BILL ANALYSIS                                                                                                                                                                                                    Ó



                                                                    AB 2119


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          CONCURRENCE IN SENATE AMENDMENTS


          AB  
          2119 (Chu)


          As Amended  August 15, 2016


          Majority vote


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          |ASSEMBLY:  |78-0  |(May 12, 2016) |SENATE: |39-0  |(August 22,      |
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          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


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          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  








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          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  








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          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