AB 1119: Developmental and mental health services: information and records: confidentiality.
- Session Year: 2017-2018
- House: Assembly
- Latest Version Date: 2017-09-27
Existing law requires all information and records obtained in the course of providing specified developmental services and mental services to either voluntary or involuntary recipients of services to be confidential, and authorizes disclosure only in specified cases, including in communications between qualified professional persons in the provision of services or appropriate referrals, and to the designated officer of an emergency response employee, and from that designated officer to an emergency response employee regarding possible exposure to the human immunodeficiency virus or the acquired immune deficiency syndrome.
This bill would additionally authorize, during the provision of emergency services and care, the communication of patient information and records between specified individuals, including, among others, a social worker with a masters degree in social work. The bill would also make technical, nonsubstantive changes.
This bill would incorporate additional changes to Section 5328 of the Welfare and Institutions Code proposed by SB 241 to be operative only if this bill and SB 241 are enacted and this bill is enacted last.
Existing law requires all information and records obtained in the course of providing specified developmental services and mental services to either voluntary or involuntary recipients of services to be confidential, and authorizes disclosure only in specified cases, including in communications between qualified professional persons in the provision of services or appropriate referrals, and to the designated officer of an emergency response employee, and from that designated officer to an emergency response employee regarding possible exposure to the human immunodeficiency virus or the acquired immune deficiency syndrome.
This bill would additionally authorize, during the provision of emergency services and care, the communication of patient information and records between specified individuals, including, among others, a social worker with a masters degree in social work. The bill would also make technical, nonsubstantive changes.
This bill would incorporate additional changes to Section 5328 of the Welfare and Institutions Code proposed by SB 241 to be operative only if this bill and SB 241 are enacted and this bill is enacted last.
Existing law requires all information and records obtained in the course of providing specified developmental services and mental services to either voluntary or involuntary recipients of services to be confidential, and authorizes disclosure only in specified cases, including in communications between qualified professional persons in the provision of services or appropriate referrals, and to the designated officer of an emergency response employee, and from that designated officer to an emergency response employee regarding possible exposure to the human immunodeficiency virus or the acquired immune deficiency syndrome.
This bill would additionally authorize, during the provision of emergency services and care, the communication of patient information and records between specified individuals, including, among others, a social worker with a masters degree in social work. The bill would also make technical, nonsubstantive changes.
This bill would incorporate additional changes to Section 5328 of the Welfare and Institutions Code proposed by SB 241 to be operative only if this bill and SB 241 are enacted and this bill is enacted last.
Existing law requires all information and records obtained in the course of providing specified developmental services and mental services to either voluntary or involuntary recipients of services to be confidential, and authorizes disclosure only in specified cases, including in communications between qualified professional persons in the provision of services or appropriate referrals, and to the designated officer of an emergency response employee, and from that designated officer to an emergency response employee regarding possible exposure to the human immunodeficiency virus or the acquired immune deficiency syndrome.
This bill would additionally authorize, during the provision of emergency services and care, the communication of patient information and records between specified individuals, including, among others, a social worker with a masters degree in social work. The bill would also make technical, nonsubstantive changes.
Existing law establishes the State Department of State Hospitals, within the California Health and Human Services Agency. Existing law provides the department with jurisdiction over the execution of laws relating to care and treatment of persons with mental health disorders under the custody of the department.This bill would make technical, nonsubstantive changes to these provisions.Existing law establishes the State Department of State Hospitals, within the California Health and Human Services Agency. Existing law provides the department with jurisdiction over the execution of laws relating to care and treatment of persons with mental health disorders under the custody of the department.
This bill would make technical, nonsubstantive changes to these provisions.
(a)All information and records obtained in the course of providing services under Division 4 (commencing with Section 4000), Division 4.1 (commencing with Section 4400), Division 4.5 (commencing with Section 4500), Division 5 (commencing with Section 5000), Division 6 (commencing with Section 6000), or Division 7 (commencing with Section 7100), to either voluntary or involuntary recipients of services shall be confidential. Information and records obtained in the course of providing similar services to either voluntary or involuntary recipients prior to 1969 shall also be confidential. Information and records shall be disclosed only in any of the following cases:
(1)In communications between qualified professional persons in the provision of services or appropriate referrals, or in the course of conservatorship proceedings. The consent of the patient, or his or her guardian or conservator, shall be obtained before information or records may be disclosed by a professional person employed by a facility to a professional person not employed by the facility who does not have the medical or psychological responsibility for the patients care.
(2)When the patient, with the approval of the physician and surgeon, licensed psychologist, social worker with a masters degree in social work, licensed marriage and family therapist, or licensed professional clinical counselor, who is in charge of the patient, designates persons to whom information or records may be released, except that this article does not compel a physician and surgeon, licensed psychologist, social worker with a masters degree in social work, licensed marriage and family therapist, licensed professional clinical counselor, nurse, attorney, or other professional person to reveal information that has been given to him or her in confidence by members of a patients family. This paragraph does not authorize a licensed marriage and family therapist or licensed professional clinical counselor to provide services or to be in charge of a patients care beyond his or her lawful scope of practice.
(3)To the extent necessary for a recipient to make a claim, or for a claim to be made on behalf of a recipient for aid, insurance, or medical assistance to which he or she may be entitled.
(4)If the recipient of services is a minor, ward, dependent, or conservatee, and his or her parent, guardian, guardian ad litem, conservator, or authorized representative designates, in writing, persons to whom records or information may be disclosed, except that this article does not compel a physician and surgeon, licensed psychologist, social worker with a masters degree in social work, licensed marriage and family therapist, licensed professional clinical counselor, nurse, attorney, or other professional person to reveal information that has been given to him or her in confidence by members of a patients family.
(5)For research, provided that the Director of Health Care Services, the Director of State Hospitals, the Director of Social Services, or the Director of Developmental Services designates by regulation, rules for the conduct of research and requires the research to be first reviewed by the appropriate institutional review board or boards. The rules shall include, but need not be limited to, the requirement that all researchers shall sign an oath of confidentiality as follows:
Date |
As a condition of doing research concerning persons who have received services from ____ (fill in the facility, agency or person), I, ____, agree to obtain the prior informed consent of such persons who have received services to the maximum degree possible as determined by the appropriate institutional review board or boards for protection of human subjects reviewing my research, and I further agree not to divulge any information obtained in the course of such research to unauthorized persons, and not to publish or otherwise make public any information regarding persons who have received services such that the person who received services is identifiable.
I recognize that the unauthorized release of confidential information may make me subject to a civil action under provisions of the Welfare and Institutions Code.
(6)To the courts, as necessary to the administration of justice.
(7)To governmental law enforcement agencies as needed for the protection of federal and state elective constitutional officers and their families.
(8)To the Senate Committee on Rules or the Assembly Committee on Rules for the purposes of legislative investigation authorized by the committee.
(9)If the recipient of services who applies for life or disability insurance designates in writing the insurer to which records or information may be disclosed.
(10)To the attorney for the patient in any and all proceedings upon presentation of a release of information signed by the patient, except that when the patient is unable to sign the release, the staff of the facility, upon satisfying itself of the identity of the attorney, and of the fact that the attorney does represent the interests of the patient, may release all information and records relating to the patient except that this article does not compel a physician and surgeon, licensed psychologist, social worker with a masters degree in social work, licensed marriage and family therapist, licensed professional clinical counselor, nurse, attorney, or other professional person to reveal information that has been given to him or her in confidence by members of a patients family.
(11)Upon written agreement by a person previously confined in or otherwise treated by a facility, the professional person in charge of the facility or his or her designee may release any information, except information that has been given in confidence by members of the persons family, requested by a probation officer charged with the evaluation of the person after his or her conviction of a crime if the professional person in charge of the facility determines that the information is relevant to the evaluation. The agreement shall only be operative until sentence is passed on the crime of which the person was convicted. The confidential information released pursuant to this paragraph shall be transmitted to the court separately from the probation report and shall not be placed in the probation report. The confidential information shall remain confidential except for purposes of sentencing. After sentencing, the confidential information shall be sealed.
(12)(A)Between persons who are trained and qualified to serve on multidisciplinary personnel teams pursuant to subdivision (d) of Section 18951. The information and records sought to be disclosed shall be relevant to the provision of child welfare services or the investigation, prevention, identification, management, or treatment of child abuse or neglect pursuant to Chapter 11 (commencing with Section 18950) of Part 6 of Division 9. Information obtained pursuant to this paragraph shall not be used in any criminal or delinquency proceeding. This paragraph does not prohibit evidence identical to that contained within the records from being admissible in a criminal or delinquency proceeding, if the evidence is derived solely from means other than this paragraph, as permitted by law.
(B)As used in this paragraph, child welfare services means those services that are directed at preventing child abuse or neglect.
(13)To county patients rights advocates who have been given knowing voluntary authorization by a client or a guardian ad litem. The client or guardian ad litem, whoever entered into the agreement, may revoke the authorization at any time, either in writing or by oral declaration to an approved advocate.
(14)To a committee established in compliance with Section 14725.
(15)In providing information as described in Section 7325.5. This paragraph does not permit the release of any information other than that described in Section 7325.5.
(16)To the county behavioral health director or the directors designee, or to a law enforcement officer, or to the person designated by a law enforcement agency, pursuant to Sections 5152.1 and 5250.1.
(17)If the patient gives his or her consent, information specifically pertaining to the existence of genetically handicapping conditions, as defined in Section 125135 of the Health and Safety Code, may be released to qualified professional persons for purposes of genetic counseling for blood relatives upon request of the blood relative. For purposes of this paragraph, qualified professional persons means those persons with the qualifications necessary to carry out the genetic counseling duties under this paragraph as determined by the genetic disease unit established in the State Department of Health Care Services under Section 125000 of the Health and Safety Code. If the patient does not respond or cannot respond to a request for permission to release information pursuant to this paragraph after reasonable attempts have been made over a two-week period to get a response, the information may be released upon request of the blood relative.
(18)When the patient, in the opinion of his or her psychotherapist, presents a serious danger of violence to a reasonably foreseeable victim or victims, then any of the information or records specified in this section may be released to that person or persons and to law enforcement agencies and county child welfare agencies as the psychotherapist determines is needed for the protection of that person or persons. For purposes of this paragraph, psychotherapist has the same meaning as provided in Section 1010 of the Evidence Code.
(19)(A)To the designated officer of an emergency response employee, and from that designated officer to an emergency response employee regarding possible exposure to HIV or AIDS, but only to the extent necessary to comply with the federal Ryan White Comprehensive AIDS Resources Emergency Act of 1990 (Public Law 101-381; 42 U.S.C. Sec. 201).
(B)For purposes of this paragraph, designated officer and emergency response employee have the same meaning as these terms are used in the federal Ryan White Comprehensive AIDS Resources Emergency Act of 1990 (Public Law 101-381; 42 U.S.C. Sec. 201).
(C)The designated officer shall be subject to the confidentiality requirements specified in Section 120980, and may be personally liable for unauthorized release of any identifying information about the HIV results. Further, the designated officer shall inform the exposed emergency response employee that the employee is also subject to the confidentiality requirements specified in Section 120980, and may be personally liable for unauthorized release of any identifying information about the HIV test results.
(20)(A)To a law enforcement officer who personally lodges with a facility, as defined in subparagraph (B), a warrant of arrest or an abstract of a warrant showing that the person sought is wanted for a serious felony, as defined in Section 1192.7 of the Penal Code, or a violent felony, as defined in Section 667.5 of the Penal Code. The information sought and released shall be limited to whether or not the person named in the arrest warrant is presently confined in the facility. This subparagraph shall be implemented with minimum disruption to health facility operations and patients, in accordance with Section 5212. If the law enforcement officer is informed that the person named in the warrant is confined in the facility, the officer may not enter the facility to arrest the person without obtaining a valid search warrant or the permission of staff of the facility.
(B)For purposes of subparagraph (A), a facility means all of the following:
(i)A state hospital, as defined in Section 4001.
(ii)A general acute care hospital, as defined in subdivision (a) of Section 1250 of the Health and Safety Code, solely with regard to information pertaining to a person with mental illness subject to this section.
(iii)An acute psychiatric hospital, as defined in subdivision (b) of Section 1250 of the Health and Safety Code.
(iv)A psychiatric health facility, as described in Section 1250.2 of the Health and Safety Code.
(v)A mental health rehabilitation center, as described in Section 5675.
(vi)A skilled nursing facility with a special treatment program for individuals with mental illness, as described in Sections 51335 and 72445 to 72475, inclusive, of Title 22 of the California Code of Regulations.
(21)Between persons who are trained and qualified to serve on multidisciplinary personnel teams pursuant to Section 15610.55, 15753.5, or 15761. The information and records sought to be disclosed shall be relevant to the prevention, identification, management, or treatment of an abused elder or dependent adult pursuant to Chapter 13 (commencing with Section 15750) of Part 3 of Division 9.
(22)(A)When an employee is served with a notice of adverse action, as defined in Section 19570 of the Government Code, all of the following information and records may be released:
(i)All information and records that the appointing authority relied upon in issuing the notice of adverse action.
(ii)All other information and records that are relevant to the adverse action, or that would constitute relevant evidence as defined in Section 210 of the Evidence Code.
(iii)The information described in clauses (i) and (ii) may be released only if both of the following conditions are met:
(I)The appointing authority has provided written notice to the consumer and the consumers legal representative or, if the consumer has no legal representative or if the legal representative is a state agency, to the clients rights advocate, and the consumer, the consumers legal representative, or the clients rights advocate has not objected in writing to the appointing authority within five business days of receipt of the notice, or the appointing authority, upon review of the objection has determined that the circumstances on which the adverse action is based are egregious or threaten the health, safety, or life of the consumer or other consumers and without the information the adverse action could not be taken.
(II)The appointing authority, the person against whom the adverse action has been taken, and the persons representative, if any, have entered into a stipulation that does all of the following:
(ia)Prohibits the parties from disclosing or using the information or records for any purpose other than the proceedings for which the information or records were requested or provided.
(ib)Requires the employee and the employees legal representative to return to the appointing authority all records provided to them under this paragraph, including, but not limited to, all records and documents from any source containing confidential information protected by this section, and all copies of those records and documents, within 10 days of the date that the adverse action becomes final except for the actual records and documents or copies thereof that are no longer in the possession of the employee or the employees legal representative because they were submitted to the administrative tribunal as a component of an appeal from the adverse action.
(ic)Requires the parties to submit the stipulation to the administrative tribunal with jurisdiction over the adverse action at the earliest possible opportunity.
(B)For the purposes of this paragraph, the State Personnel Board may, prior to any appeal from adverse action being filed with it, issue a protective order, upon application by the appointing authority, for the limited purpose of prohibiting the parties from disclosing or using information or records for any purpose other than the proceeding for which the information or records were requested or provided, and to require the employee or the employees legal representative to return to the appointing authority all records provided to them under this paragraph, including, but not limited to, all records and documents from any source containing confidential information protected by this section, and all copies of those records and documents, within 10 days of the date that the adverse action becomes final, except for the actual records and documents or copies thereof that are no longer in the possession of the employee or the employees legal representatives because they were submitted to the administrative tribunal as a component of an appeal from the adverse action.
