Amended in Senate August 19, 2013

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 Bill No. 1297

Introduced by Assembly Member John A. Pérez

begin insert

(Coauthor: Senator Anderson)

end insert

February 22, 2013

An act to amend Section 56.10 of the Civil Code, and 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, whenever that 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.

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.

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.

 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:

SECTION 1.  

Section 56.10 of the Civil Code is amended to
read:

56.10.  

(a)  begin delete No end delete begin insert A end insert provider of health care, health care service
plan, or contractor shall begin insert not end insert disclose medical information regarding
a patient of the provider of health care or an enrollee or subscriber
of a health care service plan without first obtaining an
authorization, except as provided in subdivision (b) or (c).

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

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

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

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

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

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

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

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

(8) By a coroner, when requested in the course of an
investigation by the coroner’s office for the purpose of identifying
the decedent or locating next of kin, or when investigating deaths
that may involve public health concerns, organ or tissue donation,
child abuse, elder abuse, suicides, poisonings, accidents, sudden
infant deaths, suspicious deaths, unknown deaths, or criminal
deaths, or upon notification of, or investigation of, imminent deaths
that may involve organ or tissue donation pursuant to Section
7151.15 of the Health and Safety Code, or when otherwise
authorized by the decedent’s representative. Medical information
requested by the coroner under this paragraph shall be limited to
information regarding the patient who is the decedent and who is
the subject of the investigation or who is the prospective donor
and shall be disclosed to the coroner without delay upon request.

(9) When otherwise specifically required by law.

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

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

(2) The information may be disclosed to an insurer, employer,
health care service plan, hospital service plan, employee benefit
plan, governmental authority, contractor, or begin delete any end delete other person or
entity responsible for paying for health care services rendered to
the patient, to the extent necessary to allow responsibility for
payment to be determined and payment to be made. If (A) the
patient is, by reason of a comatose or other disabling medical
condition, unable to consent to the disclosure of medical
information and (B) no other arrangements have been made to pay
for the health care services being rendered to the patient, the
information may be disclosed to a governmental authority to the
extent necessary to determine the patient’s eligibility for, and to
obtain, payment under a governmental program for health care
services provided to the patient. The information may also be
disclosed to another provider of health care or health care service
plan as necessary to assist the other provider or health care service
plan in obtaining payment for health care services rendered by that
provider of health care or health care service plan to the patient.

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

(4) The information may be disclosed to organized committees
and agents of professional societies or of medical staffs of licensed
hospitals, licensed health care service plans, professional standards
review organizations, independent medical review organizations
and their selected reviewers, utilization and quality control peer
review organizations as established by Congress in Public Law
97-248 in 1982, contractors, or persons or organizations insuring,
responsible for, or defending professional liability that a provider
may incur, if the committees, agents, health care service plans,
organizations, reviewers, contractors, or persons are engaged in
reviewing the competence or qualifications of health care
professionals or in reviewing health care services with respect to
medical necessity, level of care, quality of care, or justification of
charges.

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

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

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

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

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

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

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

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

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

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

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

(14) The information may be disclosed when the disclosure is
otherwise specifically authorized by law, including, but not limited
to, the voluntary reporting, either directly or indirectly, to the
federal Food and Drug Administration of adverse events related
to drug products or medical device problems, or to disclosures
made pursuant to subdivisions (b) and (c) of Section 11167 of the
Penal Code by a person making a report pursuant to Sections
11165.9 and 11166 of the Penal Code, provided that those
disclosures concern a report made by that person.

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

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

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

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

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

(20) The information may be disclosed as described in Section
56.103.

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

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

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

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

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

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

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

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

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

SEC. 2.  

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

7151.15.  

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

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

(c) A part shall not be removed from the body of a decedent
under the jurisdiction of a coroner for transplantation, therapy,
research, or education unless the part is the subject of an anatomical
gift. The body of a decedent under the jurisdiction of the coroner
shall not be delivered to a person for research or education unless
the body is the subject of an anatomical gift. This subdivision does
not preclude a coroner from performing the medicolegal
investigation upon the body or parts of a decedent under the
jurisdiction of the coroner.

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

SEC. 3.  

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