BILL ANALYSIS                                                                                                                                                                                                    �



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          SENATE THIRD READING
          SB 1407 (Leno)
          As Amended June 20, 2012
          Majority vote 

           SENATE VOTE  :33-0  
           
           JUDICIARY           10-0        APPROPRIATIONS      17-0        
           
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          |Ayes:|Feuer, Wagner, Atkins,    |Ayes:|Gatto, Harkey,            |
          |     |Dickinson, Gorell, Huber, |     |Blumenfield, Bradford,    |
          |     |Jones, Monning,           |     |Charles Calderon, Campos, |
          |     |Wieckowski, Chesbro       |     |Davis, Donnelly, Fuentes, |
          |     |                          |     |Hall, Hill, Cedillo,      |
          |     |                          |     |Mitchell, Nielsen, Norby, |
          |     |                          |     |Solorio, Wagner           |
          |-----+--------------------------+-----+--------------------------|
          |     |                          |     |                          |
           ----------------------------------------------------------------- 
           SUMMARY :  Prohibits the disclosure of a dependent child's mental 
          health records or information based on the request of the 
          child's parent or guardian, unless the court orders otherwise.  
          Specifically,  this bill  : 

          1)Provides that a psychotherapist, who knows that a child has 
            been removed from his or her parent's or guardian's custody in 
            dependency proceedings, shall not release the child's mental 
            health records and shall not disclose information about the 
            child based on an authorization signed by the parent or 
            guardian, unless authorized to do so in a court order issued 
            after a finding by the court that the order would not be 
            detrimental to the child.  If that occurs, requires the parent 
            or guardian to present a copy of the court order to the 
            psychotherapist before any records or information may be 
            released.  

          2)Provides that a psychotherapist does not have a duty to 
            inquire or investigate whether a child has been removed from 
            his or her parent's or guardian's custody in dependency 
            proceedings when presented by a parent with an authorization 
            to release mental health records.

          3)Provides that the prohibition in 1) above, does not limit a 








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            psychotherapist's existing authority to deny release of 
            records if the psychotherapist determines that release of the 
            records would have a detrimental effect on the 
            psychotherapist's professional relationship with the child or 
            the child's physical safety or psychological well-being, 
            notwithstanding that a juvenile court may have issued an order 
            authorizing the parent to access such records.  Provides that 
            a psychotherapist's immunity from liability for decisions 
            regarding release of records in these instances continues to 
            be governed by existing law.

           EXISTING LAW  :

          1)Specifies, under the federal Health Insurance Portability and 
            Accountability Act (HIPAA), privacy protections for patients' 
            protected health information and generally provides that a 
            covered entity, as defined, may not use or disclose protected 
            health information except as specified or as authorized by the 
            patient in writing.  

          2)Prohibits a health care provider, health care service plan, or 
            contractor from disclosing medical information, as defined, 
            regarding a patient, enrollee, or subscriber without first 
            obtaining an authorization, except as specified.  Provides 
            that a valid authorization must comply with HIPAA and the 
            California Confidentiality of Medical Information Act (CMIA).  


          3)Authorizes minors 12 years of age and older to consent to 
            mental health treatment or counseling services if, in the 
            opinion of the attending professional person, the minor is 
            mature enough to participate intelligently in the mental 
            health treatment or counseling services.  

          4)Provides that an adult patient of a health care provider, any 
            minor patient authorized by law to consent to medical 
            treatment, and any patient representative shall be entitled to 
            inspect the patient's records upon presenting to the health 
            care provider a written request for those records and upon 
            payment of reasonable clerical costs incurred in locating and 
            making the records available.  
           
           5)Provides that representatives are not entitled to inspect or 
            obtain copies of a minor patient's medical records if the 








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            minor has a right to consent to the medical care or where the 
            health care provider determines that access to the records 
            would have a detrimental effect on the provider's professional 
            relationship with the minor or the minor's physical safety or 
            psychological well-being.  Provides that, absent bad faith, 
            there is no liability for a health care provider's decision 
            regarding release of records based on detrimental effect to 
            the minor.  

          6)Provides a cause of action against any person or entity who 
            negligently releases confidential information or records in 
            violation of the CMIA.  

          7)Provides that a minor may be removed from the physical custody 
            of his or her parents and made a dependent of the juvenile 
            court as the result of abuse or neglect.  

           FISCAL EFFECT  :  According to the Assembly Appropriations 
          Committee, there are no significant costs associated with this 
          legislation.
           
          COMMENTS  :  Approximately 55,000 children in California today 
          have, as the result of abuse or neglect, been removed from their 
          parents' physical custody and reside in out-of-home placement as 
          part of the foster care system.  When a child is removed from 
          his or her parent's custody in dependency proceedings, the court 
          may temporarily limit the parent's authority over developmental 
          or educational decisions and medical care, including the 
          administration of psychotropic medications, pending 
          reunification or termination of parental rights.

          This bill provides that a therapist may only release the mental 
          health information of a dependent child to a parent without 
          physical custody of the child if there has been a court order to 
          release the information, made after a court finding that such a 
          release would not be detrimental to the child.

          This bill prohibits a psychotherapist from disclosing the mental 
          health records or information of a child based on an 
          authorization signed by the parent or guardian of that child if 
          that child has been removed from the physical custody of that 
          parent in dependency proceedings and the psychotherapist knows 
          about the removal, unless a court orders otherwise.  A court may 
          only do so if it finds that allowing the parent to access the 








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          child's mental health records would not be detrimental to the 
          child.  
           
          Both HIPAA and the California CMIA protect the privacy of 
          medical information on a patient's medical history, mental or 
          physical condition, or treatment in the possession of a health 
          care provider.  A health care provider may not use or disclose 
          protected health information except as specified or as 
          authorized by the patient or patient's representative.  Parents 
          are generally considered their child's representative for 
          disclosure of medical information.  However, once mental health 
          records have been released to a parent, there are few limits on 
          their use.    

          Current law provides an exception to protect the child patient.  
          Health care providers need not release information to a minor's 
          representative if the health care provider determines releasing 
          the information would have a detrimental effect on the 
          provider's professional relationship with the minor, or the 
          minor's physical safety or psychological well-being.  Moreover, 
          absent bad faith, a therapist will not be held liable for his or 
          her decision regarding release of records based on detrimental 
          effect to the minor.  This bill does not affect these 
          provisions.

          This bill instead creates stronger protections for the mental 
          health records of children who have been removed from their 
          parents due to abuse or neglect and made dependents of the 
          juvenile court.  Under this bill, therapists who know that a 
          child patient has been removed from a parent's custody in 
          dependency proceedings will be prohibited from releasing the 
          child's mental health records to a parent, whether or not the 
          parent signs an authorization that would otherwise be valid.  
          Parents are not completely denied access to their child's 
          records.  Parents who want to access their child's mental health 
          record can still request authorization from the court and a 
          court can make such an order, after finding that the release of 
          records would not be detrimental to the child.  A therapist has 
          no duty to inquire or investigate whether the child was a 
          dependent child.  The limitation on providing information or 
          records only applies if the therapist knows the child has been 
          removed from the parent's custody by the dependency court.  

          Even if a court orders release of the records, a therapist could 








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          still refuse to release the records if the therapist determines 
          that the release would have a detrimental effect on the 
          provider's professional relationship with the child, or the 
          child's physical safety or psychological well-being.  
                             
           
          Analysis Prepared by  :  Leora Gershenzon / JUD. / (916) 319-2334


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