(C)Individual identifiers, including, but not limited to, names, social security numbers, and hospital numbers, that are not necessary for the prosecution or defense of the adverse action, shall not be disclosed.
(D)All records, documents, or other materials containing confidential information protected by this section that have been submitted or otherwise disclosed to the administrative agency or other person as a component of an appeal from an adverse action shall, upon proper motion by the appointing authority to the administrative tribunal, be placed under administrative seal and shall not, thereafter, be subject to disclosure to any person or entity except upon the issuance of an order of a court of competent jurisdiction.
(E)For purposes of this paragraph, an adverse action becomes final when the employee fails to answer within the time specified in Section 19575 of the Government Code, or, after filing an answer, withdraws the appeal, or, upon exhaustion of the administrative appeal or of the judicial review remedies as otherwise provided by law.
(23)To the person appointed as the developmental services decisionmaker for a minor, dependent, or ward pursuant to Section 319, 361, or 726.
(24)During the provision of emergency services and care, as defined in Section 1317.1 of the Health and Safety Code, the communication of patient information between a physician and surgeon, licensed psychologist, social worker with a masters degree in social work, licensed marriage and family therapist, licensed professional clinical counselor, nurse, emergency medical personnel at the scene of an emergency or in an emergency medical transport vehicle, or other professional person or emergency medical personnel at a health facility licensed pursuant to Chapter 2 (commencing with Section 1250) of Division 2 of the Health and Safety Code.
(b)The amendment of paragraph (4) of subdivision (a) enacted at the 1970 Regular Session of the Legislature does not constitute a change in, but is declaratory of, the preexisting law.
(c)This section is not limited by Section 5150.05 or 5332.
SEC. 1.5.Section 5328 of the Welfare and Institutions Code is amended to read:5328.(a)All information and records obtained in the course of providing services under Division 4 (commencing with Section 4000), Division 4.1 (commencing with Section 4400), Division 4.5 (commencing with Section 4500), Division 5 (commencing with Section 5000), Division 6 (commencing with Section 6000), or Division 7 (commencing with Section 7100), to either voluntary or involuntary recipients of services shall be confidential. Information and records obtained in the course of providing similar services to either voluntary or involuntary recipients prior to 1969 shall also be confidential. Information and records shall be disclosed only in any of the following cases:
(1)In communications between qualified professional persons in the provision of services or appropriate referrals, or in the course of conservatorship proceedings. The consent of the patient, or his or her guardian or conservator, shall be obtained before information or records may be disclosed by a professional person employed by a facility to a professional person not employed by the facility who does not have the medical or psychological responsibility for the patients care.
(2)When the patient, with the approval of the physician and surgeon, licensed psychologist, social worker with a masters degree in social work, licensed marriage and family therapist, or licensed professional clinical counselor, who is in charge of the patient, designates persons to whom information or records may be released, except that this article does not compel a physician and surgeon, licensed psychologist, social worker with a masters degree in social work, licensed marriage and family therapist, licensed professional clinical counselor, nurse, attorney, or other professional person to reveal information that has been given to him or her in confidence by members of a patients family. This paragraph does not authorize a licensed marriage and family therapist or licensed professional clinical counselor to provide services or to be in charge of a patients care beyond his or her lawful scope of practice.
(3)To the extent necessary for a recipient to make a claim, or for a claim to be made on behalf of a recipient for aid, insurance, or medical assistance to which he or she may be entitled.
(4)If the recipient of services is a minor, ward, dependent, or conservatee, and his or her parent, guardian, guardian ad litem, conservator, or authorized representative designates, in writing, persons to whom records or information may be disclosed, except that this article does not compel a physician and surgeon, licensed psychologist, social worker with a masters degree in social work, licensed marriage and family therapist, licensed professional clinical counselor, nurse, attorney, or other professional person to reveal information that has been given to him or her in confidence by members of a patients family.
(5)For research, provided that the Director of Health Care Services, the Director of State Hospitals, the Director of Social Services, or the Director of Developmental Services designates by regulation, rules for the conduct of research and requires the research to be first reviewed by the appropriate institutional review board or boards. The rules shall include, but need not be limited to, the requirement that all researchers shall sign an oath of confidentiality as follows:
Date |
As a condition of doing research concerning persons who have received services from ____ (fill in the facility, agency or person), I, ____, agree to obtain the prior informed consent of such persons who have received services to the maximum degree possible as determined by the appropriate institutional review board or boards for protection of human subjects reviewing my research, and I further agree not to divulge any information obtained in the course of such research to unauthorized persons, and not to publish or otherwise make public any information regarding persons who have received services such that the person who received services is identifiable.
I recognize that the unauthorized release of confidential information may make me subject to a civil action under provisions of the Welfare and Institutions Code.
(6)To the courts, as necessary to the administration of justice.
(7)To governmental law enforcement agencies as needed for the protection of federal and state elective constitutional officers and their families.
(8)To the Senate Committee on Rules or the Assembly Committee on Rules for the purposes of legislative investigation authorized by the committee.
(9)If the recipient of services who applies for life or disability insurance designates in writing the insurer to which records or information may be disclosed.
(10)To the attorney for the patient in any and all proceedings upon presentation of a release of information signed by the patient, except that when the patient is unable to sign the release, the staff of the facility, upon satisfying itself of the identity of the attorney, and of the fact that the attorney does represent the interests of the patient, may release all information and records relating to the patient except that this article does not compel a physician and surgeon, licensed psychologist, social worker with a masters degree in social work, licensed marriage and family therapist, licensed professional clinical counselor, nurse, attorney, or other professional person to reveal information that has been given to him or her in confidence by members of a patients family.
(11)Upon written agreement by a person previously confined in or otherwise treated by a facility, the professional person in charge of the facility or his or her designee may release any information, except information that has been given in confidence by members of the persons family, requested by a probation officer charged with the evaluation of the person after his or her conviction of a crime if the professional person in charge of the facility determines that the information is relevant to the evaluation. The agreement shall only be operative until sentence is passed on the crime of which the person was convicted. The confidential information released pursuant to this paragraph shall be transmitted to the court separately from the probation report and shall not be placed in the probation report. The confidential information shall remain confidential except for purposes of sentencing. After sentencing, the confidential information shall be sealed.
(12)(A)Between persons who are trained and qualified to serve on multidisciplinary personnel teams pursuant to subdivision (d) of Section 18951. The information and records sought to be disclosed shall be relevant to the provision of child welfare services or the investigation, prevention, identification, management, or treatment of child abuse or neglect pursuant to Chapter 11 (commencing with Section 18950) of Part 6 of Division 9. Information obtained pursuant to this paragraph shall not be used in any criminal or delinquency proceeding. This paragraph does not prohibit evidence identical to that contained within the records from being admissible in a criminal or delinquency proceeding, if the evidence is derived solely from means other than this paragraph, as permitted by law.
(B)As used in this paragraph, child welfare services means those services that are directed at preventing child abuse or neglect.
(13)To county patients rights advocates who have been given knowing voluntary authorization by a client or a guardian ad litem. The client or guardian ad litem, whoever entered into the agreement, may revoke the authorization at any time, either in writing or by oral declaration to an approved advocate.
(14)To a committee established in compliance with Section 14725.
(15)In providing information as described in Section 7325.5. This paragraph does not permit the release of any information other than that described in Section 7325.5.
(16)To the county behavioral health director or the directors designee, or to a law enforcement officer, or to the person designated by a law enforcement agency, pursuant to Sections 5152.1 and 5250.1.
(17)If the patient gives his or her consent, information specifically pertaining to the existence of genetically handicapping conditions, as defined in Section 125135 of the Health and Safety Code, may be released to qualified professional persons for purposes of genetic counseling for blood relatives upon request of the blood relative. For purposes of this paragraph, qualified professional persons means those persons with the qualifications necessary to carry out the genetic counseling duties under this paragraph as determined by the genetic disease unit established in the State Department of Health Care Services under Section 125000 of the Health and Safety Code. If the patient does not respond or cannot respond to a request for permission to release information pursuant to this paragraph after reasonable attempts have been made over a two-week period to get a response, the information may be released upon request of the blood relative.
(18)When the patient, in the opinion of his or her psychotherapist, presents a serious danger of violence to a reasonably foreseeable victim or victims, then any of the information or records specified in this section may be released to that person or persons and to law enforcement agencies and county child welfare agencies as the psychotherapist determines is needed for the protection of that person or persons. For purposes of this paragraph, psychotherapist has the same meaning as provided in Section 1010 of the Evidence Code.
(19)(A)To the designated officer of an emergency response employee, and from that designated officer to an emergency response employee regarding possible exposure to HIV or AIDS, but only to the extent necessary to comply with the federal Ryan White Comprehensive AIDS Resources Emergency Act of 1990 (Public Law 101-381; 42 U.S.C. Sec. 201).
(B)For purposes of this paragraph, designated officer and emergency response employee have the same meaning as these terms are used in the federal Ryan White Comprehensive AIDS Resources Emergency Act of 1990 (Public Law 101-381; 42 U.S.C. Sec. 201).
(C)The designated officer shall be subject to the confidentiality requirements specified in Section 120980, and may be personally liable for unauthorized release of any identifying information about the HIV results. Further, the designated officer shall inform the exposed emergency response employee that the employee is also subject to the confidentiality requirements specified in Section 120980, and may be personally liable for unauthorized release of any identifying information about the HIV test results.
(20)(A)To a law enforcement officer who personally lodges with a facility, as defined in subparagraph (B), a warrant of arrest or an abstract of a warrant showing that the person sought is wanted for a serious felony, as defined in Section 1192.7 of the Penal Code, or a violent felony, as defined in Section 667.5 of the Penal Code. The information sought and released shall be limited to whether or not the person named in the arrest warrant is presently confined in the facility. This subparagraph shall be implemented with minimum disruption to health facility operations and patients, in accordance with Section 5212. If the law enforcement officer is informed that the person named in the warrant is confined in the facility, the officer may not enter the facility to arrest the person without obtaining a valid search warrant or the permission of staff of the facility.
(B)For purposes of subparagraph (A), a facility means all of the following:
(i)A state hospital, as defined in Section 4001.
(ii)A general acute care hospital, as defined in subdivision (a) of Section 1250 of the Health and Safety Code, solely with regard to information pertaining to a person with mental illness subject to this section.
(iii)An acute psychiatric hospital, as defined in subdivision (b) of Section 1250 of the Health and Safety Code.
(iv)A psychiatric health facility, as described in Section 1250.2 of the Health and Safety Code.
(v)A mental health rehabilitation center, as described in Section 5675.
(vi)A skilled nursing facility with a special treatment program for individuals with mental illness, as described in Sections 51335 and 72445 to 72475, inclusive, of Title 22 of the California Code of Regulations.
(21)Between persons who are trained and qualified to serve on multidisciplinary personnel teams pursuant to Section 15610.55, 15753.5, or 15761. The information and records sought to be disclosed shall be relevant to the prevention, identification, management, or treatment of an abused elder or dependent adult pursuant to Chapter 13 (commencing with Section 15750) of Part 3 of Division 9.
(22)(A)When an employee is served with a notice of adverse action, as defined in Section 19570 of the Government Code, all of the following information and records may be released:
(i)All information and records that the appointing authority relied upon in issuing the notice of adverse action.
(ii)All other information and records that are relevant to the adverse action, or that would constitute relevant evidence as defined in Section 210 of the Evidence Code.
(iii)The information described in clauses (i) and (ii) may be released only if both of the following conditions are met:
(I)The appointing authority has provided written notice to the consumer and the consumers legal representative or, if the consumer has no legal representative or if the legal representative is a state agency, to the clients rights advocate, and the consumer, the consumers legal representative, or the clients rights advocate has not objected in writing to the appointing authority within five business days of receipt of the notice, or the appointing authority, upon review of the objection has determined that the circumstances on which the adverse action is based are egregious or threaten the health, safety, or life of the consumer or other consumers and without the information the adverse action could not be taken.
(II)The appointing authority, the person against whom the adverse action has been taken, and the persons representative, if any, have entered into a stipulation that does all of the following:
(ia)Prohibits the parties from disclosing or using the information or records for any purpose other than the proceedings for which the information or records were requested or provided.
(ib)Requires the employee and the employees legal representative to return to the appointing authority all records provided to them under this paragraph, including, but not limited to, all records and documents from any source containing confidential information protected by this section, and all copies of those records and documents, within 10 days of the date that the adverse action becomes final except for the actual records and documents or copies thereof that are no longer in the possession of the employee or the employees legal representative because they were submitted to the administrative tribunal as a component of an appeal from the adverse action.
(ic)Requires the parties to submit the stipulation to the administrative tribunal with jurisdiction over the adverse action at the earliest possible opportunity.
(B)For the purposes of this paragraph, the State Personnel Board may, prior to any appeal from adverse action being filed with it, issue a protective order, upon application by the appointing authority, for the limited purpose of prohibiting the parties from disclosing or using information or records for any purpose other than the proceeding for which the information or records were requested or provided, and to require the employee or the employees legal representative to return to the appointing authority all records provided to them under this paragraph, including, but not limited to, all records and documents from any source containing confidential information protected by this section, and all copies of those records and documents, within 10 days of the date that the adverse action becomes final, except for the actual records and documents or copies thereof that are no longer in the possession of the employee or the employees legal representatives because they were submitted to the administrative tribunal as a component of an appeal from the adverse action.
(C)Individual identifiers, including, but not limited to, names, social security numbers, and hospital numbers, that are not necessary for the prosecution or defense of the adverse action, shall not be disclosed.
(D)All records, documents, or other materials containing confidential information protected by this section that have been submitted or otherwise disclosed to the administrative agency or other person as a component of an appeal from an adverse action shall, upon proper motion by the appointing authority to the administrative tribunal, be placed under administrative seal and shall not, thereafter, be subject to disclosure to any person or entity except upon the issuance of an order of a court of competent jurisdiction.
(E)For purposes of this paragraph, an adverse action becomes final when the employee fails to answer within the time specified in Section 19575 of the Government Code, or, after filing an answer, withdraws the appeal, or, upon exhaustion of the administrative appeal or of the judicial review remedies as otherwise provided by law.
(23)To the person appointed as the developmental services decisionmaker for a minor, dependent, or ward pursuant to Section 319, 361, or 726.
(24)During the provision of emergency services and care, as defined in Section 1317.1 of the Health and Safety Code, the communication of patient information between a physician and surgeon, licensed psychologist, social worker with a masters degree in social work, licensed marriage and family therapist, licensed professional clinical counselor, nurse, emergency medical personnel at the scene of an emergency or in an emergency medical transport vehicle, or other professional person or emergency medical personnel at a health facility licensed pursuant to Chapter 2 (commencing with Section 1250) of Division 2 of the Health and Safety Code.
(25)To a business associate or for health care operations purposes, in accordance with Part 160 (commencing with Section 160.101) and Part 164 (commencing with Section 164.102) of Subchapter C of Subtitle A of Title 45 of the Code of Federal Regulations.
