Delegates hear plea for patient consent Doctors, consumers support restriction on state database

March 19, 1997|By M. William Salganik | M. William Salganik,SUN STAFF

Psychiatrists, psychologists, medical groups and consumers urged the House Environmental Matters Committee yesterday to protect confidentiality by requiring patient consent before the state collects data on medical treatments and their costs.

The collectors of the information, however, said patients could not be identified from the database, and that it was a valuable tool in monitoring health care affordability and access.

Some committee members expressed skepticism about a consent requirement. Vice Chairman Michael H. Weir termed concerns over breaches of privacy "paranoia over a problem that doesn't exist." The Baltimore County Democrat said the database was being created "to try to cut health care costs to make care available to people who need it."

One witness, Dr. Richard S. Epstein, chair of the ethics committee of the American Psychiatric Association, responded to the comment on "paranoia," explaining, "as a psychiatrist I felt it's something I should comment on."

"Americans have always been suspicious of government," he said. "It's better to miss some of the data and preserve the integrity and trust in the health system."

Mimi Azrael, an attorney who testified for the Women's Law Center, said, "Medical privacy is the consumer issue of the '90s."

Dwight Sullivan, staff counsel to the American Civil Liberties Union of Maryland, agreed. "There will be citizens of Maryland who need medical help who will not seek help because they are afraid someone will get into the database," he said.

The bill requiring consent -- an identical bill has been introduced in the Senate and had a hearing last week -- would affect the collection of information by the Health Care Access and Cost Commission. The HCACC was created in 1993 as part of legislation aimed at creating a panel to study health costs and find ways to make affordable insurance available.

Beginning this year, all insurers in the state are required to submit information to HCACC on every "patient encounter" in a doctor's office or outpatient clinic. The state has been collecting similar information on hospital admissions for more than 20 years.

The computer tapes the state will receive, based on information doctors and other providers submit to insurers, will contain some information about the patient, such as ZIP code and month and year of birth. It will not include names or Social Security numbers, but will include encoded patient numbers.

Hal Cohen, a member of HCACC and a health consultant, said collecting information only from consenting patients "would bias the data" and that "verifying consent would be costly and burdensome."

Ernest Crofoot, representing the AFL-CIO's health committee, said the data was needed to control costs and "a vote for this bill is, in essence, a vote to end data collection in Maryland."

John M. Colmers, executive director of HCACC, said computer "hackers" would not be able to get to the data because there is no dial-up access. While it is possible an employee could be bribed to provide the data, he said, it would be more logical to try to bribe an employee in a doctor's office or insurance company, where the information would have names and other information attached.

But Franklin Goldstein, a lobbyist for the Maryland Psychiatric Society, said those who wanted information -- for example, to market products to people with diabetes -- would not want data on the limited number of patients of one doctor or insurer, and would try to breach the largest database available.

Pub Date: 3/19/97

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