HIPAA within context of marriage I am finding out that my ex-wife may have kept from me a genetic predisposition to Down syndrome and other abnormalities in the baby. The physician did not tell me about this either. I want to know what were my rights as the father. Did they have an obligation to disclose this information?
The regulations known as HIPAA are here. A good place to start is with who the regulations apply to. §160.10 lays that out: a health plan, health care clearinghouse, care provider, their business associates, and the Inspector General. Family members are not regulated entities. Subpart E regulates individually identifiable health information (such as "person X has condition Y") – this is protected information. §164.502 states that A covered entity or business associate may not use or disclose protected health information except as permitted or required by this subpart or by subpart C of part 160 of this subchapter. The first permitted use / disclosure is that the information may be revealed to the individual (the individual). Under 164.502(a)(2)(1) they are required to reveal information to an individual "when requested under, and required by §164.524 or §164.528" (you have a right to see your own record; you have a right to know who knows). 164.502(g) requires the covered entity to treat the "Personal Representative" as the same as the individual, and then there is a list of conditions surrounding being a personal representative, reducing to being empowered under law to act on behalf of the individual in making health decisions (it gets complicated in dealing with minors). 164.510 covers disclosure in emergencies, and under (b)(2) allows disclosure to a family member with advance consent of the individual. And so on. There is no general rule "and the covered entity may / must reveal private information to an interested individual", even a spouse, without consent of the individual. In other words, the doctor has an obligation to not disclose this information, unless permitted by the individual.
Not much. Consider the following: The father can not force the mother to abort the pregnancy. Ex post facto agreements of non-payment are, in all likelihood, unenforceable. The father will be obligated to pay child support under the laws of the state with jurisdiction over the paternity. The abortion angle won&rsquo;t work. Setting aside commentary regarding the politics or ethics of abortion. I think we can agree it is a highly charged and emotional topic for some people. I point to the fact it always seems to be an issue during Supreme Court nominations and presidential elections. Given the explosive nature of the issue of whether abortions should be legal or not (in the case where the mother does not want to carry full term) could you imagine how much more dynamite it would add to the debate if the question were whether or not to allow the father to force the mother to terminate the pregnancy against the mother's wishes! One can only imagine how much more bombastic the abortion debate might then become. You can&rsquo;t escape child support (most likely). To give you a sense of how difficult it is to escape the obligations of child support. Consider the following... A Kansas man was ordered to pay child support when he thought he was being a sperm donor only and signed numerous agreements with the lesbian couple he thought he was helping. In that case, the court justified its ruling on the grounds that a doctor was not involved in the insemination process. But nothing prevents future courts from making the same ruling in cases where a doctor is involved in the insemination process. Especially if that state either withdraws from the The Uniform Parentage Act, amends it, repeals it, or never adopts it in the first place. Sperm Donors and Child Support: Even in cases in which the donor is known, but holds himself out as unknown, some courts have held the donor legally obligated to pay child support. Read more here. Ex post facto agreements are problematic. Now that you've edited the question, the above link is even more useful for providing a possible avenue to try (albeit unlikely to work): a non-payment agreement. The discussion in that link describes that even if you could somehow convince the mother to go along with it, it is unlikely (though not impossible) to be enforced by the courts. It depends on the facts (e.g., intercourse vs. in vitro), circumstances (e.g., relationship vs. no relationship between the parties), timing (e.g., before vs. after the agreement), etc. of the impregnation itself. Notwithstanding all the above, if you still have questions, you might consider floating an idea of an approach you think you might try (in a separate question) and get reactions to that specific proposal.