(b)The amendment of paragraph (4) of subdivision (a) enacted at the 1970 Regular Session of the Legislature does not constitute a change in, but is declaratory of, the preexisting law.
(c)This section is not limited by Section 5150.05 or 5332.
SEC. 2.Section 1.5 of this bill incorporates amendments to Section 5328 of the Welfare and Institutions Code proposed by both this bill and Senate Bill 241. That section shall only become operative if (1) both bills are enacted and become effective on or before January 1, 2018, (2) each bill amends Section 5328 of the Welfare and Institutions Code, and (3) this bill is enacted after Senate Bill 241, in which case Section 1 of this bill shall not become operative.
(a)All information and records obtained in the course of providing services under Division 4 (commencing with Section 4000), Division 4.1 (commencing with Section 4400), Division 4.5 (commencing with Section 4500), Division 5 (commencing with Section 5000), Division 6 (commencing with Section 6000), or Division 7 (commencing with Section 7100), to either voluntary or involuntary recipients of services shall be confidential. Information and records obtained in the course of providing similar services to either voluntary or involuntary recipients prior to 1969 shall also be confidential. Information and records shall be disclosed only in any of the following cases:
(1)In communications between qualified professional persons in the provision of services or appropriate referrals, or in the course of conservatorship proceedings. The consent of the patient, or his or her guardian or conservator, shall be obtained before information or records may be disclosed by a professional person employed by a facility to a professional person not employed by the facility who does not have the medical or psychological responsibility for the patients care.
(2)When the patient, with the approval of the physician and surgeon, licensed psychologist, social worker with a masters degree in social work, licensed marriage and family therapist, or licensed professional clinical counselor, who is in charge of the patient, designates persons to whom information or records may be released, except that this article does not compel a physician and surgeon, licensed psychologist, social worker with a masters degree in social work, licensed marriage and family therapist, licensed professional clinical counselor, nurse, attorney, or other professional person to reveal information that has been given to him or her in confidence by members of a patients family. This paragraph does not authorize a licensed marriage and family therapist or licensed professional clinical counselor to provide services or to be in charge of a patients care beyond his or her lawful scope of practice.
(3)To the extent necessary for a recipient to make a claim, or for a claim to be made on behalf of a recipient for aid, insurance, or medical assistance to which he or she may be entitled.
(4)If the recipient of services is a minor, ward, dependent, or conservatee, and his or her parent, guardian, guardian ad litem, conservator, or authorized representative designates, in writing, persons to whom records or information may be disclosed, except that this article does not compel a physician and surgeon, licensed psychologist, social worker with a masters degree in social work, licensed marriage and family therapist, licensed professional clinical counselor, nurse, attorney, or other professional person to reveal information that has been given to him or her in confidence by members of a patients family.
(5)For research, provided that the Director of Health Care Services, the Director of State Hospitals, the Director of Social Services, or the Director of Developmental Services designates by regulation, rules for the conduct of research and requires the research to be first reviewed by the appropriate institutional review board or boards. The rules shall include, but need not be limited to, the requirement that all researchers shall sign an oath of confidentiality as follows:
Date |
As a condition of doing research concerning persons who have received services from ____ (fill in the facility, agency or person), I, ____, agree to obtain the prior informed consent of such persons who have received services to the maximum degree possible as determined by the appropriate institutional review board or boards for protection of human subjects reviewing my research, and I further agree not to divulge any information obtained in the course of such research to unauthorized persons, and not to publish or otherwise make public any information regarding persons who have received services such that the person who received services is identifiable.
I recognize that the unauthorized release of confidential information may make me subject to a civil action under provisions of the Welfare and Institutions Code.
(6)To the courts, as necessary to the administration of justice.
(7)To governmental law enforcement agencies as needed for the protection of federal and state elective constitutional officers and their families.
(8)To the Senate Committee on Rules or the Assembly Committee on Rules for the purposes of legislative investigation authorized by the committee.
(9)If the recipient of services who applies for life or disability insurance designates in writing the insurer to which records or information may be disclosed.
(10)To the attorney for the patient in any and all proceedings upon presentation of a release of information signed by the patient, except that when the patient is unable to sign the release, the staff of the facility, upon satisfying itself of the identity of the attorney, and of the fact that the attorney does represent the interests of the patient, may release all information and records relating to the patient except that this article does not compel a physician and surgeon, licensed psychologist, social worker with a masters degree in social work, licensed marriage and family therapist, licensed professional clinical counselor, nurse, attorney, or other professional person to reveal information that has been given to him or her in confidence by members of a patients family.
(11)Upon written agreement by a person previously confined in or otherwise treated by a facility, the professional person in charge of the facility or his or her designee may release any information, except information that has been given in confidence by members of the persons family, requested by a probation officer charged with the evaluation of the person after his or her conviction of a crime if the professional person in charge of the facility determines that the information is relevant to the evaluation. The agreement shall only be operative until sentence is passed on the crime of which the person was convicted. The confidential information released pursuant to this paragraph shall be transmitted to the court separately from the probation report and shall not be placed in the probation report. The confidential information shall remain confidential except for purposes of sentencing. After sentencing, the confidential information shall be sealed.
(12)(A)Between persons who are trained and qualified to serve on multidisciplinary personnel teams pursuant to subdivision (d) of Section 18951. The information and records sought to be disclosed shall be relevant to the provision of child welfare services or the investigation, prevention, identification, management, or treatment of child abuse or neglect pursuant to Chapter 11 (commencing with Section 18950) of Part 6 of Division 9. Information obtained pursuant to this paragraph shall not be used in any criminal or delinquency proceeding. This paragraph does not prohibit evidence identical to that contained within the records from being admissible in a criminal or delinquency proceeding, if the evidence is derived solely from means other than this paragraph, as permitted by law.
(B)As used in this paragraph, child welfare services means those services that are directed at preventing child abuse or neglect.
(13)To county patients rights advocates who have been given knowing voluntary authorization by a client or a guardian ad litem. The client or guardian ad litem, whoever entered into the agreement, may revoke the authorization at any time, either in writing or by oral declaration to an approved advocate.
(14)To a committee established in compliance with Section 14725.
(15)In providing information as described in Section 7325.5. This paragraph does not permit the release of any information other than that described in Section 7325.5.
(16)To the county behavioral health director or the directors designee, or to a law enforcement officer, or to the person designated by a law enforcement agency, pursuant to Sections 5152.1 and 5250.1.
(17)If the patient gives his or her consent, information specifically pertaining to the existence of genetically handicapping conditions, as defined in Section 125135 of the Health and Safety Code, may be released to qualified professional persons for purposes of genetic counseling for blood relatives upon request of the blood relative. For purposes of this paragraph, qualified professional persons means those persons with the qualifications necessary to carry out the genetic counseling duties under this paragraph as determined by the genetic disease unit established in the State Department of Health Care Services under Section 125000 of the Health and Safety Code. If the patient does not respond or cannot respond to a request for permission to release information pursuant to this paragraph after reasonable attempts have been made over a two-week period to get a response, the information may be released upon request of the blood relative.
(18)When the patient, in the opinion of his or her psychotherapist, presents a serious danger of violence to a reasonably foreseeable victim or victims, then any of the information or records specified in this section may be released to that person or persons and to law enforcement agencies and county child welfare agencies as the psychotherapist determines is needed for the protection of that person or persons. For purposes of this paragraph, psychotherapist has the same meaning as provided in Section 1010 of the Evidence Code.
(19)(A)To the designated officer of an emergency response employee, and from that designated officer to an emergency response employee regarding possible exposure to HIV or AIDS, but only to the extent necessary to comply with the federal Ryan White Comprehensive AIDS Resources Emergency Act of 1990 (Public Law 101-381; 42 U.S.C. Sec. 201).
(B)For purposes of this paragraph, designated officer and emergency response employee have the same meaning as these terms are used in the federal Ryan White Comprehensive AIDS Resources Emergency Act of 1990 (Public Law 101-381; 42 U.S.C. Sec. 201).
(C)The designated officer shall be subject to the confidentiality requirements specified in Section 120980, and may be personally liable for unauthorized release of any identifying information about the HIV results. Further, the designated officer shall inform the exposed emergency response employee that the employee is also subject to the confidentiality requirements specified in Section 120980, and may be personally liable for unauthorized release of any identifying information about the HIV test results.
(20)(A)To a law enforcement officer who personally lodges with a facility, as defined in subparagraph (B), a warrant of arrest or an abstract of a warrant showing that the person sought is wanted for a serious felony, as defined in Section 1192.7 of the Penal Code, or a violent felony, as defined in Section 667.5 of the Penal Code. The information sought and released shall be limited to whether or not the person named in the arrest warrant is presently confined in the facility. This subparagraph shall be implemented with minimum disruption to health facility operations and patients, in accordance with Section 5212. If the law enforcement officer is informed that the person named in the warrant is confined in the facility, the officer may not enter the facility to arrest the person without obtaining a valid search warrant or the permission of staff of the facility.
(B)For purposes of subparagraph (A), a facility means all of the following:
(i)A state hospital, as defined in Section 4001.
(ii)A general acute care hospital, as defined in subdivision (a) of Section 1250 of the Health and Safety Code, solely with regard to information pertaining to a person with mental illness subject to this section.
(iii)An acute psychiatric hospital, as defined in subdivision (b) of Section 1250 of the Health and Safety Code.
(iv)A psychiatric health facility, as described in Section 1250.2 of the Health and Safety Code.
(v)A mental health rehabilitation center, as described in Section 5675.
(vi)A skilled nursing facility with a special treatment program for individuals with mental illness, as described in Sections 51335 and 72445 to 72475, inclusive, of Title 22 of the California Code of Regulations.
(21)Between persons who are trained and qualified to serve on multidisciplinary personnel teams pursuant to Section 15610.55, 15753.5, or 15761. The information and records sought to be disclosed shall be relevant to the prevention, identification, management, or treatment of an abused elder or dependent adult pursuant to Chapter 13 (commencing with Section 15750) of Part 3 of Division 9.
(22)(A)When an employee is served with a notice of adverse action, as defined in Section 19570 of the Government Code, all of the following information and records may be released:
(i)All information and records that the appointing authority relied upon in issuing the notice of adverse action.
(ii)All other information and records that are relevant to the adverse action, or that would constitute relevant evidence as defined in Section 210 of the Evidence Code.
(iii)The information described in clauses (i) and (ii) may be released only if both of the following conditions are met:
(I)The appointing authority has provided written notice to the consumer and the consumers legal representative or, if the consumer has no legal representative or if the legal representative is a state agency, to the clients rights advocate, and the consumer, the consumers legal representative, or the clients rights advocate has not objected in writing to the appointing authority within five business days of receipt of the notice, or the appointing authority, upon review of the objection has determined that the circumstances on which the adverse action is based are egregious or threaten the health, safety, or life of the consumer or other consumers and without the information the adverse action could not be taken.
(II)The appointing authority, the person against whom the adverse action has been taken, and the persons representative, if any, have entered into a stipulation that does all of the following:
(ia)Prohibits the parties from disclosing or using the information or records for any purpose other than the proceedings for which the information or records were requested or provided.
(ib)Requires the employee and the employees legal representative to return to the appointing authority all records provided to them under this paragraph, including, but not limited to, all records and documents from any source containing confidential information protected by this section, and all copies of those records and documents, within 10 days of the date that the adverse action becomes final except for the actual records and documents or copies thereof that are no longer in the possession of the employee or the employees legal representative because they were submitted to the administrative tribunal as a component of an appeal from the adverse action.
(ic)Requires the parties to submit the stipulation to the administrative tribunal with jurisdiction over the adverse action at the earliest possible opportunity.
(B)For the purposes of this paragraph, the State Personnel Board may, prior to any appeal from adverse action being filed with it, issue a protective order, upon application by the appointing authority, for the limited purpose of prohibiting the parties from disclosing or using information or records for any purpose other than the proceeding for which the information or records were requested or provided, and to require the employee or the employees legal representative to return to the appointing authority all records provided to them under this paragraph, including, but not limited to, all records and documents from any source containing confidential information protected by this section, and all copies of those records and documents, within 10 days of the date that the adverse action becomes final, except for the actual records and documents or copies thereof that are no longer in the possession of the employee or the employees legal representatives because they were submitted to the administrative tribunal as a component of an appeal from the adverse action.
(C)Individual identifiers, including, but not limited to, names, social security numbers, and hospital numbers, that are not necessary for the prosecution or defense of the adverse action, shall not be disclosed.
(D)All records, documents, or other materials containing confidential information protected by this section that have been submitted or otherwise disclosed to the administrative agency or other person as a component of an appeal from an adverse action shall, upon proper motion by the appointing authority to the administrative tribunal, be placed under administrative seal and shall not, thereafter, be subject to disclosure to any person or entity except upon the issuance of an order of a court of competent jurisdiction.
(E)For purposes of this paragraph, an adverse action becomes final when the employee fails to answer within the time specified in Section 19575 of the Government Code, or, after filing an answer, withdraws the appeal, or, upon exhaustion of the administrative appeal or of the judicial review remedies as otherwise provided by law.
(23)To the person appointed as the developmental services decisionmaker for a minor, dependent, or ward pursuant to Section 319, 361, or 726.
(24)During the provision of emergency services and care, as defined in Section 1317.1 of the Health and Safety Code, the communication of patient information between a physician and surgeon, licensed psychologist, social worker with a masters degree in social work, licensed marriage and family therapist, licensed professional clinical counselor, nurse, emergency medical personnel at the scene of an emergency or in an emergency medical transport vehicle, or other professional person or emergency medical personnel at a health facility licensed pursuant to Chapter 2 (commencing with Section 1250) of Division 2 of the Health and Safety Code.
(b)The amendment of paragraph (4) of subdivision (a) enacted at the 1970 Regular Session of the Legislature does not constitute a change in, but is declaratory of, the preexisting law.
(c)This section is not limited by Section 5150.05 or 5332.
SEC. 1.5.Section 5328 of the Welfare and Institutions Code is amended to read:5328.(a)All information and records obtained in the course of providing services under Division 4 (commencing with Section 4000), Division 4.1 (commencing with Section 4400), Division 4.5 (commencing with Section 4500), Division 5 (commencing with Section 5000), Division 6 (commencing with Section 6000), or Division 7 (commencing with Section 7100), to either voluntary or involuntary recipients of services shall be confidential. Information and records obtained in the course of providing similar services to either voluntary or involuntary recipients prior to 1969 shall also be confidential. Information and records shall be disclosed only in any of the following cases:
(1)In communications between qualified professional persons in the provision of services or appropriate referrals, or in the course of conservatorship proceedings. The consent of the patient, or his or her guardian or conservator, shall be obtained before information or records may be disclosed by a professional person employed by a facility to a professional person not employed by the facility who does not have the medical or psychological responsibility for the patients care.
