BILL ANALYSIS Ó AB 2119 Page 1 CONCURRENCE IN SENATE AMENDMENTS AB 2119 (Chu) As Amended August 15, 2016 Majority vote -------------------------------------------------------------------- |ASSEMBLY: |78-0 |(May 12, 2016) |SENATE: |39-0 |(August 22, | | | | | | |2016) | | | | | | | | | | | | | | | -------------------------------------------------------------------- Original Committee Reference: HEALTH SUMMARY: Authorizes licensed physicians who perform official autopsies on behalf of a county coroner's office or the medical examiner's office to receive medical information for specified purposes. Requires a health facility, as defined, a health or behavioral health facility or clinic, and the physician in charge of the patient to release a patient's medical record relating to community mental health services, voluntary admissions and judicial commitments to mental hospitals, and county psychiatric hospitals to a medical examiner, forensic pathologist, or coroner, as specified, upon request, when a patient dies from any cause, natural or otherwise. The Senate amendments define medical examiner, forensic pathologist, and coroner for purposes of the bill, remove the state-mandated local program designation, and make other technical and clarifying changes. AB 2119 Page 2 EXISTING FEDERAL LAW enacts the Health Insurance Portability and Accountability Act of 1996 (HIPAA), was enacted on August 21, 1996, which requires the Secretary of Health and Human Services to publicize standards for the electronic exchange, privacy and security of health information. HIPAA Privacy regulations require health care providers and organizations, as well as their business associates, to develop and follow procedures that ensure the confidentiality and security of protected health information (PHI) when it is transferred, received, handled, or shared. This applies to all forms of PHI, including paper, oral, and electronic, etc. Only the minimum health information necessary to conduct business is to be used or shared. FISCAL EFFECT: 1)Potential increase in ongoing non-reimbursable local costs for local agencies to accept and respond to requests for the disclosure of specified medical death records. The statewide fiscal impact would be dependent on the administrative process involved and the volume of annual requests, which is unknown. 2)Minor and absorbable fiscal impact to the Department of Developmental Services, Department of State Hospitals, and the Department of Corrections and Rehabilitation to disclose medical information. 3)Private and non-reimbursable local costs to disclose medical records to medical examiners and forensic pathologists, in addition to coroners' offices. COMMENTS: According to the author, medical diagnoses and mental health issues affect one another and are more complex than once realized. The author asserts lack of access to mental health records restricts the coroner's and/or medical examiner's ability to consider all potential causes of death, and access to mental health records by a coroner or medical examiner can help AB 2119 Page 3 contribute to the understanding of how the effects of mental health illness relate to cause of death, as well as educate the general public and medical communities about those findings. The author states this bill would authorize a provider of 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. Epidemiologic studies have provided evidence of a link between mental illness, mental health, and physical health, especially as it relates to chronic disease occurrence, course, and treatment. For example, depression has been shown to affect the occurrence, treatment, and outcome of several chronic diseases and conditions, including heart disease, diabetes, hypertension, cancer, and obesity. Mental illnesses such as depression and indicators of mental illness such as frequent mental distress are related to certain risk behaviors, including physical inactivity, smoking, drinking, and insufficient sleep. Emerging evidence shows that positive mental health is associated with improved health outcomes. For example, in one study, individuals with mentally healthy attributes (such as optimism) had a lower risk for coronary heart disease. Other studies have shown that persons with a diagnosis of bipolar disorder may have higher incidences of cardiovascular disease. This bill is sponsored by the County of Santa Clara who states that, current law does not grant coroners and medical examiners access to a decedent's private medical records unless approved by the next-of-kin or through a court order. The sponsor notes that often if the deceased is homeless, the next-of-kin cannot be identified and a court order is problematic for a number of reasons. In this 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 sponsor contends, generally, judges are not trained to read medical or mental health records and, as a result, may not recognize the significance of certain details contained in the records and the AB 2119 Page 4 time involved in securing a court order delays completion of an autopsy and, ultimately, the determination of cause and manner of death. Analysis Prepared by: Lara Flynn / HEALTH / (916) 319-2097 FN: 0004166