This is what we mean when we say something falls between the cracks. Sorry for that. First off, in the United States, family law is not federal, it is individual to each state. This means there is no federal agency or official charged with enforcing family law. When it comes to marriage and divorce, the federal government and their border agents are after those seeking to gain benefit through fraud (i.e., attempting to attain status through fraudulent marriage). Likewise, they don't have formal cross-jurisdictional protocols controlling the right of the US government to demand personal, private family law records from other governments. Nor do they have the means to pursue that. What this means, in practical terms, is that no family law judge sitting in the US has authority, interest or means in international marriage and divorce beyond those cases initiated in their court. I hope you read that slowly and carefully. Ask me if you need clarification. I suspect that you have a very specific cause in mind that necessitates you being in possession of a divorce decree. And I get the impression that you and your ex-spouse are in agreement and working together to solve this. You might find it valuable, at this point, to take a step back a little further into history. Let's consider your marriage. You two know you got married. I suspect that your friends, loved ones, and hopefully family know you got married. Then there is that clerk somewhere in Denmark (who records more than 100 marriages every week) who knows you got married. Theoretically. Possibly. Maybe. You've been residing in Russia for some years now, and the Russian government doesn't know you are married. Marriage is illegal there. So, in actuality the Russian government, if asked by some official of some other government, can only state with truth and authority that it is certain that you are NOT married. At the same time, some US federal official decides to investigate the most highly unlikely case ever. Someone is trying to gain entry, not by claiming marriage but by hiding a marriage. (ridiculous!) So, with a budget of zero, and the authority to match, goes from country to country demanding that they open up the (extremely) private records of family courts in search of the evidence he needs. When they ask him to demonstrate cause, he boldly tells them that his sharp mind is cause enough. They agree and give him cups of tea as he searches through the private affairs of their residents. It is never-ending, but he is proud to be working to stop the flood of unwanted divorced persons trying to gain entry to the USA. - - - - You get the picture. Also, consider the option of an international divorce. I would provide a reference here, but a simple Google search will yield many providers. It is expensive and time-consuming, but an available option. I'd rank it last. There are also varied laws by jurisdiction - internationally. I'm not expert enough to know of any jurisdictions that might not require extended residency. I suspect some won't. I am confident, on the other hand, that there are several that you might access with relative short windows of required residency. This Wikipedia article should give you a good start. You are also maybe a little fast in dismissing Denmark as a possible venue. European Union states, at one time, experienced a tangled mess regarding family law across jurisdictions and specifically divorce. In 2003, however, the EU implemented Regulation 2201/2003 providing for conferred jurisdictional competence by way of exception in cases involving applicants for divorce similarly situated to you. And now jurisprudence, in a wonderful show, is beginning to catch up with regulation and public sentiment on the matter. The provisions seem complicated, but they are definitely outside the abilities of a couple of Russians who have managed to get this far. Here's a starting point to get the ball rolling. Aside from those three solutions, you might be stuck. You would be ill-advised to seek some creative solution outside of the law. And I struggle to think of anything that might work. Unfortunately, justice and law are often connected by a mere thread, and sometimes not at all. You are left to forge ahead on behalf of others, who enjoy the fruits of your labour. For that, you have our gratitude. And while I am no expert on the fight for justice, There is this man - an American, who is. He wasn't gay, so much as black. Be he figured out a lot regarding justice. There are two types of laws: just and unjust. I would be the first to advocate obeying just laws. One has not only a legal but a moral responsibility to obey just laws. Conversely, one has a moral responsibility to disobey unjust laws. I would agree with St. Augustine that "an unjust law is no law at all." -Martin Luther King Jr. I salute you.
In the United States, the main statute governing the use of health care information is HIPAA, the Health Insurance Portability and Accountability Act. HIPAA and its related statutes and regulations detail what you can and can't do with medical information. You can't always collect it; if you do, you can't always share it, and you can't always delete it. This is a complex field of law and it's easy to screw up in a way that would cause big, serious, company-destroying, job-ending problems for everyone involved. To put this another way: this is absolutely, positively, not something you want to get advice on from strangers on the internet. You don't just need a lawyer; you need a HIPAA specialist--or the equivalent in whatever other countries you plan to operate in--before you push anything out to real-life patients, especially children.