(2)When the patient, with the approval of the physician and surgeon, licensed psychologist, social worker with a masters degree in social work, licensed marriage and family therapist, or licensed professional clinical counselor, who is in charge of the patient, designates persons to whom information or records may be released, except that this article does not compel a physician and surgeon, licensed psychologist, social worker with a masters degree in social work, licensed marriage and family therapist, licensed professional clinical counselor, nurse, attorney, or other professional person to reveal information that has been given to him or her in confidence by members of a patients family. This paragraph does not authorize a licensed marriage and family therapist or licensed professional clinical counselor to provide services or to be in charge of a patients care beyond his or her lawful scope of practice.
(3)To the extent necessary for a recipient to make a claim, or for a claim to be made on behalf of a recipient for aid, insurance, or medical assistance to which he or she may be entitled.
(4)If the recipient of services is a minor, ward, dependent, or conservatee, and his or her parent, guardian, guardian ad litem, conservator, or authorized representative designates, in writing, persons to whom records or information may be disclosed, except that this article does not compel a physician and surgeon, licensed psychologist, social worker with a masters degree in social work, licensed marriage and family therapist, licensed professional clinical counselor, nurse, attorney, or other professional person to reveal information that has been given to him or her in confidence by members of a patients family.
(5)For research, provided that the Director of Health Care Services, the Director of State Hospitals, the Director of Social Services, or the Director of Developmental Services designates by regulation, rules for the conduct of research and requires the research to be first reviewed by the appropriate institutional review board or boards. The rules shall include, but need not be limited to, the requirement that all researchers shall sign an oath of confidentiality as follows:
Date |
As a condition of doing research concerning persons who have received services from ____ (fill in the facility, agency or person), I, ____, agree to obtain the prior informed consent of such persons who have received services to the maximum degree possible as determined by the appropriate institutional review board or boards for protection of human subjects reviewing my research, and I further agree not to divulge any information obtained in the course of such research to unauthorized persons, and not to publish or otherwise make public any information regarding persons who have received services such that the person who received services is identifiable.
I recognize that the unauthorized release of confidential information may make me subject to a civil action under provisions of the Welfare and Institutions Code.
(6)To the courts, as necessary to the administration of justice.
(7)To governmental law enforcement agencies as needed for the protection of federal and state elective constitutional officers and their families.
(8)To the Senate Committee on Rules or the Assembly Committee on Rules for the purposes of legislative investigation authorized by the committee.
(9)If the recipient of services who applies for life or disability insurance designates in writing the insurer to which records or information may be disclosed.
(10)To the attorney for the patient in any and all proceedings upon presentation of a release of information signed by the patient, except that when the patient is unable to sign the release, the staff of the facility, upon satisfying itself of the identity of the attorney, and of the fact that the attorney does represent the interests of the patient, may release all information and records relating to the patient except that this article does not compel a physician and surgeon, licensed psychologist, social worker with a masters degree in social work, licensed marriage and family therapist, licensed professional clinical counselor, nurse, attorney, or other professional person to reveal information that has been given to him or her in confidence by members of a patients family.
(11)Upon written agreement by a person previously confined in or otherwise treated by a facility, the professional person in charge of the facility or his or her designee may release any information, except information that has been given in confidence by members of the persons family, requested by a probation officer charged with the evaluation of the person after his or her conviction of a crime if the professional person in charge of the facility determines that the information is relevant to the evaluation. The agreement shall only be operative until sentence is passed on the crime of which the person was convicted. The confidential information released pursuant to this paragraph shall be transmitted to the court separately from the probation report and shall not be placed in the probation report. The confidential information shall remain confidential except for purposes of sentencing. After sentencing, the confidential information shall be sealed.
(12)(A)Between persons who are trained and qualified to serve on multidisciplinary personnel teams pursuant to subdivision (d) of Section 18951. The information and records sought to be disclosed shall be relevant to the provision of child welfare services or the investigation, prevention, identification, management, or treatment of child abuse or neglect pursuant to Chapter 11 (commencing with Section 18950) of Part 6 of Division 9. Information obtained pursuant to this paragraph shall not be used in any criminal or delinquency proceeding. This paragraph does not prohibit evidence identical to that contained within the records from being admissible in a criminal or delinquency proceeding, if the evidence is derived solely from means other than this paragraph, as permitted by law.
(B)As used in this paragraph, child welfare services means those services that are directed at preventing child abuse or neglect.
(13)To county patients rights advocates who have been given knowing voluntary authorization by a client or a guardian ad litem. The client or guardian ad litem, whoever entered into the agreement, may revoke the authorization at any time, either in writing or by oral declaration to an approved advocate.
(14)To a committee established in compliance with Section 14725.
(15)In providing information as described in Section 7325.5. This paragraph does not permit the release of any information other than that described in Section 7325.5.
(16)To the county behavioral health director or the directors designee, or to a law enforcement officer, or to the person designated by a law enforcement agency, pursuant to Sections 5152.1 and 5250.1.
(17)If the patient gives his or her consent, information specifically pertaining to the existence of genetically handicapping conditions, as defined in Section 125135 of the Health and Safety Code, may be released to qualified professional persons for purposes of genetic counseling for blood relatives upon request of the blood relative. For purposes of this paragraph, qualified professional persons means those persons with the qualifications necessary to carry out the genetic counseling duties under this paragraph as determined by the genetic disease unit established in the State Department of Health Care Services under Section 125000 of the Health and Safety Code. If the patient does not respond or cannot respond to a request for permission to release information pursuant to this paragraph after reasonable attempts have been made over a two-week period to get a response, the information may be released upon request of the blood relative.
(18)When the patient, in the opinion of his or her psychotherapist, presents a serious danger of violence to a reasonably foreseeable victim or victims, then any of the information or records specified in this section may be released to that person or persons and to law enforcement agencies and county child welfare agencies as the psychotherapist determines is needed for the protection of that person or persons. For purposes of this paragraph, psychotherapist has the same meaning as provided in Section 1010 of the Evidence Code.
(19)(A)To the designated officer of an emergency response employee, and from that designated officer to an emergency response employee regarding possible exposure to HIV or AIDS, but only to the extent necessary to comply with the federal Ryan White Comprehensive AIDS Resources Emergency Act of 1990 (Public Law 101-381; 42 U.S.C. Sec. 201).
(B)For purposes of this paragraph, designated officer and emergency response employee have the same meaning as these terms are used in the federal Ryan White Comprehensive AIDS Resources Emergency Act of 1990 (Public Law 101-381; 42 U.S.C. Sec. 201).
(C)The designated officer shall be subject to the confidentiality requirements specified in Section 120980, and may be personally liable for unauthorized release of any identifying information about the HIV results. Further, the designated officer shall inform the exposed emergency response employee that the employee is also subject to the confidentiality requirements specified in Section 120980, and may be personally liable for unauthorized release of any identifying information about the HIV test results.
(20)(A)To a law enforcement officer who personally lodges with a facility, as defined in subparagraph (B), a warrant of arrest or an abstract of a warrant showing that the person sought is wanted for a serious felony, as defined in Section 1192.7 of the Penal Code, or a violent felony, as defined in Section 667.5 of the Penal Code. The information sought and released shall be limited to whether or not the person named in the arrest warrant is presently confined in the facility. This subparagraph shall be implemented with minimum disruption to health facility operations and patients, in accordance with Section 5212. If the law enforcement officer is informed that the person named in the warrant is confined in the facility, the officer may not enter the facility to arrest the person without obtaining a valid search warrant or the permission of staff of the facility.
(B)For purposes of subparagraph (A), a facility means all of the following:
(i)A state hospital, as defined in Section 4001.
(ii)A general acute care hospital, as defined in subdivision (a) of Section 1250 of the Health and Safety Code, solely with regard to information pertaining to a person with mental illness subject to this section.
(iii)An acute psychiatric hospital, as defined in subdivision (b) of Section 1250 of the Health and Safety Code.
(iv)A psychiatric health facility, as described in Section 1250.2 of the Health and Safety Code.
(v)A mental health rehabilitation center, as described in Section 5675.
(vi)A skilled nursing facility with a special treatment program for individuals with mental illness, as described in Sections 51335 and 72445 to 72475, inclusive, of Title 22 of the California Code of Regulations.
(21)Between persons who are trained and qualified to serve on multidisciplinary personnel teams pursuant to Section 15610.55, 15753.5, or 15761. The information and records sought to be disclosed shall be relevant to the prevention, identification, management, or treatment of an abused elder or dependent adult pursuant to Chapter 13 (commencing with Section 15750) of Part 3 of Division 9.
(22)(A)When an employee is served with a notice of adverse action, as defined in Section 19570 of the Government Code, all of the following information and records may be released:
(i)All information and records that the appointing authority relied upon in issuing the notice of adverse action.
(ii)All other information and records that are relevant to the adverse action, or that would constitute relevant evidence as defined in Section 210 of the Evidence Code.
(iii)The information described in clauses (i) and (ii) may be released only if both of the following conditions are met:
(I)The appointing authority has provided written notice to the consumer and the consumers legal representative or, if the consumer has no legal representative or if the legal representative is a state agency, to the clients rights advocate, and the consumer, the consumers legal representative, or the clients rights advocate has not objected in writing to the appointing authority within five business days of receipt of the notice, or the appointing authority, upon review of the objection has determined that the circumstances on which the adverse action is based are egregious or threaten the health, safety, or life of the consumer or other consumers and without the information the adverse action could not be taken.
(II)The appointing authority, the person against whom the adverse action has been taken, and the persons representative, if any, have entered into a stipulation that does all of the following:
(ia)Prohibits the parties from disclosing or using the information or records for any purpose other than the proceedings for which the information or records were requested or provided.
(ib)Requires the employee and the employees legal representative to return to the appointing authority all records provided to them under this paragraph, including, but not limited to, all records and documents from any source containing confidential information protected by this section, and all copies of those records and documents, within 10 days of the date that the adverse action becomes final except for the actual records and documents or copies thereof that are no longer in the possession of the employee or the employees legal representative because they were submitted to the administrative tribunal as a component of an appeal from the adverse action.
(ic)Requires the parties to submit the stipulation to the administrative tribunal with jurisdiction over the adverse action at the earliest possible opportunity.
(B)For the purposes of this paragraph, the State Personnel Board may, prior to any appeal from adverse action being filed with it, issue a protective order, upon application by the appointing authority, for the limited purpose of prohibiting the parties from disclosing or using information or records for any purpose other than the proceeding for which the information or records were requested or provided, and to require the employee or the employees legal representative to return to the appointing authority all records provided to them under this paragraph, including, but not limited to, all records and documents from any source containing confidential information protected by this section, and all copies of those records and documents, within 10 days of the date that the adverse action becomes final, except for the actual records and documents or copies thereof that are no longer in the possession of the employee or the employees legal representatives because they were submitted to the administrative tribunal as a component of an appeal from the adverse action.
(C)Individual identifiers, including, but not limited to, names, social security numbers, and hospital numbers, that are not necessary for the prosecution or defense of the adverse action, shall not be disclosed.
(D)All records, documents, or other materials containing confidential information protected by this section that have been submitted or otherwise disclosed to the administrative agency or other person as a component of an appeal from an adverse action shall, upon proper motion by the appointing authority to the administrative tribunal, be placed under administrative seal and shall not, thereafter, be subject to disclosure to any person or entity except upon the issuance of an order of a court of competent jurisdiction.
(E)For purposes of this paragraph, an adverse action becomes final when the employee fails to answer within the time specified in Section 19575 of the Government Code, or, after filing an answer, withdraws the appeal, or, upon exhaustion of the administrative appeal or of the judicial review remedies as otherwise provided by law.
(23)To the person appointed as the developmental services decisionmaker for a minor, dependent, or ward pursuant to Section 319, 361, or 726.
(24)During the provision of emergency services and care, as defined in Section 1317.1 of the Health and Safety Code, the communication of patient information between a physician and surgeon, licensed psychologist, social worker with a masters degree in social work, licensed marriage and family therapist, licensed professional clinical counselor, nurse, emergency medical personnel at the scene of an emergency or in an emergency medical transport vehicle, or other professional person or emergency medical personnel at a health facility licensed pursuant to Chapter 2 (commencing with Section 1250) of Division 2 of the Health and Safety Code.
(25)To a business associate or for health care operations purposes, in accordance with Part 160 (commencing with Section 160.101) and Part 164 (commencing with Section 164.102) of Subchapter C of Subtitle A of Title 45 of the Code of Federal Regulations.
(b)The amendment of paragraph (4) of subdivision (a) enacted at the 1970 Regular Session of the Legislature does not constitute a change in, but is declaratory of, the preexisting law.
(c)This section is not limited by Section 5150.05 or 5332.
SEC. 2.Section 1.5 of this bill incorporates amendments to Section 5328 of the Welfare and Institutions Code proposed by both this bill and Senate Bill 241. That section shall only become operative if (1) both bills are enacted and become effective on or before January 1, 2018, (2) each bill amends Section 5328 of the Welfare and Institutions Code, and (3) this bill is enacted after Senate Bill 241, in which case Section 1 of this bill shall not become operative.
(a)All information and records obtained in the course of providing services under Division 4 (commencing with Section 4000), Division 4.1 (commencing with Section 4400), Division 4.5 (commencing with Section 4500), Division 5 (commencing with Section 5000), Division 6 (commencing with Section 6000), or Division 7 (commencing with Section 7100), to either voluntary or involuntary recipients of services shall be confidential. Information and records obtained in the course of providing similar services to either voluntary or involuntary recipients prior to 1969 shall also be confidential. Information and records shall be disclosed only in any of the following cases:
(1)In communications between qualified professional persons in the provision of services or appropriate referrals, or in the course of conservatorship proceedings. The consent of the patient, or his or her guardian or conservator, shall be obtained before information or records may be disclosed by a professional person employed by a facility to a professional person not employed by the facility who does not have the medical or psychological responsibility for the patients care.
(2)When the patient, with the approval of the physician and surgeon, licensed psychologist, social worker with a masters degree in social work, licensed marriage and family therapist, or licensed professional clinical counselor, who is in charge of the patient, designates persons to whom information or records may be released, except that this article shall does not compel a physician and surgeon, licensed psychologist, social worker with a masters degree in social work, licensed marriage and family therapist, licensed professional clinical counselor, nurse, attorney, or other professional person to reveal information that has been given to him or her in confidence by members of a patients family. This paragraph shall does not authorize a licensed marriage and family therapist or licensed professional clinical counselor to provide services or to be in charge of a patients care beyond his or her lawful scope of practice.
(3)To the extent necessary for a recipient to make a claim, or for a claim to be made on behalf of a recipient for aid, insurance, or medical assistance to which he or she may be entitled.
(4)If the recipient of services is a minor, ward, dependent, or conservatee, and his or her parent, guardian, guardian ad litem, conservator, or authorized representative designates, in writing, persons to whom records or information may be disclosed, except that this article shall does not compel a physician and surgeon, licensed psychologist, social worker with a masters degree in social work, licensed marriage and family therapist, licensed professional clinical counselor, nurse, attorney, or other professional person to reveal information that has been given to him or her in confidence by members of a patients family.
