Do the HIPAA regulations in the United States prevent medical providers from disclosing relevant health information on patient A to patient B? If a medical provider is aware of some health information on patient A that can affect patient B, do the HIPAA regulations still prevent the medical provider from conveying that information to patient B? For example, if patient A is patient B's father, and patient A has some genetic disorder that may impact patient B and that is known to the medical provider, do the HIPAA regulations prevent the medical provider from disclosing that information to patient B? This issue has recently been raised in the United Kingdom: Legal action over non-disclosure of father’s Huntington’s disease could lead to huge changes in patient confidentiality (mirror)
HIPAA does not legally protect physicians from disclosing PHI to another party, although there are a few exceptions: HHS provides an excellent resource on these, but the regulation most relevant to your question is Permitted Uses and Disclosures (5) Public Interest and Benefit Activities, which includes "Required by Law. Covered entities may use and disclose protected health information without individual authorization as required by law (including by statute, regulation, or court orders)." These statues, regulations, and court orders vary from state, but almost all of them refer to STDs and not genetic conditions (in some states, physicians are required to disclose positive STD test results to known sexual partners, but I can't find similar legislation for genetic tests). Here's an example of a voluntary patient information disclosure form – you'll notice that an individual has to specify the parties to whom they're willing to have PHI disclosed. The example you provided is still a violation of the Privacy Rule in the U.S., but this is a very curious grey area in bioethics and law. Disclosure of Genetic Information Within Families: How nurses can facilitate family communication. Gallo et al. Am J Nurs. 2009 Apr; 109(4): 65–69. (Emphasis mine.) HIPAA and Genetic Disclosure Does the law affect families? The privacy rule of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) went into effect on April 14, 2003. The rule created new requirements for health care providers, third-party payers, and health care clearinghouses to protect the privacy and security of health information, including genetic information, that could identify a person. A person's decision not to disclose her or his risk of developing a genetic condition to a family member may pose a dilemma for the health care professional, who has to choose between ethical obligations to inform the at-risk party and legal requirements to respect and protect the patient's privacy. The potential for harm to family members often plays a large role in the decision. For example, in rare cases, the use of a certain surgical anesthesia can cause death in people with the mutation that disposes them to malignant hyperthermia. Likewise, strenuous exercise can bring on sudden death in people with hypertrophic cardiomyopathy. In such cases, clinicians should carefully explain the reasons for sharing information with family members, strongly encourage patients to notify at-risk relatives, and offer to help develop a plan for notifying them. When patients choose not to notify family members, clinicians typically respect the decision. There are situations, however, in which the clinician may consider overriding the patient's preferences because the family member is judged to be in danger of serious or immediate harm or there is a high likelihood that a dangerous condition will occur that can be either prevented or adequately treated with early recognition. Clinicians who believe it is necessary to override a patient's wish regarding the notification of family members, should consider consulting an ethics committee or legal council. In most situations, though, the risk of serious harm associated with nondisclosure is not clearly immediate. For instance, if a woman has tested positive for the BRCA1 or BRCA2 mutation but doesn't want to upset her two sisters by sharing that information with them, the need for disclosure isn't clearly urgent. Each sister has a one in two chance of carrying the same mutation. It would be understandable for the patient to try to learn more about what the mutation means for her and her children and to give careful thought to whether and how she'll share her test results with her sisters. Clinicians can best help family members by clearly informing patients who test positive for genetic conditions or the mutations that cause them about the risks faced by their family members, discussing the value of disclosure and offering assistance with it. The "Duty to Warn" a Patient's Family Members About Hereditary Disease Risks. Offit et al. JAMA. 2004;292(12): 1469–1473. (I can send you the full-text of this if you want it; it contains an excellent overview of cases and their outcomes relating to disclosing genetic information in the U.S. under HIPAA.) In general, the special nature of genetic tests has been viewed as a barrier to physicians' breaching the confidentiality of personal genetic information. However, the failure to warn family members about hereditary disease risks has already resulted in 3 lawsuits against physicians in the United States. While the findings of case law and the state and federal statutes that bear on the issue of "duty to warn" of inherited health risk are still being defined, we believe that health care professionals have a responsibility to encourage but not to coerce the sharing of genetic information in families, while respecting the boundaries imposed by the law and by the ethical practice of medicine. ...in considering whether to breach patient confidentiality to warn of risks of a genetic disease, clinicians need to balance the actual risk of that disease, the efficacy of potential preventive interventions, as well as emerging legal considerations and potential liabilities. Overriding patient confidentiality and genetic privacy might very well mean violation of HIPAA and certain state regulations, with attendant civil or criminal liability. At the same time, in one state appellate court decision that has not been overturned, the estate of a physician was held liable for his failure to warn relatives of hereditary disease risk.
