Amended in Senate June 4, 2013

Amended in Assembly April 10, 2013

Amended in Assembly March 21, 2013

California Legislature—2013–14 Regular Session

Assembly BillNo. 1297


Introduced by Assembly Member John A. Pérez

February 22, 2013


An actbegin insert to amend Section 56.10 of the Civil Code, andend insert to amend Section 7151.15 of the Health and Safety Code, relating to public health.

LEGISLATIVE COUNSEL’S DIGEST

AB 1297, as amended, John A. Pérez. Coroners: organ donation.

Existing law requires a coroner to cooperate with procurement organizations to maximize the opportunity to recover anatomical gifts for the purpose of transplantation, therapy, research, or education. Existing law requires a coroner or designee to conduct a post mortem examination of a body or part that is available for or has been donated to a procurement organization in a manner and within a period compatible with the body or part’s preservation for the purposes of the gift.

This bill would authorize a procurement organization, when specified circumstances are present, to notify a coroner, prior to the donor’s death, that a donor has made or may make an anatomical gift, and would require a coroner to accept that notification,begin delete if suchend deletebegin insert whenever thatend insert notification will facilitate the coroner’s ability to conduct his or her duties in a manner and within a period compatible with the preservation of the body or part for the purposes of the gift. The bill would also require a coroner to conduct a post mortem investigation in a manner and time period compatible with the preservation of the body or part for the purposes of the gift, thereby imposing a state-mandated local program.

begin insert

Existing law, the Confidentiality of Medical Information Act, prohibits a health care provider, a contractor, or a health care service plan from disclosing medical information, as defined, regarding a patient of the provider or an enrollee or subscriber of the health care service plan without first obtaining an authorization, except as specified. Existing law requires the disclosure of medical information if the disclosure is compelled by a coroner when investigating deaths that may involve organ or tissue donation. Existing law makes a violation of the act that results in economic loss or personal injury to a patient a misdemeanor.

end insert
begin insert

This bill would additionally require the disclosure of medical information if the disclosure is compelled by a coroner upon notification of, or investigation of, imminent deaths that may involve organ or tissue donation pursuant to the above-described provisions.

end insert

 The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that no reimbursement shall be made pursuant to these statutory provisions for costs mandated by the state pursuant to this act, but would recognize that local agencies and school districts may pursue any available remedies to seek reimbursement for these costs.

Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: yes.

The people of the State of California do enact as follows:

P2    1begin insert

begin insertSECTION 1.end insert  

end insert

begin insertSection 56.10 of the end insertbegin insertCivil Codeend insertbegin insert is amended to
2read:end insert

3

56.10.  

(a) No provider of health care, health care service plan,
4or contractor shall disclose medical information regarding a patient
5of the provider of health care or an enrollee or subscriber of a
6health care service plan without first obtaining an authorization,
7except as provided in subdivision (b) or (c).

8(b) A provider of health care, a health care service plan, or a
9contractor shall disclose medical information if the disclosure is
10compelled by any of the following:

11(1) By a court pursuant to an order of that court.

P3    1(2) By a board, commission, or administrative agency for
2purposes of adjudication pursuant to its lawful authority.

3(3) By a party to a proceeding before a court or administrative
4agency pursuant to a subpoena, subpoena duces tecum, notice to
5appear served pursuant to Section 1987 of the Code of Civil
6Procedure, or any provision authorizing discovery in a proceeding
7before a court or administrative agency.

8(4) By a board, commission, or administrative agency pursuant
9to an investigative subpoena issued under Article 2 (commencing
10with Section 11180) of Chapter 2 of Part 1 of Division 3 of Title
112 of the Government Code.

12(5) By an arbitrator or arbitration panel, when arbitration is
13lawfully requested by either party, pursuant to a subpoena duces
14tecum issued under Section 1282.6 of the Code of Civil Procedure,
15or another provision authorizing discovery in a proceeding before
16an arbitrator or arbitration panel.

