BILL ANALYSIS                                                                                                                                                                                                    Ó



                                                                    AB 2119


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          Date of Hearing:  May 3, 2016 


                ASSEMBLY COMMITTEE ON PRIVACY AND CONSUMER PROTECTION


                                   Ed Chau, Chair


          AB 2119  
          (Chu) - As Amended April 27, 2016


          SUBJECT:  Medical information: disclosure: medical examiners and  
          forensic pathologists


          SUMMARY:  Adds "medical examiner" and "forensic pathologist" to  
          as the list of professionals working in the office of a county  
          coroner who are eligible to request and receive a decedent's  
          medical information under California's medical privacy laws.   
          Specifically, this bill:  


          1)Requires a provider of health care, a health care service  
            plan, or contractor to disclose, without delay, medical  
            information about a patient if requested by a medical examiner  
            or forensic pathologist, provided the request is for the  
            purpose of a coroner's office investigation to identify the  
            decedent or locate 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, or when otherwise authorized by the  
            decedent's representative. 

          2)Authorizes a provider of health care or a health care service  








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            plan to disclose medical information to a medical examiner or  
            forensic pathologist of a county coroner's office, when  
            requested for all purposes not included in the above  
            provision. 

          3)Prohibits a medical examiner, forensic pathologist, or coroner  
            from disclosing medical information obtained under this bill  
            to a third party, unless there is a court order.  



          4)Clarifies that other sections of law authorizing only a  
            coroner to have access to medical information regarding  
            patients in state mental hospitals and state developmental  
            centers are not affected by this bill. 



          5)Specifies that a "medical examiner, forensic pathologist, or  
            coroner" is limited to a licensed physician who currently  
            performs official autopsies on behalf of a county coroner's  
            office or medical examiner's office, whether as a government  
            employee or under contract to that office.



          6)Makes legislative findings as to the need to limit public  
            access to records shared with a medical examiner or forensic  
            pathologist under this bill.



          7)Makes other technical, nonsubstantive changes to statute.

          EXISTING LAW:  


          1)Prohibits, under the federal Health Insurance Portability and  
            Accountability Act (HIPAA), a covered entity (health plan,  








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            health care provider, and health care clearing house) from  
            disclosing medical information, except as specified or as  
            authorized by the patient in writing.  (45 C.F.R. Sec. 164.500  
            et seq.)  
          2)Prohibits, under the state Confidentiality of Medical  
            Information Act (CMIA), providers of health care, health care  
            service plans, or contractors, as defined, from sharing  
            medical information without the patient's written  
            authorization, subject to certain exceptions.  (Civil Code  
            (CC) Section 56 et seq.) 


            


          3)Defines "medical information" as individually identifiable  
            information, in electronic or physical form, in possession of  
            or derived from a provider of health care, health care service  
            plan, pharmaceutical company, or contractor regarding a  
            patient's medical history, mental or physical condition, or  
            treatment.  (CC 56.05(g))



          4)Defines "individually identifiable" as medical information  
            that includes or contains any element of personal identifying  
            information sufficient to allow identification of the  
            individual, such as the patient's name, address, electronic  
            mail address, telephone number, or Social Security number, or  
            other information that, alone or in combination with other  
            publicly available information, reveals the individual's  
            identity.  (CC 56.05(g))
            


          5)Defines "provider of health care" as any person licensed or  
            certified pursuant to the Business & Professions Code; any  
            person licensed pursuant to the Osteopathic Initiative Act or  
            the Chiropractic Initiative Act; any clinic, health  








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            dispensary, or licensed health facility licensed, as  
            specified.  (CC 56.05(m))



          6)Defines a "licensed health care professional" as any person  
            licensed or certified pursuant to the Business and Professions  
            Code, the Osteopathic Initiative Act or the Chiropractic  
            Initiative Act, or the Health and Safety Code, as specified.   
            (CC 56.05(h))



          7)Defines "health care service plan" as any entity regulated  
            pursuant to the Knox-Keene Health Care Service Plan Act of  
            1975.  (CC 56.05(g))



          8)Subjects any provider of health care, a health care service  
            plan, pharmaceutical company, or contractor, who negligently  
            creates, maintains, preserves, stores, abandons, destroys, or  
            disposes of written or electronic medical records, to damages  
            in a civil action or an administrative fine, as specified.   
            (CC 56.36)



          9)Requires, as an exception to the above prohibition against  
            sharing a patient's medical information, a provider of health  
            care, a health care service plan, or contractor to disclose  
            without delay medical information about a patient if requested  
            by a coroner, provided that the coroner's request is for the  
            purpose of an investigation to identify 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,  








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            imminent deaths that may involve organ or tissue donation, or  
            when otherwise authorized by the decedent's representative.   
            (CC 56.10(b)(8))

          10)Authorizes a provider of health care or a health care service  
            plan to disclose medical information to a county coroner, when  
            requested for all purposes not included in the above exception  
            (CC 56.10(b)(8)).  (CC 56.10(c)(6))

          FISCAL EFFECT:  None.  This bill is keyed nonfiscal by the  
          Legislative Counsel. 


