President allows medical privacy rules to take effect

But Bush may revisit industry concerns later


WASHINGTON - President Bush announced yesterday that he would allow sweeping rules to protect the privacy of medical records to go into effect tomorrow.

But he said the rules, issued by President Bill Clinton, could be modified later to address "legitimate concerns" of the health care industry.

By allowing the rules to take effect, despite the administration's view that some provisions are unworkable, Bush avoided the firestorm of criticism that surrounded the rollback of other Clinton administration policies. Those policies dealt with arsenic in drinking water, global warming and the prevention of repetitive-stress injuries in the workplace, among other issues.

In reversing many Clinton policies, Bush ran the political risk that he would cement an image of his administration as pro-business and anti-consumer.

Rather than suffer another embarrassment like the one last week over salmonella in school lunch meat, Bush took a more nuanced approach yesterday, embracing the popular cause of medical privacy while opening the door to changes sought by the regulated industry.

"I believe that we must protect both vital health care services and the right of every American to have confidence that his or her personal medical records will remain private," Bush said.

At the same time, Bush left room for his administration to revise the rules, asking the secretary of health and human services, Tommy G. Thompson, to suggest "appropriate modifications" in order to avoid disrupting routine operations of the health care industry.

Bush's decision guarantees a new struggle over details of the rules and their interpretation.

The rules establish the first comprehensive federal standards for medical privacy and will affect virtually every doctor, patient, hospital, pharmacy and health insurance plan in the United States.

The decision was a victory for consumer groups and privacy advocates, without being an utter defeat for the health care industry and insurance companies, which strenuously opposed the rules.

Democrats, consumer groups and privacy advocates praised the Bush administration. Hospital executives and other health care providers said they were profoundly disappointed.

Peter R. Swire, chief privacy officer in the Clinton White House, said: "Today's decision by President Bush sends a clear signal to industry that it's time to stop the delay and get to work protecting privacy. But there's a risk that possible future modification of the rules could turn into very large exceptions."

The American Civil Liberties Union welcomed the "surprise decision," but said it saw "ominous signs" that the administration might weaken the rules - by reducing patients' control over their medical files and by giving parents access to medical records when minors had abortions.

Thompson said Bush was taking "a bold and definitive step" to protect privacy rights. "The president considers this a tremendous victory for American consumers," the secretary said.

In the past month, Thompson publicly expressed concern that the rules could impose a "tremendous burden" and cost on health care providers. At a news conference on Monday, he said the effective date of the rules would probably be delayed.

In an interview yesterday, Thompson said: "I have not changed my opinion with regard to the need for changes. There has to be some fix-up of the rules to inject a greater degree of common sense."

Under the rules, doctors, hospitals and other health care providers must obtain written consent from patients before using or disclosing medical information even for routine purposes such as treatment or the payment of claims. Patients would, for the first time, have a federal right to inspect and copy their records and could propose corrections.

The rules cover not only paper records, but also electronic records and oral communications that could reveal "individually identifiable health information."

The ACLU and the American Psychoanalytic Association had threatened to sue the government if it delayed the rules.

The changes

What privacy rules will do:

Require health care and insurance providers to get permission before disclosing personal patient information.

Allow patients to get copies of their records and request amendments.

Require people who handle medical data to account for disclosures outside their organization for purposes other than treatment or payment.

Allow government to impose fines and criminal penalties on those who misuse the medical information.

What modifications will do:

Allow physicians to share medical information with specialists treating the same patients.

Permit pharmacists to fill prescriptions over the phone.

Allow parents to get information about their children, including records on mental health, drug use and abortion.

Source: U.S. Department of Health and Human Services

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