Note: All links in Spanish (sorry). Regardless or your father being or not the legal owner of the home, the issue at play is that of alimentos1. This is an obligation between some family relationships to help each other so if family member (the alimentista) is in dire need of help (i.e., needs the help to survive) the others have the obligation to provide the help. The relatives of the alimentista affected are, in order: The couple, always when married and only when expressly agreed upon for non-married couples. Descendants: sons/daughters and grandsons/granddaughters. Ascendants: parents and grandparents. Brothers: Only when indispensable and the minimum amount. The order determines who of all the family members is under obligation to provide the help; in case of multiple people in the same category the amount is to be divided between them in function of their income. The amount of the help is not fixed and will depend of the circunstances of the situation2; and it is possible to provide by providing the needs(shelter, food) directly. Now, until when does a father/grandfather need to provide alimentos to a son or daughter? Certainly until s/he is 183, as this is the date of full age in Spain, but it is usual to consider that the obligation exists while the alimentista is studying and lacks of his/her own means of subsistence. That is not a "free rider" situation, as alimentos may be denied by several reasons: Obviously, because the person that should provide the help does not have the means to do so without endangering his own subsistence. The alimentista gets his/her own means of subsistence. Any of the causes that would make the alimentista unable to inherit from the person providing the help4: attempted murder, coercion to change their will, and other grave crimes. The alimentista does not do enough to get his/her own means of subsistence. If a judge decides that the alimentista son/daughter is neither studying nor seriously trying to get a job, the help can be revoked. Judges seem to be progressively taking a harsher stance against descendants who refuse to do their part. The article quotes the case of a 19 years old guy whose claim to the pension was denied. As a side note, rejecting to pay alimentos is another of the causes that would cause the person doing it to lose any right to inheritance from the alimentista. If for whatever the reason you do not qualify for alimentos, the details of the agreement between your father and your grandfather for the home become relevant5: If your father has formally rented the house then your grandfather position is not relevant, as your father has all of the rights6. If your grandfather allows your father to live in the house without paying rent, then it is your grandfather rights as owner against your father rights as an occupant. No idea about the outcome of that situation. UPDATE: You still do not tell about your grandfather stance about the issue, which is important. If your grandfather agrees with your father7 then the only way to stay at home is that of alimentos. What you describe is a situation of either precario or comodato, where your grandfather allows the use of the home without compensation. The differences are: precario is for an undefined time. comodato is for a defined time/use (e.g. for X years). Now, I have to suppose that you are not part of the agreement so it is just between your father and grandfather. That makes it your father's dwelling, and beyond alimentos he cannot be forced to share his dwelling with you. But if this is a situation of precario (which is what most often happens) your grandfather has the "nuclear option"8 of threatening to evict your father, as it is a relatively easy (in the legal sense, not the personal one) procedure. In a situation of comodato your grandfather could not evict your father until the conditions of the cession expire, making threats somewhat weaker. As a final note, and given how specific this answer has become: I am not a lawyer, you have not provided enough specific info, and this is not legal advice. Talk to a lawyer. Maybe a lawyer will check the agreement and it will turn out that your father is paying rent by performing some service, voiding the precario aspect. Maybe with the details provided the lawyer can find a way to an agreement that is more amenable to all. Talk to a lawyer. Shut up. The issue at hand may be stressful, and sometimes it might be tempting to boast to your father about the issues of alimentos or precario. Don't. If there is something to be said about that, let your lawyer do the talking. Try to stay calm. Consider the effect of your actions before taking them. While there is nothing wrong with talking to a lawyer, going beyond that and beginning a legal battle with members of your own family is most of the times an ugly affair. It could easily have an effect for a very long time in your relationship with most of your family, even with those who are not directly implied. Try to stay calm. 1 Literally, "foodstuffs", but when used as a legal term it includes other basic needs. 2 There are some official guidelines but judges seem to have freedom to follow them or not. 3 I believe that there are some exceptional reasons to lose such right before becoming 18 (e.g., sons condemned of attacking their fathers and the like) but I have no specific data about those. 4 As a side note, in Spain last wills do not allow the "donor" to distribute the goods freely, as some porcentajes of the inheritance must obligatory be provided to descendants and widowers. 5 Of course, in the case that your grandfather wanted to oppose your father's decision. 6 Since one of the legal reasons to end a rent agreement is to provide a home for a first degree relative, your grandfather could expel you from your rented home to give it to your father, but not the other way around. 7 And "agree" does not mean "Is happy with the decision" but "Will not go to the court to challenge your father decision". 8 Which is a very relevant analogy, because it could be almost as damaging to your family as a literal nuclear bomb.
I don’t understand why you think this is a “3rd party communication” - as I read it it says it’s an email from you. You are most definitely not a third party. Notwithstanding, communication between 3rd parties is not prima facie excluded. For example, correspondence between your company and your accountant (who are both third parties) is likely to be extremely relevant to a family law case. Assuming that it is relevant (which is hard to say without context) and that it doesn’t fall foul of one of the evidentiary rules (hearsay, opinion, privilege etc.) there is no reason why it wouldn’t be admissible.