17(6) By a search warrant lawfully issued to a governmental law
18enforcement agency.

19(7) By the patient or the patient’s representative pursuant to
20Chapter 1 (commencing with Section 123100) of Part 1 of Division
21106 of the Health and Safety Code.

22(8) By a coroner, when requested in the course of an
23investigation by the coroner’s office for the purpose of identifying
24the decedent or locating next of kin, or when investigating deaths
25that may involve public health concerns, organ or tissue donation,
26child abuse, elder abuse, suicides, poisonings, accidents, sudden
27infant deaths, suspicious deaths, unknown deaths, or criminal
28deaths,begin insert or upon notification of, or investigation of, imminent deaths
29that may involve organ or tissue donation pursuant to Section
307151.15 of the Health and Safety Code,end insert
or when otherwise
31authorized by the decedent’s representative. Medical information
32requested by the coroner under this paragraph shall be limited to
33information regarding the patient who is the decedent and who is
34the subject of the investigationbegin insert or who is the prospective donorend insert
35 and shall be disclosed to the coroner without delay upon request.

36(9) When otherwise specifically required by law.

37(c) A provider of health care or a health care service plan may
38disclose medical information as follows:

39(1) The information may be disclosed to providers of health
40care, health care service plans, contractors, or other health care
P4    1 professionals or facilities for purposes of diagnosis or treatment
2of the patient. This includes, in an emergency situation, the
3communication of patient information by radio transmission or
4other means between emergency medical personnel at the scene
5of an emergency, or in an emergency medical transport vehicle,
6and emergency medical personnel at a health facility licensed
7pursuant to Chapter 2 (commencing with Section 1250) of Division
82 of the Health and Safety Code.

9(2) The information may be disclosed to an insurer, employer,
10health care service plan, hospital service plan, employee benefit
11plan, governmental authority, contractor, or any other person or
12entity responsible for paying for health care services rendered to
13the patient, to the extent necessary to allow responsibility for
14payment to be determined and payment to be made. If (A) the
15patient is, by reason of a comatose or other disabling medical
16condition, unable to consent to the disclosure of medical
17information and (B) no other arrangements have been made to pay
18for the health care services being rendered to the patient, the
19information may be disclosed to a governmental authority to the
20extent necessary to determine the patient’s eligibility for, and to
21obtain, payment under a governmental program for health care
22services provided to the patient. The information may also be
23disclosed to another provider of health care or health care service
24plan as necessary to assist the other provider or health care service
25plan in obtaining payment for health care services rendered by that
26provider of health care or health care service plan to the patient.

27(3) The information may be disclosed to a person or entity that
28provides billing, claims management, medical data processing, or
29other administrative services for providers of health care or health
30care service plans or for any of the persons or entities specified in
31paragraph (2). However, information so disclosed shall not be
32further disclosed by the recipient in a way that would violate this
33part.

34(4) The information may be disclosed to organized committees
35and agents of professional societies or of medical staffs of licensed
36hospitals, licensed health care service plans, professional standards
37review organizations, independent medical review organizations
38and their selected reviewers, utilization and quality control peer
39review organizations as established by Congress in Public Law
4097-248 in 1982, contractors, or persons or organizations insuring,
P5    1responsible for, or defending professional liability that a provider
2may incur, if the committees, agents, health care service plans,
3organizations, reviewers, contractors, or persons are engaged in
4reviewing the competence or qualifications of health care
5professionals or in reviewing health care services with respect to
6medical necessity, level of care, quality of care, or justification of
7charges.

8(5) The information in the possession of a provider of health
9care or health care service plan may be reviewed by a private or
10public body responsible for licensing or accrediting the provider
11of health care or health care service plan. However, no
12patient-identifying medical information may be removed from the
13premises except as expressly permitted or required elsewhere by
14law, nor shall that information be further disclosed by the recipient
15in a way that would violate this part.