(5)For research, provided that the Director of Health Care Services, the Director of State Hospitals, the Director of Social Services, or the Director of Developmental Services designates by regulation, rules for the conduct of research and requires the research to be first reviewed by the appropriate institutional review board or boards. The rules shall include, but need not be limited to, the requirement that all researchers shall sign an oath of confidentiality as follows:
Date |
As a condition of doing research concerning persons who have received services from ____ (fill in the facility, agency or person), I, ____, agree to obtain the prior informed consent of such persons who have received services to the maximum degree possible as determined by the appropriate institutional review board or boards for protection of human subjects reviewing my research, and I further agree not to divulge any information obtained in the course of such research to unauthorized persons, and not to publish or otherwise make public any information regarding persons who have received services such that the person who received services is identifiable.
I recognize that the unauthorized release of confidential information may make me subject to a civil action under provisions of the Welfare and Institutions Code.
(6)To the courts, as necessary to the administration of justice.
(7)To governmental law enforcement agencies as needed for the protection of federal and state elective constitutional officers and their families.
(8)To the Senate Committee on Rules or the Assembly Committee on Rules for the purposes of legislative investigation authorized by the committee.
(9)If the recipient of services who applies for life or disability insurance designates in writing the insurer to which records or information may be disclosed.
(10)To the attorney for the patient in any and all proceedings upon presentation of a release of information signed by the patient, except that when the patient is unable to sign the release, the staff of the facility, upon satisfying itself of the identity of the attorney, and of the fact that the attorney does represent the interests of the patient, may release all information and records relating to the patient except that this article shall does not compel a physician and surgeon, licensed psychologist, social worker with a masters degree in social work, licensed marriage and family therapist, licensed professional clinical counselor, nurse, attorney, or other professional person to reveal information that has been given to him or her in confidence by members of a patients family.
(11)Upon written agreement by a person previously confined in or otherwise treated by a facility, the professional person in charge of the facility or his or her designee may release any information, except information that has been given in confidence by members of the persons family, requested by a probation officer charged with the evaluation of the person after his or her conviction of a crime if the professional person in charge of the facility determines that the information is relevant to the evaluation. The agreement shall only be operative until sentence is passed on the crime of which the person was convicted. The confidential information released pursuant to this paragraph shall be transmitted to the court separately from the probation report and shall not be placed in the probation report. The confidential information shall remain confidential except for purposes of sentencing. After sentencing, the confidential information shall be sealed.
(12)(A)Between persons who are trained and qualified to serve on multidisciplinary personnel teams pursuant to subdivision (d) of Section 18951. The information and records sought to be disclosed shall be relevant to the provision of child welfare services or the investigation, prevention, identification, management, or treatment of child abuse or neglect pursuant to Chapter 11 (commencing with Section 18950) of Part 6 of Division 9. Information obtained pursuant to this paragraph shall not be used in any criminal or delinquency proceeding. This paragraph shall does not prohibit evidence identical to that contained within the records from being admissible in a criminal or delinquency proceeding, if the evidence is derived solely from means other than this paragraph, as permitted by law.
(B)As used in this paragraph, child welfare services means those services that are directed at preventing child abuse or neglect.
(13)To county patients rights advocates who have been given knowing voluntary authorization by a client or a guardian ad litem. The client or guardian ad litem, whoever entered into the agreement, may revoke the authorization at any time, either in writing or by oral declaration to an approved advocate.
(14)To a committee established in compliance with Section 14725.
(15)In providing information as described in Section 7325.5. This paragraph shall does not permit the release of any information other than that described in Section 7325.5.
(16)To the county behavioral health director or the directors designee, or to a law enforcement officer, or to the person designated by a law enforcement agency, pursuant to Sections 5152.1 and 5250.1.
(17)If the patient gives his or her consent, information specifically pertaining to the existence of genetically handicapping conditions, as defined in Section 125135 of the Health and Safety Code, may be released to qualified professional persons for purposes of genetic counseling for blood relatives upon request of the blood relative. For purposes of this paragraph, qualified professional persons means those persons with the qualifications necessary to carry out the genetic counseling duties under this paragraph as determined by the genetic disease unit established in the State Department of Health Care Services under Section 125000 of the Health and Safety Code. If the patient does not respond or cannot respond to a request for permission to release information pursuant to this paragraph after reasonable attempts have been made over a two-week period to get a response, the information may be released upon request of the blood relative.
(18)When the patient, in the opinion of his or her psychotherapist, presents a serious danger of violence to a reasonably foreseeable victim or victims, then any of the information or records specified in this section may be released to that person or persons and to law enforcement agencies and county child welfare agencies as the psychotherapist determines is needed for the protection of that person or persons. For purposes of this paragraph, psychotherapist has the same meaning as provided in Section 1010 of the Evidence Code.
(19)(A)To the designated officer of an emergency response employee, and from that designated officer to an emergency response employee regarding possible exposure to HIV or AIDS, but only to the extent necessary to comply with the federal Ryan White Comprehensive AIDS Resources Emergency Act of 1990 (Public Law 101-381; 42 U.S.C. Sec. 201).
(B)For purposes of this paragraph, designated officer and emergency response employee have the same meaning as these terms are used in the federal Ryan White Comprehensive AIDS Resources Emergency Act of 1990 (Public Law 101-381; 42 U.S.C. Sec. 201).
(C)The designated officer shall be subject to the confidentiality requirements specified in Section 120980, and may be personally liable for unauthorized release of any identifying information about the HIV results. Further, the designated officer shall inform the exposed emergency response employee that the employee is also subject to the confidentiality requirements specified in Section 120980, and may be personally liable for unauthorized release of any identifying information about the HIV test results.
(20)(A)To a law enforcement officer who personally lodges with a facility, as defined in subparagraph (B), a warrant of arrest or an abstract of a warrant showing that the person sought is wanted for a serious felony, as defined in Section 1192.7 of the Penal Code, or a violent felony, as defined in Section 667.5 of the Penal Code. The information sought and released shall be limited to whether or not the person named in the arrest warrant is presently confined in the facility. This subparagraph shall be implemented with minimum disruption to health facility operations and patients, in accordance with Section 5212. If the law enforcement officer is informed that the person named in the warrant is confined in the facility, the officer may not enter the facility to arrest the person without obtaining a valid search warrant or the permission of staff of the facility.
(B)For purposes of subparagraph (A), a facility means all of the following:
(i)A state hospital, as defined in Section 4001.
(ii)A general acute care hospital, as defined in subdivision (a) of Section 1250 of the Health and Safety Code, solely with regard to information pertaining to a person with mental illness subject to this section.
(iii)An acute psychiatric hospital, as defined in subdivision (b) of Section 1250 of the Health and Safety Code.
(iv)A psychiatric health facility, as described in Section 1250.2 of the Health and Safety Code.
(v)A mental health rehabilitation center, as described in Section 5675.
(vi)A skilled nursing facility with a special treatment program for individuals with mental illness, as described in Sections 51335 and 72445 to 72475, inclusive, of Title 22 of the California Code of Regulations.
(21)Between persons who are trained and qualified to serve on multidisciplinary personnel teams pursuant to Section 15610.55, 15753.5, or 15761. The information and records sought to be disclosed shall be relevant to the prevention, identification, management, or treatment of an abused elder or dependent adult pursuant to Chapter 13 (commencing with Section 15750) of Part 3 of Division 9.
(22)(A)When an employee is served with a notice of adverse action, as defined in Section 19570 of the Government Code, all of the following information and records may be released:
(i)All information and records that the appointing authority relied upon in issuing the notice of adverse action.
(ii)All other information and records that are relevant to the adverse action, or that would constitute relevant evidence as defined in Section 210 of the Evidence Code.
(iii)The information described in clauses (i) and (ii) may be released only if both of the following conditions are met:
(I)The appointing authority has provided written notice to the consumer and the consumers legal representative or, if the consumer has no legal representative or if the legal representative is a state agency, to the clients rights advocate, and the consumer, the consumers legal representative, or the clients rights advocate has not objected in writing to the appointing authority within five business days of receipt of the notice, or the appointing authority, upon review of the objection has determined that the circumstances on which the adverse action is based are egregious or threaten the health, safety, or life of the consumer or other consumers and without the information the adverse action could not be taken.
(II)The appointing authority, the person against whom the adverse action has been taken, and the persons representative, if any, have entered into a stipulation that does all of the following:
(ia)Prohibits the parties from disclosing or using the information or records for any purpose other than the proceedings for which the information or records were requested or provided.
(ib)Requires the employee and the employees legal representative to return to the appointing authority all records provided to them under this paragraph, including, but not limited to, all records and documents from any source containing confidential information protected by this section, and all copies of those records and documents, within 10 days of the date that the adverse action becomes final except for the actual records and documents or copies thereof that are no longer in the possession of the employee or the employees legal representative because they were submitted to the administrative tribunal as a component of an appeal from the adverse action.
(ic)Requires the parties to submit the stipulation to the administrative tribunal with jurisdiction over the adverse action at the earliest possible opportunity.
(B)For the purposes of this paragraph, the State Personnel Board may, prior to any appeal from adverse action being filed with it, issue a protective order, upon application by the appointing authority, for the limited purpose of prohibiting the parties from disclosing or using information or records for any purpose other than the proceeding for which the information or records were requested or provided, and to require the employee or the employees legal representative to return to the appointing authority all records provided to them under this paragraph, including, but not limited to, all records and documents from any source containing confidential information protected by this section, and all copies of those records and documents, within 10 days of the date that the adverse action becomes final, except for the actual records and documents or copies thereof that are no longer in the possession of the employee or the employees legal representatives because they were submitted to the administrative tribunal as a component of an appeal from the adverse action.
(C)Individual identifiers, including, but not limited to, names, social security numbers, and hospital numbers, that are not necessary for the prosecution or defense of the adverse action, shall not be disclosed.
(D)All records, documents, or other materials containing confidential information protected by this section that have been submitted or otherwise disclosed to the administrative agency or other person as a component of an appeal from an adverse action shall, upon proper motion by the appointing authority to the administrative tribunal, be placed under administrative seal and shall not, thereafter, be subject to disclosure to any person or entity except upon the issuance of an order of a court of competent jurisdiction.
(E)For purposes of this paragraph, an adverse action becomes final when the employee fails to answer within the time specified in Section 19575 of the Government Code, or, after filing an answer, withdraws the appeal, or, upon exhaustion of the administrative appeal or of the judicial review remedies as otherwise provided by law.
(23)To the person appointed as the developmental services decisionmaker for a minor, dependent, or ward pursuant to Section 319, 361, or 726.
(24)During the provision of emergency services and care, as defined in Section 1317.1 of the Health and Safety Code, the communication of patient information between a physician and surgeon, licensed psychologist, social worker with a masters degree in social work, licensed marriage and family therapist, licensed professional clinical counselor, nurse, emergency medical personnel at the scene of an emergency or in an emergency medical transport vehicle, or other professional person or emergency medical personnel at a health facility licensed pursuant to Chapter 2 (commencing with Section 1250) of Division 2 of the Health and Safety Code.
(b)The amendment of paragraph (4) of subdivision (a) enacted at the 1970 Regular Session of the Legislature does not constitute a change in, but is declaratory of, the preexisting law.
(c)This section shall not be is not limited by Section 5150.05 or 5332.
SEC. 1.5.Section 5328 of the Welfare and Institutions Code is amended to read:5328.(a)All information and records obtained in the course of providing services under Division 4 (commencing with Section 4000), Division 4.1 (commencing with Section 4400), Division 4.5 (commencing with Section 4500), Division 5 (commencing with Section 5000), Division 6 (commencing with Section 6000), or Division 7 (commencing with Section 7100), to either voluntary or involuntary recipients of services shall be confidential. Information and records obtained in the course of providing similar services to either voluntary or involuntary recipients prior to 1969 shall also be confidential. Information and records shall be disclosed only in any of the following cases:
(a)(1)In communications between qualified professional persons in the provision of services or appropriate referrals, or in the course of conservatorship proceedings. The consent of the patient, or his or her guardian or conservator, shall be obtained before information or records may be disclosed by a professional person employed by a facility to a professional person not employed by the facility who does not have the medical or psychological responsibility for the patients care.
(b)(2)When the patient, with the approval of the physician and surgeon, licensed psychologist, social worker with a masters degree in social work, licensed marriage and family therapist, or licensed professional clinical counselor, who is in charge of the patient, designates persons to whom information or records may be released, except that nothing in this article shall be construed to does not compel a physician and surgeon, licensed psychologist, social worker with a masters degree in social work, licensed marriage and family therapist, licensed professional clinical counselor, nurse, attorney, or other professional person to reveal information that has been given to him or her in confidence by members of a patients family. Nothing in this subdivision shall be construed to This paragraph does not authorize a licensed marriage and family therapist or licensed professional clinical counselor to provide services or to be in charge of a patients care beyond his or her lawful scope of practice.
(c)(3)To the extent necessary for a recipient to make a claim, or for a claim to be made on behalf of a recipient for aid, insurance, or medical assistance to which he or she may be entitled.
(d)(4)If the recipient of services is a minor, ward, dependent, or conservatee, and his or her parent, guardian, guardian ad litem, conservator, or authorized representative designates, in writing, persons to whom records or information may be disclosed, except that nothing in this article shall be construed to does not compel a physician and surgeon, licensed psychologist, social worker with a masters degree in social work, licensed marriage and family therapist, licensed professional clinical counselor, nurse, attorney, or other professional person to reveal information that has been given to him or her in confidence by members of a patients family.
(e)(5)For research, provided that the Director of Health Care Services, the Director of State Hospitals, the Director of Social Services, or the Director of Developmental Services designates by regulation, rules for the conduct of research and requires the research to be first reviewed by the appropriate institutional review board or boards. The rules shall include, but need not be limited to, the requirement that all researchers shall sign an oath of confidentiality as follows:
Date |
As a condition of doing research concerning persons who have received services from ____ (fill in the facility, agency or person), I, ____, agree to obtain the prior informed consent of such persons who have received services to the maximum degree possible as determined by the appropriate institutional review board or boards for protection of human subjects reviewing my research, and I further agree not to divulge any information obtained in the course of such research to unauthorized persons, and not to publish or otherwise make public any information regarding persons who have received services such that the person who received services is identifiable.
I recognize that the unauthorized release of confidential information may make me subject to a civil action under provisions of the Welfare and Institutions Code.
(f)
(6)To the courts, as necessary to the administration of justice.
(g)(7)To governmental law enforcement agencies as needed for the protection of federal and state elective constitutional officers and their families.
(h)(8)To the Senate Committee on Rules or the Assembly Committee on Rules for the purposes of legislative investigation authorized by the committee.
(i)(9)If the recipient of services who applies for life or disability insurance designates in writing the insurer to which records or information may be disclosed.
(j)(10)To the attorney for the patient in any and all proceedings upon presentation of a release of information signed by the patient, except that when the patient is unable to sign the release, the staff of the facility, upon satisfying itself of the identity of the attorney, and of the fact that the attorney does represent the interests of the patient, may release all information and records relating to the patient except that nothing in this article shall be construed to does not compel a physician and surgeon, licensed psychologist, social worker with a masters degree in social work, licensed marriage and family therapist, licensed professional clinical counselor, nurse, attorney, or other professional person to reveal information that has been given to him or her in confidence by members of a patients family.