Yes in general Generally, almost all western jurisdictions (be they civil law or common law) have some way to get medical records into evidence, be that via subpoenaing, or by discovery requests or court orders. In most cases, the party that brings the suit is also the patient or their legal representative, and they give (or imply) consent to the use of the records. And in cases where the defendant's medical records are required, usually, the defense wants those in too to prove some condition. And then there are cases where the state or their representatives brings the charge. They usually can bring a warrant or court order to obtain the documents. Then there are Medical records that had been made specifically on the behest of the state. Here, the warrant is usually filed to obtain the samples or access to the body to be investigated, the record itself forms the basis for the investigators to proceed - and is not under client-doctor confidentially in the first place. It had been made specifically for the state and it is a state-owned medical record, be they made on request of the executive power (police) with a warrant signed by a judge or on behalf of the judicative after a court order to evaluate capacity (see below). However, medical records can generally only be obtained if the records are relevant to the case at hand and only to the degree necessary: You can't request the medical records about a person's fertility status in a case that discusses damages for his broken arm. As a result, the medical record available in court might be only an extract from the original, with irrelevant passages sealed or redacted. Unlike many people think, it's quite common to get some medical records into court in some way or another: As the basis of injury cases If you have a case of physical injury, the injuries themselves need to be proven in court. This is done generally by getting the medical records - thus they can be subpoenaed by a party, usually the injured party here. Then a medical expert can discuss them, be they a court-appointed one or paid by either of the parties. In this category also fall mandatory reports of certain types of wounds or situations. As such, the treating doctor has to provide a medical report with enumerated types of injuries, like bullet wounds or where child abuse might be the reason. Very necessarily in malpractice cases Malpractice is pretty much injury on steroids: the injuring party made the records and would never want to give them up to the one suing them - if they could. Alice shall remove Appendix. It goes haywire and the day after Charly needs to cut Bob open again. Now Bob sues Alice for malpractice. Bob needs medical records from both Alice, the doctor who botched it, and Charly, who was fixing Alice's error. Generally, both records are subpoena-able to the degree relevant and necessary, and indeed the opposing medical opinions on the operation and records form the very basis of the case for either side. Without the ability to subpoena the - in this case unmodified - records from the injuring doctor, proving - or defending - a case of malpractice would be impossible: the very truth of the allegation should be in the medical records. It's routine in cases around death What is the very last medical record a person can ever get? An autopsy record! That's a very sensitive medical record, but they routinely are used in homicide cases. Oftentimes, the investigators also subpoena the medical records of the victim from their doctors to corroborate the autopsy record, while the defense might subpoena them to try and disprove it. Even in civil cases, like the OJ-Simpson civil damages case, autopsy and medical records from an accompanying criminal case can and will be &quot;pulled&quot; (copied over) from the other trial's docket. Regularly in child protection cases Whenever child protection is on the line, be them protective orders or who a child will live with after the child protection service (whatever its name is) is in on a case, then medical records are often required to bolster one side. Those records could be medical records from quite many doctors, be they physicals or psychological evaluations... Sometimes the medical records required here are only created due to court-ordered medical or psychological evaluation by a doctor. Whenever incompetence defense is called When the lawyer claims temporary incompetence or insanity, courts generally order a psychological evaluation. These medical records are evidence, but usually don't need to be subpoenaed: they have a waiver form to be disclosed to the court almost built-in. Are they available to the public? Medical records are part of truth-finding, but they are also quite sensitive. As a result, most medical records can not be gotten from the court and enter the dockets under seal. Another option is, that they enter the docket partially or even mostly redacted, with passages blackened.
The issue is more one of what an attorney is ethically authorized to disclose pursuant to professional ethics rules (Rule of Professional Conduct 1.6 as enacted locally) more than one of attorney-client privilege. Attorney-client privilege governs what someone can or cannot be compelled to disclose without their consent (usually by subpoena). Attorney confidentiality, in contrast, governs what an attorney can disclosed when not compelled to do so by something like a subpoena. Generally, disclosure of confidential client information is allowed if it is in furtherance of the representation or authorized by the client (there are also other exceptions but those aren't really any different in a two lawyer v. one lawyer situation). Often when two attorneys represent the same person (and the disclosure won't waive the privileged nature of the information vis-a-vis third-parties under a joint defense theory), disclosures from one attorney for a person to another attorney for a person will do that. In practice, however, the analysis could be quite fact specific and there isn't really a bright line rule governing when it would or would not be allowed.