16(6) The information may be disclosed to the county coroner in
17the course of an investigation by the coroner’s office when
18requested for all purposes not included in paragraph (8) of
19subdivision (b).

20(7) The information may be disclosed to public agencies, clinical
21investigators, including investigators conducting epidemiologic
22studies, health care research organizations, and accredited public
23or private nonprofit educational or health care institutions for bona
24fide research purposes. However, no information so disclosed shall
25be further disclosed by the recipient in a way that would disclose
26the identity of a patient or violate this part.

27(8) A provider of health care or health care service plan that has
28created medical information as a result of employment-related
29health care services to an employee conducted at the specific prior
30written request and expense of the employer may disclose to the
31employee’s employer that part of the information that:

32(A) Is relevant in a lawsuit, arbitration, grievance, or other claim
33or challenge to which the employer and the employee are parties
34and in which the patient has placed in issue his or her medical
35history, mental or physical condition, or treatment, provided that
36information may only be used or disclosed in connection with that
37proceeding.

38(B) Describes functional limitations of the patient that may
39entitle the patient to leave from work for medical reasons or limit
40the patient’s fitness to perform his or her present employment,
P6    1provided that no statement of medical cause is included in the
2information disclosed.

3(9) Unless the provider of health care or a health care service
4plan is notified in writing of an agreement by the sponsor, insurer,
5or administrator to the contrary, the information may be disclosed
6to a sponsor, insurer, or administrator of a group or individual
7insured or uninsured plan or policy that the patient seeks coverage
8by or benefits from, if the information was created by the provider
9of health care or health care service plan as the result of services
10conducted at the specific prior written request and expense of the
11sponsor, insurer, or administrator for the purpose of evaluating the
12application for coverage or benefits.

13(10) The information may be disclosed to a health care service
14plan by providers of health care that contract with the health care
15service plan and may be transferred among providers of health
16care that contract with the health care service plan, for the purpose
17of administering the health care service plan. Medical information
18shall not otherwise be disclosed by a health care service plan except
19in accordance with this part.

20(11) This part does not prevent the disclosure by a provider of
21health care or a health care service plan to an insurance institution,
22agent, or support organization, subject to Article 6.6 (commencing
23with Section 791) of Chapter 1 of Part 2 of Division 1 of the
24Insurance Code, of medical information if the insurance institution,
25agent, or support organization has complied with all of the
26requirements for obtaining the information pursuant to Article 6.6
27(commencing with Section 791) of Chapter 1 of Part 2 of Division
281 of the Insurance Code.

29(12) The information relevant to the patient’s condition, care,
30and treatment provided may be disclosed to a probate court
31investigator in the course of an investigation required or authorized
32in a conservatorship proceeding under the
33Guardianship-Conservatorship Law as defined in Section 1400 of
34the Probate Code, or to a probate court investigator, probation
35officer, or domestic relations investigator engaged in determining
36the need for an initial guardianship or continuation of an existing
37guardianship.

38(13) The information may be disclosed to an organ procurement
39organization or a tissue bank processing the tissue of a decedent
40for transplantation into the body of another person, but only with
P7    1respect to the donating decedent, for the purpose of aiding the
2transplant. For the purpose of this paragraph, “tissue bank” and
3“tissue” have the same meanings as defined in Section 1635 of the
4Health and Safety Code.

5(14) The information may be disclosed when the disclosure is
6otherwise specifically authorized by law, including, but not limited
7to, the voluntary reporting, either directly or indirectly, to the
8federal Food and Drug Administration of adverse events related
9to drug products or medical device problems, or to disclosures
10made pursuant to subdivisions (b) and (c) of Section 11167 of the
11Penal Code by a person making a report pursuant to Sections
1211165.9 and 11166 of the Penal Code, provided that those
13disclosures concern a report made by that person.