(k)(11)Upon written agreement by a person previously confined in or otherwise treated by a facility, the professional person in charge of the facility or his or her designee may release any information, except information that has been given in confidence by members of the persons family, requested by a probation officer charged with the evaluation of the person after his or her conviction of a crime if the professional person in charge of the facility determines that the information is relevant to the evaluation. The agreement shall only be operative until sentence is passed on the crime of which the person was convicted. The confidential information released pursuant to this subdivision paragraph shall be transmitted to the court separately from the probation report and shall not be placed in the probation report. The confidential information shall remain confidential except for purposes of sentencing. After sentencing, the confidential information shall be sealed.
(l)(1)(12)(A)Between persons who are trained and qualified to serve on multidisciplinary personnel teams pursuant to subdivision (d) of Section 18951. The information and records sought to be disclosed shall be relevant to the provision of child welfare services or the investigation, prevention, identification, management, or treatment of child abuse or neglect pursuant to Chapter 11 (commencing with Section 18950) of Part 6 of Division 9. Information obtained pursuant to this subdivision paragraph shall not be used in any criminal or delinquency proceeding. Nothing in this subdivision shall This paragraph does not prohibit evidence identical to that contained within the records from being admissible in a criminal or delinquency proceeding, if the evidence is derived solely from means other than this subdivision, paragraph, as permitted by law.
(2)(B)As used in this subdivision, paragraph, child welfare services means those services that are directed at preventing child abuse or neglect.
(m)(13)To county patients rights advocates who have been given knowing voluntary authorization by a client or a guardian ad litem. The client or guardian ad litem, whoever entered into the agreement, may revoke the authorization at any time, either in writing or by oral declaration to an approved advocate.
(n)(14)To a committee established in compliance with Section 14725.
(o)(15)In providing information as described in Section 7325.5. Nothing in this subdivision shall This paragraph does not permit the release of any information other than that described in Section 7325.5.
(p)(16)To the county behavioral health director or the directors designee, or to a law enforcement officer, or to the person designated by a law enforcement agency, pursuant to Sections 5152.1 and 5250.1.
(q)(17)If the patient gives his or her consent, information specifically pertaining to the existence of genetically handicapping conditions, as defined in Section 125135 of the Health and Safety Code, may be released to qualified professional persons for purposes of genetic counseling for blood relatives upon request of the blood relative. For purposes of this subdivision, paragraph, qualified professional persons means those persons with the qualifications necessary to carry out the genetic counseling duties under this subdivision paragraph as determined by the genetic disease unit established in the State Department of Health Care Services under Section 125000 of the Health and Safety Code. If the patient does not respond or cannot respond to a request for permission to release information pursuant to this subdivision paragraph after reasonable attempts have been made over a two-week period to get a response, the information may be released upon request of the blood relative.
(r)(18)When the patient, in the opinion of his or her psychotherapist, presents a serious danger of violence to a reasonably foreseeable victim or victims, then any of the information or records specified in this section may be released to that person or persons and to law enforcement agencies and county child welfare agencies as the psychotherapist determines is needed for the protection of that person or persons. For purposes of this subdivision, psychotherapist means anyone so defined within paragraph, psychotherapist has the same meaning as provided in Section 1010 of the Evidence Code.
(s)(1)(19)(A)To the designated officer of an emergency response employee, and from that designated officer to an emergency response employee regarding possible exposure to HIV or AIDS, but only to the extent necessary to comply with provisions of the federal Ryan White Comprehensive AIDS Resources Emergency Act of 1990 (Public Law 101-381; 42 U.S.C. Sec. 201).
(2)(B)For purposes of this subdivision, paragraph, designated officer and emergency response employee have the same meaning as these terms are used in the federal Ryan White Comprehensive AIDS Resources Emergency Act of 1990 (Public Law 101-381; 42 U.S.C. Sec. 201).
(3)(C)The designated officer shall be subject to the confidentiality requirements specified in Section 120980, and may be personally liable for unauthorized release of any identifying information about the HIV results. Further, the designated officer shall inform the exposed emergency response employee that the employee is also subject to the confidentiality requirements specified in Section 120980, and may be personally liable for unauthorized release of any identifying information about the HIV test results.
(t)(1)(20)(A)To a law enforcement officer who personally lodges with a facility, as defined in paragraph (2), subparagraph (B), a warrant of arrest or an abstract of such a warrant showing that the person sought is wanted for a serious felony, as defined in Section 1192.7 of the Penal Code, or a violent felony, as defined in Section 667.5 of the Penal Code. The information sought and released shall be limited to whether or not the person named in the arrest warrant is presently confined in the facility. This paragraph subparagraph shall be implemented with minimum disruption to health facility operations and patients, in accordance with Section 5212. If the law enforcement officer is informed that the person named in the warrant is confined in the facility, the officer may not enter the facility to arrest the person without obtaining a valid search warrant or the permission of staff of the facility.
(2)(B)For purposes of paragraph (1), subparagraph (A), a facility means all of the following:
(A)(i)A state hospital, as defined in Section 4001.
(B)(ii)A general acute care hospital, as defined in subdivision (a) of Section 1250 of the Health and Safety Code, solely with regard to information pertaining to a person with mental illness subject to this section.
(C)(iii)An acute psychiatric hospital, as defined in subdivision (b) of Section 1250 of the Health and Safety Code.
(D)(iv)A psychiatric health facility, as described in Section 1250.2 of the Health and Safety Code.
(E)(v)A mental health rehabilitation center, as described in Section 5675.
(F)(vi)A skilled nursing facility with a special treatment program for individuals with mental illness, as described in Sections 51335 and 72445 to 72475, inclusive, of Title 22 of the California Code of Regulations.
(u)(21)Between persons who are trained and qualified to serve on multidisciplinary personnel teams pursuant to Section 15610.55, 15753.5, or 15761. The information and records sought to be disclosed shall be relevant to the prevention, identification, management, or treatment of an abused elder or dependent adult pursuant to Chapter 13 (commencing with Section 15750) of Part 3 of Division 9.
(v)The amendment of subdivision (d) enacted at the 1970 Regular Session of the Legislature does not constitute a change in, but is declaratory of, the preexisting law.(w)This section shall not be limited by Section 5150.05 or 5332.(x)(1)(22)(A)When an employee is served with a notice of adverse action, as defined in Section 19570 of the Government Code, all of the following information and records may be released:
(A)(i)All information and records that the appointing authority relied upon in issuing the notice of adverse action.
(B)(ii)All other information and records that are relevant to the adverse action, or that would constitute relevant evidence as defined in Section 210 of the Evidence Code.
(C)(iii)The information described in subparagraphs (A) and (B) clauses (i) and (ii) may be released only if both of the following conditions are met:
(i)(I)The appointing authority has provided written notice to the consumer and the consumers legal representative or, if the consumer has no legal representative or if the legal representative is a state agency, to the clients rights advocate, and the consumer, the consumers legal representative, or the clients rights advocate has not objected in writing to the appointing authority within five business days of receipt of the notice, or the appointing authority, upon review of the objection has determined that the circumstances on which the adverse action is based are egregious or threaten the health, safety, or life of the consumer or other consumers and without the information the adverse action could not be taken.
(ii)(II)The appointing authority, the person against whom the adverse action has been taken, and the persons representative, if any, have entered into a stipulation that does all of the following:
(I)(ia)Prohibits the parties from disclosing or using the information or records for any purpose other than the proceedings for which the information or records were requested or provided.
(II)(ib)Requires the employee and the employees legal representative to return to the appointing authority all records provided to them under this subdivision, paragraph, including, but not limited to, all records and documents from any source containing confidential information protected by this section, and all copies of those records and documents, within 10 days of the date that the adverse action becomes final except for the actual records and documents or copies thereof that are no longer in the possession of the employee or the employees legal representative because they were submitted to the administrative tribunal as a component of an appeal from the adverse action.
(III)(ic)Requires the parties to submit the stipulation to the administrative tribunal with jurisdiction over the adverse action at the earliest possible opportunity.
(2)(B)For the purposes of this subdivision, paragraph, the State Personnel Board may, prior to any appeal from adverse action being filed with it, issue a protective order, upon application by the appointing authority, for the limited purpose of prohibiting the parties from disclosing or using information or records for any purpose other than the proceeding for which the information or records were requested or provided, and to require the employee or the employees legal representative to return to the appointing authority all records provided to them under this subdivision, paragraph, including, but not limited to, all records and documents from any source containing confidential information protected by this section, and all copies of those records and documents, within 10 days of the date that the adverse action becomes final, except for the actual records and documents or copies thereof that are no longer in the possession of the employee or the employees legal representatives because they were submitted to the administrative tribunal as a component of an appeal from the adverse action.
(3)(C)Individual identifiers, including, but not limited to, names, social security numbers, and hospital numbers, that are not necessary for the prosecution or defense of the adverse action, shall not be disclosed.
(4)(D)All records, documents, or other materials containing confidential information protected by this section that have been submitted or otherwise disclosed to the administrative agency or other person as a component of an appeal from an adverse action shall, upon proper motion by the appointing authority to the administrative tribunal, be placed under administrative seal and shall not, thereafter, be subject to disclosure to any person or entity except upon the issuance of an order of a court of competent jurisdiction.
(5)(E)For purposes of this subdivision, paragraph, an adverse action becomes final when the employee fails to answer within the time specified in Section 19575 of the Government Code, or, after filing an answer, withdraws the appeal, or, upon exhaustion of the administrative appeal or of the judicial review remedies as otherwise provided by law.
(y)(23)To the person appointed as the developmental services decisionmaker for a minor, dependent, or ward pursuant to Section 319, 361, or 726.
(24)During the provision of emergency services and care, as defined in Section 1317.1 of the Health and Safety Code, the communication of patient information between a physician and surgeon, licensed psychologist, social worker with a masters degree in social work, licensed marriage and family therapist, licensed professional clinical counselor, nurse, emergency medical personnel at the scene of an emergency or in an emergency medical transport vehicle, or other professional person or emergency medical personnel at a health facility licensed pursuant to Chapter 2 (commencing with Section 1250) of Division 2 of the Health and Safety Code.
(25)To a business associate or for health care operations purposes, in accordance with Part 160 (commencing with Section 160.101) and Part 164 (commencing with Section 164.102) of Subchapter C of Subtitle A of Title 45 of the Code of Federal Regulations.
(b)The amendment of paragraph (4) of subdivision (a) enacted at the 1970 Regular Session of the Legislature does not constitute a change in, but is declaratory of, the preexisting law.
(c)This section is not limited by Section 5150.05 or 5332.
SEC. 2.Section 1.5 of this bill incorporates amendments to Section 5328 of the Welfare and Institutions Code proposed by both this bill and Senate Bill 241. That section shall only become operative if (1) both bills are enacted and become effective on or before January 1, 2018, (2) each bill amends Section 5328 of the Welfare and Institutions Code, and (3) this bill is enacted after Senate Bill 241, in which case Section 1 of this bill shall not become operative.
(a)All information and records obtained in the course of providing services under Division 4 (commencing with Section 4000), Division 4.1 (commencing with Section 4400), Division 4.5 (commencing with Section 4500), Division 5 (commencing with Section 5000), Division 6 (commencing with Section 6000), or Division 7 (commencing with Section 7100), to either voluntary or involuntary recipients of services shall be confidential. Information and records obtained in the course of providing similar services to either voluntary or involuntary recipients prior to 1969 shall also be confidential. Information and records shall be disclosed only in any of the following cases:
(a)(1)In communications between qualified professional persons in the provision of services or appropriate referrals, or in the course of conservatorship proceedings. The consent of the patient, or his or her guardian or conservator, shall be obtained before information or records may be disclosed by a professional person employed by a facility to a professional person not employed by the facility who does not have the medical or psychological responsibility for the patients care.
(b)(2)When the patient, with the approval of the physician and surgeon, licensed psychologist, social worker with a masters degree in social work, licensed marriage and family therapist, or licensed professional clinical counselor, who is in charge of the patient, designates persons to whom information or records may be released, except that nothing in this article shall be construed to not compel a physician and surgeon, licensed psychologist, social worker with a masters degree in social work, licensed marriage and family therapist, licensed professional clinical counselor, nurse, attorney, or other professional person to reveal information that has been given to him or her in confidence by members of a patients family. Nothing in this subdivision This paragraph shall be construed to not authorize a licensed marriage and family therapist or licensed professional clinical counselor to provide services or to be in charge of a patients care beyond his or her lawful scope of practice.
(c)(3)To the extent necessary for a recipient to make a claim, or for a claim to be made on behalf of a recipient for aid, insurance, or medical assistance to which he or she may be entitled.
(d)(4)If the recipient of services is a minor, ward, dependent, or conservatee, and his or her parent, guardian, guardian ad litem, conservator, or authorized representative designates, in writing, persons to whom records or information may be disclosed, except that nothing in this article shall be construed to not compel a physician and surgeon, licensed psychologist, social worker with a masters degree in social work, licensed marriage and family therapist, licensed professional clinical counselor, nurse, attorney, or other professional person to reveal information that has been given to him or her in confidence by members of a patients family.
(e)(5)For research, provided that the Director of Health Care Services, the Director of State Hospitals, the Director of Social Services, or the Director of Developmental Services designates by regulation, rules for the conduct of research and requires the research to be first reviewed by the appropriate institutional review board or boards. The rules shall include, but need not be limited to, the requirement that all researchers shall sign an oath of confidentiality as follows:
Date |
As a condition of doing research concerning persons who have received services from ____ (fill in the facility, agency or person), I, ____, agree to obtain the prior informed consent of such persons who have received services to the maximum degree possible as determined by the appropriate institutional review board or boards for protection of human subjects reviewing my research, and I further agree not to divulge any information obtained in the course of such research to unauthorized persons, and not to publish or otherwise make public any information regarding persons who have received services such that the person who received services is identifiable.
I recognize that the unauthorized release of confidential information may make me subject to a civil action under provisions of the Welfare and Institutions Code.
(f)
(6)To the courts, as necessary to the administration of justice.
(g)(7)To governmental law enforcement agencies as needed for the protection of federal and state elective constitutional officers and their families.
(h)(8)To the Senate Committee on Rules or the Assembly Committee on Rules for the purposes of legislative investigation authorized by the committee.
(i)(9)If the recipient of services who applies for life or disability insurance designates in writing the insurer to which records or information may be disclosed.
(j)(10)To the attorney for the patient in any and all proceedings upon presentation of a release of information signed by the patient, except that when the patient is unable to sign the release, the staff of the facility, upon satisfying itself of the identity of the attorney, and of the fact that the attorney does represent the interests of the patient, may release all information and records relating to the patient except that nothing in this article shall be construed to not compel a physician and surgeon, licensed psychologist, social worker with a masters degree in social work, licensed marriage and family therapist, licensed professional clinical counselor, nurse, attorney, or other professional person to reveal information that has been given to him or her in confidence by members of a patients family.