          COMMENTS:  


           1)Purpose of this bill  .  This bill is intended to authorize a  
            provider of public mental health services to release a  
            decedent's mental health information to a coroner, medical  
            examiner, or forensic pathologist when required in the course  
            of an investigation into the cause and manner of the  
            decedent's death, while also prohibiting the disclosure of  
            such records to third parties.  This measure is sponsored by  
            the County of Santa Clara.    



           2)Author's statement  . According to the author's office, "Medical  
            diagnoses and mental health issues affect one another and are  
            more complex than once realized.  The lack of access to mental  
            health records restricts the coroner's and/or medical  
            examiner's ability to consider all potential causes of death.   
            Access to mental health records by a coroner or medical  
            examiner can help contribute to the understanding of how the  
            effects of mental health illness relate to cause of death and  
            educate the general public and medical communities about the  
            findings.  










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            "AB 2119 would authorize a provider of public mental health  
            services to disclose mental health records regarding a patient  
            to a coroner, medical examiner, or forensic pathologist when  
            requested in the course of an investigation by a coroner,  
            medical examiner, or forensic pathologist, and the patient is  
            the decedent who is the subject of the investigation."





           3)Updating medical privacy law to include medical examiners and  
            forensic pathologists  .  Current law does not grant medical  
            examiners and forensic pathologists access to a decedent's  
            private medical records unless approved by the next-of-kin or  
            through a court order.  When the deceased is homeless, the  
            next-of-kin cannot be identified and securing a court order is  
            problematic.  In the court order process, the judge reviews  
            the mental health records in closed chambers and decides which  
            records may be released to the coroner or medical examiner.   
            The time involved in securing a court order can delay  
            completion of an autopsy and, ultimately, the identification  
            of the deceased, the determination of cause and manner of  
            death, and the notification of next of kin.  As a result, the  
            author asserts that a lack of access to mental health records  
            can restrict a medical examiner's or forensic pathologist's  
            ability to consider all potential causes of death. 



            This bill would authorize a provider of medical or mental  
            health services to disclose medical and mental health records  
            regarding a patient to a county medical examiner or forensic  
            pathologist when requested in the course of an investigation  
            by a medical examiner or forensic pathologist and the patient  
            is the decedent who is the subject of the investigation.   
            Current law already allows county coroners access to this  
            data, but the statute does not specifically allow medical  








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            examiners and forensic pathologists the same access.  As an  
            added measure of privacy protection, this bill would also  
            explicitly prohibit the disclosure of medical information  
            obtained under these provisions to a third party, absent a  
            court order. 



           4)Arguments in support  .  This bill is sponsored by the County of  
            Santa Clara, which states in support: "Mental health illness  
            and medical ailments are more integrated and complex than once  
            thought.  By providing the? medical examiner and forensic  
            pathologist access to?records, more definitive and accurate  
            causes of death will be rendered.  A more accurate diagnosis  
            may aid the family in addressing other health concerns not  
            previously identified especially in those illnesses which have  
            a genetic predisposition."
           


          5)Related legislation  .  SB 1443 (Galgiani) would also amend the  
            CMIA to allow disclosure of information between county and  
            state correctional facilities to ensure the continuity of  
            health care for inmates being transferred.   SB 1443 is  
            pending in the Senate Appropriations Committee. 

           6)Prior legislation  .  AB 1297 (John A. Pérez), Chapter 341,  
            Statutes of 2013, facilitated the sharing of information  
            between coroners and organ procurement organizations regarding  
            cases in which an anatomical gift may be available from a  
            person whose demise is imminent and that person's body will be  
            subject to a death investigation by the coroner.  





           7)Double-referral  .  This bill was double-referred to the  
            Assembly Health Committee where it was heard on April 12,  








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            2016, and passed on a 19-0 vote.  
          REGISTERED SUPPORT / OPPOSITION:




          Support


          County of Santa Clara (sponsor)


          California State Coroners' Association


          Urban Counties of California




          Opposition


          None on file.




          Analysis Prepared by:Jennie Bretschneider / P. & C.P. / (916)  
          319-2200

















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