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
AB 2119
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