You can refuse to pay. The doctor can either accept your refusal or pursue the debt in court. If he pursues the debt you will probably lose. The Common Law position Your contract with the doctor was for him to do whatever he did and you to pay for it. Your contract with your insurer is for you to pay the premium and them to reimburse you for whatever they cover. The fundamental question is why you were taking the doctor's (via his secretary) advice on your contract with your insurer? The advice was wrong, however, it is difficult to see that there is a case for negligent misstatement; you would have difficulty showing there was a duty of care and even if you did showing what damage flowed from it since it is quite likely that you would have had the procedure notwithstanding the absence of cover, unless it was purely cosmetic. The Consumer Law position California probably has consumer protection laws regarding misleading and deceptive conduct - I have no idea what they are. If this is so then your doctor's statement was misleading - consequences may flow from this.
I'm not a lawyer or a medical professional, but on Wikipedia's page about DNR, we see the following quote: In the United States the documentation is especially complicated in that each state accepts different forms, and advance directives and living wills are not accepted by EMS as legally valid forms. If a patient has a living will that states the patient wishes to be DNR but does not have an appropriately filled out state sponsored form that is co-signed by a physician, EMS will attempt resuscitation. Based on this, I would hazard the guess that you can't treat anything other than those forms as legally binding, as they even ignore a living will without that state's form.
If you are worried that some secret will become public, you should find and meet with an attorney, not a financial adviser or other nonlawyer. Your attorney is able to shield your secret information from disclosure in ways other professionals cannot. Raise any credit score issues you're concerned about. In general, the public has a right to access judicial records. See Nixon v. Warner Communications, Inc., 435 US 589, 597 (1978) (noting that the right is rarely litigated and not clearly defined). That right is not absolute; some records can be sealed, which means that the public can't read them. Local rules govern when that happens. I don't think the existence of a civil lawsuit could be made secretly except in special circumstances. Likewise, the plaintiff usually must identify herself, except in special circumstances. A plaintiff should assume that everything about the lawsuit--who filed it, against whom, what evidence arises, the trial, and who wins and loses--will be public.
There aren't any specific laws or regulations about medical charges. Instead, this is a matter of general contract law, where you have to agree. You have to consent to be treated, and a signature is taken to be evidence of consent. The law does not say that they have to ask permission for absolutely everything they do, the action just as to be in accordance with an accepted standard of medical practice among members of the medical profession with similar training and experience in the same or similar medical community as that of the person treating, examining, or operating on the patient for whom the consent is obtained This law insulates doctors from getting sued. In a situation where treatment is provided against a patient's instructions, you may have a cause of action for e.g. battery. In general, a doctor can't poke you, draw blood, make "offensive contact" etc. without consent, and consenting to one procedure does not "open the floodgates" of consent for any othre procedure. Of course, if the procedure was not performed, you obviously are not liable for the cost (and they are not liable for a non-occurring battery). This may in fact constitute gross negligence. During trial, the primary issue is likely to be whether there is proof that the procedure was expressly rejected. The doctor would probably provide the consent form, and that form may or may not indicate that the test would be conducted. It would not be surprising if the patient never saw an actual form and instead just electro-signed, having been told that this is authorization to treat. Corroborating witnesses would be helpful. From a practical perspective, especially if the billing department is being recalcitrant, this is probably a matter best handled by an attorney who would start with a formal letter summarizing the consequences of unauthorized medical treatment.
Attorneys are universally required to tell the truth at all times and generally, they do. They are not allowed to lie on behalf of their clients or themselves. This doesn't mean that someone else's attorney necessarily has your best interests at heart. And, attorneys can, for example, fail to mention options that exist, but might not be the best for the attorney's client. Also, if an attorney's client lies to him or her about the facts, the attorney could conceivably say something inaccurate while believing it to be true. In the kind of meeting you are describing, however, most likely, the attorneys are simply going to explain your parents' estate plan, over which you have no control or say in any case, and there is no reason for suspicion or paranoia.