This looks very iffy. It purports to require you to consent unconditionally to medical examination. It further purports to demand unredacted medical examination irrespective of relevance. According to http://www.acas.org.uk/media/pdf/n/9/B11_1.pdf The Access to Medical Reports Act 1988 requires an employer to obtain written consent from a worker before applying to his or her doctor for a medical report. The Act lays down a procedure to be followed and gives workers the right to see the report, to request amendments or to withhold consent to the report being supplied. The relevant provision is available at https://www.legislation.gov.uk/ukpga/1988/28/section/3 While there may be theoretical loopholes to this, an employer would be unwise not to follow the norms laid out above. It would be ethically questionable for a doctor to examine without consent (where a person has that capacity); or to rely on a contract entered into some time ago under different circumstances as evidence for consent. In practice an Occupational Health professional will almost certainly want to protect themselves professionally by establishing genuine informed consent first. The TUC has more guidance on the complexities of this: https://www.tuc.org.uk/research-analysis/reports/confidentiality-and-medical-records The contract term may also be unenforceable under GDPR insofar as it is a) processing data reliant on consent which is not freely given and b) processing more sensitive data than is strictly necessary for the task. Now just because you have the right to refuse consent doesn't mean the employer will do nothing about it. The employer might attempt to refuse payment under an occupational sick pay scheme, to which some reasonable additional conditions may be attached, but a) so long as you notify them and get appropriate doctor's notes in the usual way (see https://www.gov.uk/statutory-sick-pay for details) your employment contract cannot invent additional conditions to prevent you receiving Statutory Sick Pay, and b) it is questionable whether submitting to a disclosure arrangement as described would be reasonable. The employer might attempt to discipline or dismiss you for refusing to comply. The reasonableness of this is likely to depend on the existence of exceptional circumstances. There may be cases where there is a statutory duty to monitor for specific exposures which give rise to a refusal to consent being a sufficient reason for dismissal (and I do not know for certain) although the contract wording given does not lead me to expect that this is the case here. In the absence of such a reason, any detriment might lay them open to a claim of victimisation of an employee asserting their rights. If the employer takes any such detrimental action, you would likely need to submit a grievance and be willing to pursue to Tribunal to sort it out. If you are currently being required to submit to an examination under this term, seek advice without delay from your union representative. If you did not have the prior presence of mind to join a union, a solicitor specialising in employment law may be able to give advice (for which you should expect to pay). Having said all that, I notice the term does not specify that the employer may insist on who does the medical examination... I do wonder if you could meet this requirement by simply visiting your own GP, who will presumably be bound by the legislation above (definitely get advice before trying to use this!).
From a legal perspective, I think the ruling is reductio ad absurdum correct. California voters passed Proposition 65. Consequently, CA Health and Safety Code 25249.6 says "No person in the course of doing business shall knowingly and intentionally expose any individual to a chemical known to the state to cause cancer or reproductive toxicity without first giving clear and reasonable warning to such individual, except as provided in Section 25249.10". Section 25249.8 mandates a list, and defines "known to the state" A chemical is known to the state to cause cancer or reproductive toxicity within the meaning of this chapter if in the opinion of the state’s qualified experts it has been clearly shown through scientifically valid testing according to generally accepted principles to cause cancer or reproductive toxicity, or if a body considered to be authoritative by such experts has formally identified it as causing cancer or reproductive toxicity, or if an agency of the state or federal government has formally required it to be labeled or identified as causing cancer or reproductive toxicity. Acrylamide is so listed, and has been for 18 years, reason code listed as "AB-IARC, AB-US EPA". The law does not say that "the benefits may outweigh the risks", nor does the law say anything about usual doses. There is an "escape clause", if one (the defendant) can prove that there is no effect (25249.8(b)): An exposure for which the person responsible can show that the exposure poses no significant risk assuming lifetime exposure at the level in question for substances known to the state to cause cancer, and that the exposure will have no observable effect assuming exposure at one thousand (1000) times the level in question for substances known to the state to cause reproductive toxicity, based on evidence and standards of comparable scientific validity to the evidence and standards which form the scientific basis for the listing of such chemical pursuant to subdivision (a) of Section 25249.8. In any action brought to enforce Section 25249.6, the burden of showing that an exposure meets the criteria of this subdivision shall be on the defendant. The answer on Skeptics does not address the EPA finding (and the science underlying it). At this point we can only conjecture about the defense's scientific argument (the ruling is still in the works, pending feedback from parties), but the judge said "While plaintiff offered evidence that consumption of coffee increases the risk of harm to the fetus, to infants, to children and to adults, defendants' medical and epidemiology experts testified that they had no opinion on causation" and that the coffee makers hadn't presented the proper grounds at trial to prevail. Insofar as human subjects testing of suspected carcinogens is illegal, any argument that "but this only shows that it causes cancer in rats" is legally empty: rats are a suitable proxy for humans. This is a state report addressing a potential carcinogen, 4-Methylimidazole. The report notes that to have a No Significant Risk Level finding, the substance must have less than a "daily intake level posing a 10^-5 lifetime risk of cancer". A further requirement is that "risk analysis shall be based on the most sensitive study deemed to be of sufficient quality" (whatever that is). This study mentions a previous study which was rejected because "these studies do not meet the criteria specified in Section 25703(a) because the experiments were not designed to adequately control for and examine the potential carcinogenicity of 4-MEI". Basically, Spiegelhalter's argument is too meta, and doesn't constitute a proof that acrylamide poses no risk of cancer. If the defendants commissioned an independent scientific study to overcome earlier carcinogen findings, perhaps the study failed on technical grounds. The bar that has to be cleared is very high. The EPA regulation says that the maximum contaminant level goal for acrylamide is zero. That is the carcinogen-science basis for specific allowable levels in water supplies.