal relationship, if made in accordance with good medical or other
professional practice, unless the patient has instructed the health care
provider in writing not to make the disclosure;
(f) To a health care provider who is the
successor in interest to the health care provider maintaining the health care
information;
(g) For use in a research project that an
institutional review board has determined:
(i) Is of sufficient importance to outweigh the
intrusion into the privacy of the patient that would result from the
disclosure;
(ii) Is impracticable without the use or
disclosure of the health care information in individually identifiable form;
(iii) Contains reasonable safeguards to protect
the information from redisclosure;
(iv) Contains reasonable safeguards to protect
against identifying, directly or indirectly, any patient in any report of the
research project; and
(v) Contains procedures to remove or destroy at
the earliest opportunity, consistent with the purposes of the project,
information that would enable the patient to be identified, unless an
institutional review board authorizes retention of identifying information for
purposes of another research project;
(h) To a person who obtains information for
purposes of an audit, if that person agrees in writing to:
(i) Remove or destroy, at the earliest
opportunity consistent with the purpose of the audit, information that would
enable the patient to be identified; and
(ii) Not to disclose the information further,
except to accomplish the audit or report unlawful or improper conduct involving
fraud in payment for health care by a health care provider or patient, or other
unlawful conduct by the health care provider;
(i) To an official of a penal or other
custodial institution in which the patient is detained;
(j) To provide directory information, unless
the patient has instructed the health care provider not to make the disclosure;
(k) In the case of a hospital or health care
provider to provide, in cases reported by fire, police, sheriff, or other
public authority, name, residence, sex, age, occupation, condition, diagnosis,
or extent and location of injuries as determined by a physician, and whether
the patient was conscious when admitted.
(2) A health care provider shall disclose
health care information about a patient without the patient's authorization if
the disclosure is:
(a) To federal, state, or local public health
authorities, to the extent the health care provider is required by law to
report health care information; when needed to determine compliance with state
or federal licensure, certification or registration rules or laws; or when
needed to protect the public health;
(b) To federal, state, or local law enforcement
authorities to the extent the health care provider is required by law;
(c) Pursuant to compulsory process in
accordance with RCW 70.02.060.
(3) All state or local agencies obtaining
patient health care information pursuant to this section shall adopt rules
establishing their record acquisition, retention, and security policies that
are consistent with this chapter.
Sec. 5.
RCW 70.02.080 and 1991 c 335 s 301 are each amended to read as follows:
(1) Upon receipt of a written request from a
patient to examine or copy all or part of the patient's recorded health care
information, a health care provider, as promptly as required under the
circumstances, but no later than fifteen working days after receiving the
request shall:
(a) Make the information available for
examination during regular business hours and provide a copy, if requested, to
the patient;
(b) Inform the patient if the information does
not exist or cannot be found;
(c) If the health care provider does not
maintain a record of the information, inform the patient and provide the name
and address, if known, of the health care provider who maintains the record;
(d) If the information is in use or unusual
circumstances have delayed handling the request, inform the patient and specify
in writing the reasons for the delay and the earliest date, not later than
twenty-one working days after receiving the request, when the information will
be available for examination or copying or when the request will be otherwise
disposed of; or
(e) Deny the request, in whole or in part,
under RCW 70.02.090 and inform the patient.
(2) Upon request, the health care provider
shall provide an explanation of any code or abbreviation used in the health
care information. If a record of the particular health care information
requested is not maintained by the health care provider in the requested form,
the health care provider is not required to create a new record or reformulate
an existing record to make the health care information available in the
requested form. The health care provider may charge a reasonable fee((, not
to exceed the health care provider's actual cost,)) for providing the
health care information and is not required to permit examination or copying
until the fee is paid.
Sec. 6.
RCW 71.05.390 and 1990 c 3 s 112 are each amended to read as follows:
The fact of admission and all information and
records compiled, obtained, or maintained in the course of providing services
to either voluntary or involuntary recipients of services at public or private
agencies shall be confidential.
Information and records may be disclosed only:
(1) In communications between qualified
professional persons to meet the requirements of this chapter, in the provision
of services or appropriate referrals, or in the course of guardianship
proceedings. The consent of the patient, or his or her guardian, ((must))
shall be obtained before information or records may be disclosed by a
professional person employed by a facility to a professional person, not
employed by the facility, who does not have the medical responsibility for the
patient's care or who is not a designated county mental health professional or
who is not involved in providing services under the community mental health
services act, chapter 71.24 RCW.
(2) When the communications regard the special
needs of a patient and the necessary circumstances giving rise to such needs
and the disclosure is made by a facility providing outpatient services to the
operator of a care facility in which the patient resides.
(3) When the person receiving services, or his or
her guardian, designates persons to whom information or records may be
released, or if the person is a minor, when his or her parents make such
designation.
(4) To the extent necessary for a recipient to
make a claim, or for a claim to be made on behalf of a recipient for aid,
insurance, or medical assistance to which he or she may be entitled.
(5) For either program evaluation ((and/or))
or research, or both: PROVIDED, That the secretary of social and
health services adopts rules for the conduct of ((such)) the
evaluation ((and/or)) or research, or both. Such rules
shall include, but need not be limited to, the requirement that all evaluators
and researchers must sign an oath of confidentiality substantially as follows:
"As a condition of conducting evaluation
or research concerning persons who have received services from (fill in the
facility, agency, or person) I,
. . . . . . . . ., agree not to
divulge, publish, or otherwise make known to unauthorized persons or the public
any information obtained in the course of such evaluation or research regarding
persons who have received services such that the person who received such
services is identifiable.