(k)(11)Upon written agreement by a person previously confined in or otherwise treated by a facility, the professional person in charge of the facility or his or her designee may release any information, except information that has been given in confidence by members of the persons family, requested by a probation officer charged with the evaluation of the person after his or her conviction of a crime if the professional person in charge of the facility determines that the information is relevant to the evaluation. The agreement shall only be operative until sentence is passed on the crime of which the person was convicted. The confidential information released pursuant to this subdivision paragraph shall be transmitted to the court separately from the probation report and shall not be placed in the probation report. The confidential information shall remain confidential except for purposes of sentencing. After sentencing, the confidential information shall be sealed.
(l)(1)(12)(A)Between persons who are trained and qualified to serve on multidisciplinary personnel teams pursuant to subdivision (d) of Section 18951. The information and records sought to be disclosed shall be relevant to the provision of child welfare services or the investigation, prevention, identification, management, or treatment of child abuse or neglect pursuant to Chapter 11 (commencing with Section 18950) of Part 6 of Division 9. Information obtained pursuant to this subdivision paragraph shall not be used in any criminal or delinquency proceeding. Nothing in this subdivision This paragraph shall not prohibit evidence identical to that contained within the records from being admissible in a criminal or delinquency proceeding, if the evidence is derived solely from means other than this subdivision, paragraph, as permitted by law.
(2)(B)As used in this subdivision, paragraph, child welfare services means those services that are directed at preventing child abuse or neglect.
(m)(13)To county patients rights advocates who have been given knowing voluntary authorization by a client or a guardian ad litem. The client or guardian ad litem, whoever entered into the agreement, may revoke the authorization at any time, either in writing or by oral declaration to an approved advocate.
(n)(14)To a committee established in compliance with Section 14725.
(o)(15)In providing information as described in Section 7325.5. Nothing in this subdivision This paragraph shall not permit the release of any information other than that described in Section 7325.5.
(p)(16)To the county behavioral health director or the directors designee, or to a law enforcement officer, or to the person designated by a law enforcement agency, pursuant to Sections 5152.1 and 5250.1.
(q)(17)If the patient gives his or her consent, information specifically pertaining to the existence of genetically handicapping conditions, as defined in Section 125135 of the Health and Safety Code, may be released to qualified professional persons for purposes of genetic counseling for blood relatives upon request of the blood relative. For purposes of this subdivision, paragraph, qualified professional persons means those persons with the qualifications necessary to carry out the genetic counseling duties under this subdivision paragraph as determined by the genetic disease unit established in the State Department of Health Care Services under Section 125000 of the Health and Safety Code. If the patient does not respond or cannot respond to a request for permission to release information pursuant to this subdivision paragraph after reasonable attempts have been made over a two-week period to get a response, the information may be released upon request of the blood relative.
(r)(18)When the patient, in the opinion of his or her psychotherapist, presents a serious danger of violence to a reasonably foreseeable victim or victims, then any of the information or records specified in this section may be released to that person or persons and to law enforcement agencies and county child welfare agencies as the psychotherapist determines is needed for the protection of that person or persons. For purposes of this subdivision, paragraph, psychotherapist means anyone so defined within has the same meaning as provided in Section 1010 of the Evidence Code.
(s)(1)(19)(A)To the designated officer of an emergency response employee, and from that designated officer to an emergency response employee regarding possible exposure to HIV or AIDS, but only to the extent necessary to comply with provisions of the federal Ryan White Comprehensive AIDS Resources Emergency Act of 1990 (Public Law 101-381; 42 U.S.C. Sec. 201).
(2)(B)For purposes of this subdivision, paragraph, designated officer and emergency response employee have the same meaning as these terms are used in the federal Ryan White Comprehensive AIDS Resources Emergency Act of 1990 (Public Law 101-381; 42 U.S.C. Sec. 201).
(3)(C)The designated officer shall be subject to the confidentiality requirements specified in Section 120980, and may be personally liable for unauthorized release of any identifying information about the HIV results. Further, the designated officer shall inform the exposed emergency response employee that the employee is also subject to the confidentiality requirements specified in Section 120980, and may be personally liable for unauthorized release of any identifying information about the HIV test results.
(t)(1)(20)(A)To a law enforcement officer who personally lodges with a facility, as defined in paragraph (2), subparagraph (B), a warrant of arrest or an abstract of such a warrant showing that the person sought is wanted for a serious felony, as defined in Section 1192.7 of the Penal Code, or a violent felony, as defined in Section 667.5 of the Penal Code. The information sought and released shall be limited to whether or not the person named in the arrest warrant is presently confined in the facility. This paragraph subparagraph shall be implemented with minimum disruption to health facility operations and patients, in accordance with Section 5212. If the law enforcement officer is informed that the person named in the warrant is confined in the facility, the officer may not enter the facility to arrest the person without obtaining a valid search warrant or the permission of staff of the facility.
(2)(B)For purposes of paragraph (1), subparagraph (A), a facility means all of the following:
(A)(i)A state hospital, as defined in Section 4001.
(B)(ii)A general acute care hospital, as defined in subdivision (a) of Section 1250 of the Health and Safety Code, solely with regard to information pertaining to a person with mental illness subject to this section.
(C)(iii)An acute psychiatric hospital, as defined in subdivision (b) of Section 1250 of the Health and Safety Code.
(D)(iv)A psychiatric health facility, as described in Section 1250.2 of the Health and Safety Code.
(E)(v)A mental health rehabilitation center, as described in Section 5675.
(F)(vi)A skilled nursing facility with a special treatment program for individuals with mental illness, as described in Sections 51335 and 72445 to 72475, inclusive, of Title 22 of the California Code of Regulations.
(u)(21)Between persons who are trained and qualified to serve on multidisciplinary personnel teams pursuant to Section 15610.55, 15753.5, or 15761. The information and records sought to be disclosed shall be relevant to the prevention, identification, management, or treatment of an abused elder or dependent adult pursuant to Chapter 13 (commencing with Section 15750) of Part 3 of Division 9.
(v)The amendment of subdivision (d) enacted at the 1970 Regular Session of the Legislature does not constitute a change in, but is declaratory of, the preexisting law. (w)This section shall not be limited by Section 5150.05 or 5332. (x)(1)(22)(A)When an employee is served with a notice of adverse action, as defined in Section 19570 of the Government Code, all of the following information and records may be released:
(A)(i)All information and records that the appointing authority relied upon in issuing the notice of adverse action.
(B)(ii)All other information and records that are relevant to the adverse action, or that would constitute relevant evidence as defined in Section 210 of the Evidence Code.
(C)(iii)The information described in subparagraphs (A) clauses (i) and (B) (ii) may be released only if both of the following conditions are met:
(i)(I)The appointing authority has provided written notice to the consumer and the consumers legal representative or, if the consumer has no legal representative or if the legal representative is a state agency, to the clients rights advocate, and the consumer, the consumers legal representative, or the clients rights advocate has not objected in writing to the appointing authority within five business days of receipt of the notice, or the appointing authority, upon review of the objection has determined that the circumstances on which the adverse action is based are egregious or threaten the health, safety, or life of the consumer or other consumers and without the information the adverse action could not be taken.
(ii)(II)The appointing authority, the person against whom the adverse action has been taken, and the persons representative, if any, have entered into a stipulation that does all of the following:
(I)(ia)Prohibits the parties from disclosing or using the information or records for any purpose other than the proceedings for which the information or records were requested or provided.
(II)(ib)Requires the employee and the employees legal representative to return to the appointing authority all records provided to them under this subdivision, paragraph, including, but not limited to, all records and documents from any source containing confidential information protected by this section, and all copies of those records and documents, within 10 days of the date that the adverse action becomes final except for the actual records and documents or copies thereof that are no longer in the possession of the employee or the employees legal representative because they were submitted to the administrative tribunal as a component of an appeal from the adverse action.
(III)(ic)Requires the parties to submit the stipulation to the administrative tribunal with jurisdiction over the adverse action at the earliest possible opportunity.
(2)(B)For the purposes of this subdivision, paragraph, the State Personnel Board may, prior to any appeal from adverse action being filed with it, issue a protective order, upon application by the appointing authority, for the limited purpose of prohibiting the parties from disclosing or using information or records for any purpose other than the proceeding for which the information or records were requested or provided, and to require the employee or the employees legal representative to return to the appointing authority all records provided to them under this subdivision, paragraph, including, but not limited to, all records and documents from any source containing confidential information protected by this section, and all copies of those records and documents, within 10 days of the date that the adverse action becomes final, except for the actual records and documents or copies thereof that are no longer in the possession of the employee or the employees legal representatives because they were submitted to the administrative tribunal as a component of an appeal from the adverse action.
(3)(C)Individual identifiers, including, but not limited to, names, social security numbers, and hospital numbers, that are not necessary for the prosecution or defense of the adverse action, shall not be disclosed.
(4)(D)All records, documents, or other materials containing confidential information protected by this section that have been submitted or otherwise disclosed to the administrative agency or other person as a component of an appeal from an adverse action shall, upon proper motion by the appointing authority to the administrative tribunal, be placed under administrative seal and shall not, thereafter, be subject to disclosure to any person or entity except upon the issuance of an order of a court of competent jurisdiction.
(5)(E)For purposes of this subdivision, paragraph, an adverse action becomes final when the employee fails to answer within the time specified in Section 19575 of the Government Code, or, after filing an answer, withdraws the appeal, or, upon exhaustion of the administrative appeal or of the judicial review remedies as otherwise provided by law.
(y)(23)To the person appointed as the developmental services decisionmaker for a minor, dependent, or ward pursuant to Section 319, 361, or 726.
(24)During the provision of emergency services and care, as defined in Section 1317.1 of the Health and Safety Code, the communication of patient information between a physician and surgeon, licensed psychologist, social worker with a masters degree in social work, licensed marriage and family therapist, licensed professional clinical counselor, nurse, emergency medical personnel at the scene of an emergency or in an emergency medical transport vehicle, or other professional person or emergency medical personnel at a health facility licensed pursuant to Chapter 2 (commencing with Section 1250) of Division 2 of the Health and Safety Code.
(b)The amendment of paragraph (4) of subdivision (a) enacted at the 1970 Regular Session of the Legislature does not constitute a change in, but is declaratory of, the preexisting law.
(c)This section shall not be limited by Section 5150.05 or 5332.
SECTION 1.Section 4000 of the Welfare and Institutions Code is amended to read:4000.There is within the California Health and Human Services Agency the State Department of State Hospitals.There is in within the California Health and Human Services Agency a the State Department of State Hospitals.
|
Date
|
Status
|
|---|---|
| Sep 27, 2017 | Chaptered by Secretary of State - Chapter 323, Statutes of 2017. |
| Sep 27, 2017 | Approved by the Governor. |
| Sep 13, 2017 | Enrolled and presented to the Governor at 4 p.m. |
| Sep 7, 2017 | Senate amendments concurred in. To Engrossing and Enrolling. |
| Sep 5, 2017 | In Assembly. Concurrence in Senate amendments pending. May be considered on or after September 7 pursuant to Assembly Rule 77. |
| Sep 5, 2017 | Read third time. Passed. Ordered to the Assembly. |
| Aug 24, 2017 | Read second time. Ordered to third reading. |
| Aug 23, 2017 | Read third time and amended. Ordered to second reading. |
| Jul 20, 2017 | Read second time. Ordered to Consent Calendar. |
| Jul 19, 2017 | From committee: Do pass. To Consent Calendar. (Ayes 7. Noes 0.) (July 18). |
| Jun 14, 2017 | From committee: Do pass and re-refer to Com. on JUD. with recommendation: To Consent Calendar. (Ayes 9. Noes 0.) (June 14). Re-referred to Com. on JUD. |
| Jun 1, 2017 | Referred to Coms. on HEALTH and JUD. |
| May 18, 2017 | In Senate. Read first time. To Com. on RLS. for assignment. |
| May 18, 2017 | Read third time. Passed. Ordered to the Senate. (Ayes 69. Noes 0. Page 1616.) |
| May 11, 2017 | Read second time. Ordered to Consent Calendar. |
| May 10, 2017 | From committee: Do pass. To Consent Calendar. (Ayes 14. Noes 0.) (May 9). |
| Apr 3, 2017 | Re-referred to Com. on HEALTH. |
| Mar 30, 2017 | From committee chair, with author's amendments: Amend, and re-refer to Com. on HEALTH. Read second time and amended. |
| Mar 30, 2017 | Referred to Com. on HEALTH. |
| Feb 19, 2017 | From printer. May be heard in committee March 21. |
| Feb 17, 2017 | Read first time. To print. |
|
Date
|
Description
|
Location
|
Votes
|
|
|---|---|---|---|---|
| Sep 7, 2017 | AB 1119 LIMÓN Concurrence in Senate Amendments | Assembly Floor |
Passed |
|
| Sep 5, 2017 | Assembly 3rd Reading AB1119 Limón By Monning | Senate Floor |
Passed |
|
| Jul 18, 2017 | Do pass and be ordered to the Consent Calendar | Senate Standing Committee on Judiciary |
Passed |
|
| Jun 14, 2017 | Do pass, but first be re-referred to the Committee on [Judiciary] with the recommendation: To Consent Calendar | Senate Standing Committee on Health |
Passed |
|
| May 18, 2017 | AB 1119 LIMÓN Consent Calendar Second Day | Assembly Floor |
Passed |
|
| May 9, 2017 | Do pass. To Consent Calendar. | Assembly Standing Committee on Health |
Passed |
This list shows positions taken on this bill by organizations on the date displayed, which is linked to the original source.
Positions by individuals are not included.
|
Organization
|
Position
|
Date
|
|---|---|---|
| Steinberg Institute | ** Support | Aug 25, 2017 |
| Tenet Health | ** Support | Aug 25, 2017 |
CONCURRENCE IN SENATE AMENDMENTS
CSA1 Bill Id:AB 1119
Author:(Limón)
As Amended Ver:August 23, 2017
Majority vote
ASSEMBLY: | 69-0 | (May 18, 2017) | SENATE: | 40-0 | (September 5, 2017) |
Original Committee Reference: HEALTH
SUMMARY: Authorizes the disclosure of patient information and records of individuals with developmental and mental health disabilities who are voluntarily or involuntarily detained, including those detained under the Lanterman-Petris-Short (LPS) Act, during the provision of emergency services and care, as defined, including the communication of patient information between a physician and surgeon, licensed psychologist, social worker with a master's degree in social work, licensed marriage and family therapist, licensed professional clinical counselor, nurse, emergency medical personnel at the scene of an emergency or in an emergency medical transport vehicle, or other professional person or emergency medical personnel at a health facility, as specified. Makes other technical and non-substantive changes.
The Senate amendments add language to avoid chaptering out this bill with SB 241 (Monning) of the current legislative session.
FISCAL EFFECT: None
COMMENTS: According to the author, lack of information is a substantial barrier to effective care in the emergency department setting where patients are in crisis and timely consent is not always possible. This bill provides emergency physicians with improved access to important medical records to allow them to deliver critical care to patients in need. For example, having a patient's complete medical information allows an emergency physician to restart a medication or follow an existing treatment plan. Healthcare providers have interpreted existing law differently resulting in incomplete health records or information not released to emergency physicians at all.