14(15) Basic information, including the patient’s name, city of
15residence, age, sex, and general condition, may be disclosed to a
16state-recognized or federally recognized disaster relief organization
17for the purpose of responding to disaster welfare inquiries.

18(16) The information may be disclosed to a third party for
19purposes of encoding, encrypting, or otherwise anonymizing data.
20However, no information so disclosed shall be further disclosed
21by the recipient in a way that would violate this part, including the
22unauthorized manipulation of coded or encrypted medical
23information that reveals individually identifiable medical
24information.

25(17) For purposes of disease management programs and services
26as defined in Section 1399.901 of the Health and Safety Code,
27information may be disclosed as follows: (A) to an entity
28contracting with a health care service plan or the health care service
29plan’s contractors to monitor or administer care of enrollees for a
30covered benefit, if the disease management services and care are
31authorized by a treating physician, or (B) to a disease management
32organization, as defined in Section 1399.900 of the Health and
33Safety Code, that complies fully with the physician authorization
34requirements of Section 1399.902 of the Health and Safety Code,
35if the health care service plan or its contractor provides or has
36provided a description of the disease management services to a
37treating physician or to the health care service plan’s or contractor’s
38network of physicians. This paragraph does not require physician
39authorization for the care or treatment of the adherents of a
40well-recognized church or religious denomination who depend
P8    1solely upon prayer or spiritual means for healing in the practice
2of the religion of that church or denomination.

3(18) The information may be disclosed, as permitted by state
4and federal law or regulation, to a local health department for the
5purpose of preventing or controlling disease, injury, or disability,
6including, but not limited to, the reporting of disease, injury, vital
7events, including, but not limited to, birth or death, and the conduct
8of public health surveillance, public health investigations, and
9public health interventions, as authorized or required by state or
10federal law or regulation.

11(19) The information may be disclosed, consistent with
12applicable law and standards of ethical conduct, by a
13psychotherapist, as defined in Section 1010 of the Evidence Code,
14if the psychotherapist, in good faith, believes the disclosure is
15necessary to prevent or lessen a serious and imminent threat to the
16health or safety of a reasonably foreseeable victim or victims, and
17the disclosure is made to a person or persons reasonably able to
18prevent or lessen the threat, including the target of the threat.

19(20) The information may be disclosed as described in Section
2056.103.

21(21) (A) The information may be disclosed to an employee
22welfare benefit plan, as defined under Section 3(1) of the Employee
23Retirement Income Security Act of 1974 (29 U.S.C. Sec. 1002(1)),
24which is formed under Section 302(c)(5) of the Taft-Hartley Act
25(29 U.S.C. Sec. 186(c)(5)), to the extent that the employee welfare
26benefit plan provides medical care, and may also be disclosed to
27an entity contracting with the employee welfare benefit plan for
28billing, claims management, medical data processing, or other
29administrative services related to the provision of medical care to
30persons enrolled in the employee welfare benefit plan for health
31care coverage, if all of the following conditions are met:

32(i) The disclosure is for the purpose of determining eligibility,
33coordinating benefits, or allowing the employee welfare benefit
34plan, or the contracting entity, to advocate on the behalf of a patient
35or enrollee with a provider, a health care service plan, or a state
36or federal regulatory agency.

37(ii) The request for the information is accompanied by a written
38authorization for the release of the information submitted in a
39manner consistent with subdivision (a) and Section 56.11.

P9    1(iii) The disclosure is authorized by and made in a manner
2consistent with the Health Insurance Portability and Accountability
3Act of 1996 (Public Law 104-191).

4(iv) Any information disclosed is not further used or disclosed
5by the recipient in any way that would directly or indirectly violate
6this part or the restrictions imposed by Part 164 of Title 45 of the
7Code of Federal Regulations, including the manipulation of the
8information in any way that might reveal individually identifiable
9medical information.

10(B) For purposes of this paragraph, Section 1374.8 of the Health
11and Safety Code shall not apply.