I recognize that unauthorized release of
confidential information may subject me to civil liability under the provisions
of state law.
/s/................................................................................................................... "
(6) To the courts as necessary to the
administration of this chapter.
(7) To law enforcement officers, public health
officers, or personnel of the department of corrections or the indeterminate
sentence review board for persons who are the subject of the records and who
are committed to the custody of the department of corrections or indeterminate
sentence review board which information or records are necessary to carry out
the responsibilities of their office. Except for dissemination of information
released pursuant to RCW 71.05.425 and 4.24.550, regarding persons committed
under this chapter under RCW 71.05.280(3) and 71.05.320(2)(c) after dismissal
of a sex offense as defined in RCW 9.94A.030, the extent of information that
may be released is limited as follows:
(a) Only the fact, place, and date of
involuntary admission, the fact and date of discharge, and the last known
address shall be disclosed upon request; and
(b) The law enforcement and public health
officers or personnel of the department of corrections or indeterminate
sentence review board shall be obligated to keep such information confidential
in accordance with this chapter; and
(c) Additional information shall be disclosed
only after giving notice to said person and his or her counsel and upon
a showing of clear, cogent and convincing evidence that such information is
necessary and that appropriate safeguards for strict confidentiality are and
will be maintained((: PROVIDED)). However, ((that))
in the event the said person has escaped from custody, said notice prior to
disclosure is not necessary and that the facility from which the person escaped
shall include an evaluation as to whether the person is of danger to persons or
property and has a propensity toward violence.
(8) To the attorney of the detained person.
(9) To the prosecuting attorney as necessary to
carry out the responsibilities of the office under RCW 71.05.330(2) and
71.05.340(1)(b) and 71.05.335. The prosecutor shall be provided access to
records regarding the committed person's treatment and prognosis, medication,
behavior problems, and other records relevant to the issue of whether treatment
less restrictive than inpatient treatment is in the best interest of the
committed person or others. Information shall be disclosed only after giving
notice to the committed person and the person's counsel.
(10) To appropriate law enforcement agencies
and to a person, when the identity of the person is known to the public or
private agency, whose health and safety has been threatened, or who is known to
have been repeatedly harassed, by the patient. The person may designate a
representative to receive the disclosure. The disclosure shall be made by the
professional person in charge of the public or private agency or his or her designee
and shall include the dates of admission, discharge, authorized or unauthorized
absence from the agency's facility, and only such other information that is
pertinent to the threat or harassment. The decision to disclose or not shall
not result in civil liability for the agency or its employees so long as the
decision was reached in good faith and without gross negligence.
(11) To the persons designated in RCW 71.05.425
for the purposes described in that section.
(12) Civil liability and immunity for the
release of information about a particular person who is committed to the
department under RCW 71.05.280(3) and 71.05.320(2)(c) after dismissal of a sex
offense as defined in RCW 9.94A.030, is governed by RCW 4.24.550.
(13) To a patient's next of kin, guardian,
or conservator, if any, in the event of death, as provided in RCW 71.05.400.
(14) To the department of health of the
purposes of determining compliance with state or federal licensure,
certification, or registration rules or laws. However, the information and
records obtained under this subsection are exempt from public inspection and
copying pursuant to chapter 42.17 RCW.
The fact of admission, as well as all records,
files, evidence, findings, or orders made, prepared, collected, or maintained
pursuant to this chapter shall not be admissible as evidence in any legal
proceeding outside this chapter without the written consent of the person who
was the subject of the proceeding except in a subsequent criminal prosecution
of a person committed pursuant to RCW 71.05.280(3) or 71.05.320(2)(c) on
charges that were dismissed pursuant to chapter 10.77 RCW due to incompetency
to stand trial or in a civil commitment proceeding pursuant to chapter 71.09
RCW. The records and files maintained in any court proceeding pursuant to this
chapter shall be confidential and available subsequent to such proceedings only
to the person who was the subject of the proceeding or his or her
attorney. In addition, the court may order the subsequent release or use of such
records or files only upon good cause shown if the court finds that appropriate
safeguards for strict confidentiality are and will be maintained.
Sec. 7.
RCW 71.05.400 and 1974 ex.s. c 115 s 1 are each amended to read as follows:
(1) A public or private agency shall release to
a patient's next of kin, attorney, guardian, or conservator, if any,
(a) The information that the person is
presently a patient in the facility or that the person is seriously physically
ill;
(b) A statement evaluating the mental and
physical condition of the patient, and a statement of the probable duration of
the patient's confinement, if such information is requested by the next of kin,
attorney, guardian, or conservator; and such other information requested by the
next of kin or attorney as may be necessary to decide whether or not
proceedings should be instituted to appoint a guardian or conservator.
(2) Upon the death of a patient, his or her
next of kin, guardian, or conservator, if any, shall be notified.
Next of kin who are of legal age and competent
shall be notified under this section in the following order: Spouse, parents,
children, brothers and sisters, and other relatives according to the degree of
relation. Access to all records and information compiled, obtained, or
maintained in the course of providing services to a deceased patient shall be
governed by RCW 70.02.140.
NEW SECTION. Sec. 8. A
new section is added to chapter 71.05 RCW to read as follows:
Except as otherwise provided in this chapter,
the uniform health care information act, chapter 70.02 RCW, applies to all
records and information compiled, obtained, or maintained in the course of
providing services.
NEW SECTION. Sec. 9.
This act is necessary for the immediate preservation of the public peace,
health, or safety, or support of the state government and its existing public
institutions, and shall take effect July 1, 1993.