12(22) Information may be disclosed pursuant to subdivision (a)
13of Section 15633.5 of the Welfare and Institutions Code by a person
14required to make a report pursuant to Section 15630 of the Welfare
15and Institutions Code, provided that the disclosure under
16subdivision (a) of Section 15633.5 concerns a report made by that
17person. Covered entities, as they are defined in Section 160.103
18of Title 45 of the Code of Federal Regulations, shall comply with
19the requirements of the Health Insurance Portability and
20Accountability Act (HIPAA) privacy rule pursuant to subsection
21(c) of Section 164.512 of Title 45 of the Code of Federal
22Regulations if the disclosure is not for the purpose of public health
23 surveillance, investigation, intervention, or reporting an injury or
24death.

25(d) Except to the extent expressly authorized by a patient or
26enrollee or subscriber or as provided by subdivisions (b) and (c),
27a provider of health care, health care service plan, contractor, or
28corporation and its subsidiaries and affiliates shall not intentionally
29share, sell, use for marketing, or otherwise use medical information
30for a purpose not necessary to provide health care services to the
31patient.

32(e) Except to the extent expressly authorized by a patient or
33enrollee or subscriber or as provided by subdivisions (b) and (c),
34a contractor or corporation and its subsidiaries and affiliates shall
35not further disclose medical information regarding a patient of the
36provider of health care or an enrollee or subscriber of a health care
37service plan or insurer or self-insured employer received under
38 this section to a person or entity that is not engaged in providing
39direct health care services to the patient or his or her provider of
P10   1health care or health care service plan or insurer or self-insured
2employer.

3

begin deleteSECTION 1.end delete
4begin insertSEC. 2.end insert  

Section 7151.15 of the Health and Safety Code is
5amended to read:

6

7151.15.  

(a) A county coroner shall cooperate with
7procurement organizations to maximize the opportunity to recover
8anatomical gifts for the purpose of transplantation, therapy,
9research, or education.

10(b) If a county coroner receives notice from a procurement
11organization that an anatomical gift might be available or was
12made with respect to a decedent whose body is under the
13jurisdiction of the coroner and a post mortem examination or
14investigation is going to be performed, unless the coroner denies
15recovery in accordance with Section 7151.20, the coroner or
16designee shall conduct a post mortem examination or investigation
17of the body or the part in a manner and within a period compatible
18with its preservation for the purposes of the gift.

19(c) A part shall not be removed from the body of a decedent
20under the jurisdiction of a coroner for transplantation, therapy,
21research, or education unless the part is the subject of an anatomical
22gift. The body of a decedent under the jurisdiction of the coroner
23shall not be delivered to a person for research or education unless
24the body is the subject of an anatomical gift. This subdivision does
25not preclude a coroner from performing the medico legal
26investigation upon the body or parts of a decedent under the
27jurisdiction of the coroner.

28(d) Notwithstanding any other law, when an anatomical gift
29might be available or has been made by a person whose death is
30imminent due to the lawful withdrawal of medical treatment and
31if that person’s body, post mortem, will be subject to the coroner’s
32jurisdiction pursuant to Section 27491 of the Government Code,
33a procurement organization may notify a coroner of the anatomical
34gift, and a coroner shall accept the notification,begin delete if suchend deletebegin insert whenever
35thatend insert
notification will facilitate the coroner’s ability to conduct a
36post mortem examination or investigation of the body or the part
37in a manner and within a period compatible with its preservation
38for the purposes of the gift.

P11   1

begin deleteSEC. 2.end delete
2begin insertSEC. 3.end insert  

No reimbursement shall be made pursuant to Part 7
3(commencing with Section 17500) of Division 4 of Title 2 of the
4Government Code for costs mandated by the state pursuant to this
5act. It is recognized, however, that a local agency or school district
6may pursue any remedies to obtain reimbursement available to it
7under Part 7 (commencing with Section 17500) and any other
8provisions of law.



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