The state Confidentiality of Medical Information Act (CMIA) authorizes disclosure of clinical records and information between providers for the purpose of diagnosis or treatment of the patient. This includes, in an emergency situation, the communication of patient information by radio transmission or other means between emergency medical personnel at the scene of an emergency, or in an emergency medical transport vehicle, and emergency medical personnel at a licensed health facility. A California HealthCare Foundation July 2015 (CHCF) article, "Fine Print: Rules for Exchanging Behavioral Health Information in California," described the legal framework for sharing behavioral health information in California, under both federal and state law. According to the CHCF article, the LPS Act, rather than the CMIA, governs the exchange of patient information by some mental health providers. The LPS Act applies to federal, state, and county mental hospitals; institutions that treat involuntarily detained mental health patients; and, residential programs such as mental health rehabilitation centers and community residential treatment systems. The LPS Act can also apply to outpatient providers to the extent they participate in certain government-funded programs covered under the LPS Act, such as gambling treatment programs, homeless outreach programs, or the provision of care to judicially committed people under the Forensic Conditional Release Program. Like the Health Insurance Portability and Accountability Act of 1996 and the CMIA, the LPS Act contains an exception that allows for the exchange of mental health information for treatment purposes. "Qualified professional persons" may share patient medical information with one another in the course of providing services without obtaining patient consent. The statute does not define a "qualified professional person." This language is potentially narrower than the language in the treatment exception of the CMIA, which makes clear that a provider may share information with a broad range of health care organizations and professionals treating the patient. At a minimum, the LPS Act allows a health care professional to share patient information with another health care professional who treats that patient, even if the two professionals work at different facilities or locations.
In practice, the exception appears to be interpreted more broadly to permit the sharing of information by mental health facilities or programs at the organizational level, with access by nonprofessional personnel who provide support for the professional's activities. Given the way in which data are shared between institutions, there may be no other practical way to interpret the exception according to the CHCF article. But the precise scope of the exception is subject to interpretation, and this lack of clarity likely leads to different interpretations across the state with respect to the type of sharing that is permitted. The CHCF article further notes that existing California initiatives have implemented different approaches to sharing mental health data, with some requiring prior patient consent and some not.
The CHCF article concluded that clarification of California's LPS Act would facilitate more consistent exchange of mental health information. California law permits providers to share physical and mental health information with one another for treatment purposes without the individual's consent. Under the CMIA and the LPS Act, providers engaged in organized data exchange initiatives in California do not have to obtain consent but the experience of initiative participants interviewed for the CHCF article suggests there is not a universal, consistent understanding of the LPS Act. According to the CHCF article, the state could ease the administrative burden on providers by clarifying that the LPS Act does not require patient consent for the sharing of mental health information.
The California Chapter of the American College of Emergency Physicians (California ACEP), sponsor, writes that there is confusion on the part of many providers who have interpreted the law to require patient consent to share information and that this is a substantial barrier to effective care in the emergency department. California ACEP also states that different interpretations mean that some health records are incomplete and others are not released to emergency physicians. Tenet Health states that this bill will contribute to improved communication and patient safety, will expedite patient care and in some cases reduce should reduce the need for hospitalization.
There is no registered opposition to this bill.
Analysis Prepared by: Kristene Mapile / HEALTH / (916) 319-2097 FN: 0001533
Office of Senate Floor Analyses (916) 651-1520 Fax: (916) 327-4478 | AB |
THIRD READING
Bill No: AB 1119
Amended: 8/23/17 in Senate
SENATE HEALTH COMMITTEE: 9-0, 6/14/17
AYES: Hernandez, Nguyen, Atkins, Leyva, Mitchell, Monning, Newman, Nielsen, Roth
SENATE JUDICIARY COMMITTEE: 7-0, 7/18/17
AYES: Jackson, Moorlach, Anderson, Hertzberg, Monning, Stern, Wieckowski
ASSEMBLY FLOOR: 69-0, 5/18/17 (Consent) - See last page for vote
SUBJECT: Developmental and mental health services: information and records: confidentiality
SOURCE: California Chapter of the American College of Emergency Physicians
DIGEST:
This bill authorizes, during the provision of emergency services and care, the communication of patient information and records between specified health care professionals and others to effectively treat patients with developmental disabilities and mental health disorders.
Senate Floor Amendments of 8/23/17 make technical amendments to address chaptering out conflicts with SB 241 (Monning).
Existing federal law:
- Establishes, under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), standards for privacy of individually identifiable health information and security standards for the protection of electronic protected health information, including, through regulations, that a HIPAA covered entity may not condition the provision to an individual of treatment, payment, enrollment in the health plan, or eligibility for benefits on the provision of an authorization, except under specified circumstances.
- Provides that if its provisions conflict with a provision of state law, the provision that is most protective of patient privacy prevails.
Existing state law:
- Prohibits, pursuant to the Confidentiality of Medical Information Act (CMIA), a provider of health care, a health care service plan, a contractor, a corporation and its subsidiaries and affiliates, or any business that offers software or hardware to consumers, including a mobile application or other related device, as defined, from intentionally sharing, selling, using for marketing, or otherwise using any medical information, as defined, for any purpose not necessary to provide health care services to a patient, except as expressly authorized by the patient, enrollee, or subscriber, as specified, or as otherwise required or authorized by law.
- Authorizes, pursuant to the CMIA, disclosure of clinical records and information between providers for the purpose of diagnosis or treatment of the patient, including, in an emergency situation, the communication of patient information by radio transmission or other means between emergency medical personnel at the scene of an emergency, or in an emergency medical transport vehicle, and emergency medical personnel at a licensed health facility.
- Defines, for purposes of the CMIA, medical information to mean any 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.
- Requires all information and records obtained in the course of providing specified developmental services and mental services to either voluntary or involuntary recipients of services to be confidential, and authorizes disclosure only in specified cases, including in communications between qualified professional persons in the provision of services or appropriate referrals, and to the designated officer of an emergency response employee, and from that designated officer to an emergency response employee regarding possible exposure to the human immunodeficiency virus or the acquired immune deficiency syndrome.
- Defines “emergency services and care” as the medical screening, examination, and evaluation by a physician or, to the extent permitted by applicable law, by other appropriate personnel under the supervision of a physician to determine the care, treatment, and surgery by a physician necessary to relieve or eliminate the emergency medical condition or active labor, within the capacity of the facility.
This bill:
- Authorizes, during the provision of emergency services and care, the communication of patient information, for patients who are developmentally disabled and have a mental health disorder, between a physician and surgeon, licensed psychologist, social worker with a master’s degree in social work, licensed marriage and family therapist, licensed professional clinical counselor, nurse, emergency medical personnel at the scene of an emergency or in an emergency medical transport vehicle, or other professional person or emergency medical personnel at a licensed health facility, as specified, and to business associates or for health care operations purposes, per HIPAA.
- Prohibits the authority in 1) above, related to the communication of patient information during the provision of emergency services and care, from being limited by existing exceptions to the sharing of information in current law during emergency situations.
- Makes other technical, nonsubstantive changes.
Background
A California HealthCare Foundation (CHCF) report from July 2015, “Fine Print: Rules for Exchanging Behavioral Health Information in California,” described the legal framework for sharing behavioral health (mental health and substance use disorder) patients’ information in California under both federal and state law. According to the CHCF report, the Lanterman-Petris-Short (LPS) Act, rather than the CMIA, governs the exchange of patient information by some mental health providers. The LPS Act applies to federal, state, and county mental hospitals; institutions that treat involuntarily detained mental health patients; and residential programs, such as mental health rehabilitation centers and community residential treatment systems. The LPS Act can also apply to outpatient providers to the extent they participate in certain government-funded programs covered under the LPS Act, such as gambling treatment programs, homeless outreach programs, or the provision of care to judicially committed people under the Forensic Conditional Release Program. Like HIPAA and CMIA, the LPS Act contains an exception that allows for the exchange of mental health information for treatment purposes. “Qualified professional persons” may share patient medical information with one another in the course of providing services without obtaining patient consent. The statute does not define a “qualified professional person.” This language is potentially narrower than the language in the treatment exception of the CMIA, which makes clear that a provider may share information with a broad range of health care organizations and professionals treating the patient. At a minimum, the LPS Act allows a health care professional to share patient information with another health care professional who treats that patient, even if the two professionals work at different facilities or locations.
The CHCF report states that, in practice, the LPS Act exception appears to be interpreted more broadly to permit the sharing of information by mental health facilities or programs at the organizational level, with access by nonprofessional personnel who provide support for the professional’s activities. Given the way in which data are shared between institutions, there may be no other practical way to interpret the exception according to the CHCF report. CHCF states that the precise scope of the exception is subject to interpretation, and this lack of clarity likely leads to different interpretations across the state with respect to the type of sharing that is permitted. CHCF further notes that existing California initiatives have implemented different approaches to sharing mental health data, with some requiring prior patient consent and some not.
The CHCF report concludes that clarification of the LPS Act would facilitate more consistent exchange of mental health information. California law permits providers to share physical and mental health information with one another for treatment purposes without the individual’s consent. Under the CMIA and the LPS Act, providers engaged in organized data exchange initiatives do not have to obtain consent, but the experience of initiative participants interviewed for the CHCF article suggests there is not a universal, consistent understanding of the LPS Act. According to CHCF, the state could ease the administrative burden on providers by clarifying that the LPS Act does not require patient consent for the sharing of mental health information.
Author’s statement. According to the author, lack of information is a substantial barrier to effective care in the emergency department setting where patients are in crisis and timely consent is not always possible. This bill provides emergency physicians with improved access to important medical records to allow them to deliver critical care to patients in need. For example, having a patient’s complete medical information allows an emergency physician to restart a medication or follow an existing treatment plan. Health care providers have interpreted existing confidentiality laws differently, resulting in incomplete health records and others not released to emergency physicians at all.
FISCAL EFFECT: Appropriation: No Fiscal Com.: No Local: No
California Chapter of the American College of Emergency Physicians (source)
Steinberg Institute
Tenet Health
OPPOSITION: (Verified 8/24/17)
None received
ARGUMENTS IN SUPPORT: The California Chapter of the American College of Emergency Physicians (CalACEP), sponsor of this bill, states that while HIPAA, the LPS Act, and the CMIA allow providers to share patient information for treatment purposes, there is confusion on the part of many providers who have interpreted the law to require patient consent to share that information, which creates a substantial barrier to effective care in the emergency department setting where patients are in crisis and timely consent is not always possible. CalACEP states that this bill seeks to provide the clarification recommended by the CHCF report to provide emergency physicians with improved access to important medical records, allowing them to provide better care for their patients. The Steinberg Institute states that AB 1119 facilitates a more consistent exchange of mental health information and improves the safety of clients by providing emergency physicians with improved access to important medical records to allow them to deliver critical care to patients in need. The Steinberg Institute gives the example that having a patient’s complete medical information allows an emergency physician to restart a medication or follow an existing treatment plan. The Steinberg Institute and Tenet Health state that this bill will expedite patient care and in some cases should reduce the need for hospitalization.
ASSEMBLY FLOOR: 69-0, 5/18/17
AYES: Acosta, Travis Allen, Arambula, Baker, Berman, Bigelow, Bloom, Bocanegra, Bonta, Brough, Burke, Caballero, Cervantes, Chávez, Chen, Chiu, Choi, Chu, Cooley, Cooper, Cunningham, Dababneh, Dahle, Daly, Eggman, Flora, Fong, Gallagher, Cristina Garcia, Eduardo Garcia, Gomez, Gonzalez Fletcher, Gray, Grayson, Harper, Irwin, Jones-Sawyer, Kalra, Kiley, Lackey, Levine, Limón, Low, Maienschein, Mathis, Mayes, McCarty, Medina, Melendez, Muratsuchi, Nazarian, Obernolte, O'Donnell, Patterson, Quirk, Quirk-Silva, Reyes, Ridley-Thomas, Rodriguez, Rubio, Salas, Steinorth, Mark Stone, Thurmond, Ting, Voepel, Waldron, Weber, Wood
NO VOTE RECORDED: Aguiar-Curry, Calderon, Chau, Frazier, Friedman, Gipson, Gloria, Holden, Mullin, Santiago, Rendon
8/25/17 10:53:59
**** END ****
Office of Senate Floor Analyses (916) 651-1520 Fax: (916) 327-4478 | AB |
THIRD READING
Bill No: AB 1119
:
SENATE HEALTH COMMITTEE: 9-0, 6/14/17
AYES: Hernandez, Nguyen, Atkins, Leyva, Mitchell, Monning, Newman, Nielsen, Roth
SENATE JUDICIARY COMMITTEE: 7-0, 7/18/17
AYES: Jackson, Moorlach, Anderson, Hertzberg, Monning, Stern, Wieckowski
ASSEMBLY FLOOR: 69-0, 5/18/17 (Consent) - See last page for vote
SOURCE: California Chapter of the American College of Emergency Physicians
DIGEST:
This bill authorizes, during the provision of emergency services and care, the communication of patient information and records between specified health care professionals and others to effectively treat patients with developmental disabilities and mental health disorders.
Existing federal law:
- Establishes, under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), standards for privacy of individually identifiable health information and security standards for the protection of electronic protected health information, including, through regulations, that a HIPAA covered entity may not condition the provision to an individual of treatment, payment, enrollment in the health plan, or eligibility for benefits on the provision of an authorization, except under specified circumstances.
- Provides that if its provisions conflict with a provision of state law, the provision that is most protective of patient privacy prevails.
Existing state law:
- Prohibits, pursuant to the Confidentiality of Medical Information Act (CMIA), a provider of health care, a health care service plan, a contractor, a corporation and its subsidiaries and affiliates, or any business that offers software or hardware to consumers, including a mobile application or other related device, as defined, from intentionally sharing, selling, using for marketing, or otherwise using any medical information, as defined, for any purpose not necessary to provide health care services to a patient, except as expressly authorized by the patient, enrollee, or subscriber, as specified, or as otherwise required or authorized by law.
- Authorizes, pursuant to the CMIA, disclosure of clinical records and information between providers for the purpose of diagnosis or treatment of the patient, including, in an emergency situation, the communication of patient information by radio transmission or other means between emergency medical personnel at the scene of an emergency, or in an emergency medical transport vehicle, and emergency medical personnel at a licensed health facility.
- Defines, for purposes of the CMIA, medical information to mean any 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.
- Requires all information and records obtained in the course of providing specified developmental services and mental services to either voluntary or involuntary recipients of services to be confidential, and authorizes disclosure only in specified cases, including in communications between qualified professional persons in the provision of services or appropriate referrals, and to the designated officer of an emergency response employee, and from that designated officer to an emergency response employee regarding possible exposure to the human immunodeficiency virus or the acquired immune deficiency syndrome.
- Defines “emergency services and care” as the medical screening, examination, and evaluation by a physician or, to the extent permitted by applicable law, by other appropriate personnel under the supervision of a physician to determine the care, treatment, and surgery by a physician necessary to relieve or eliminate the emergency medical condition or active labor, within the capacity of the facility.
This bill:
- Authorizes, during the provision of emergency services and care, the communication of patient information, for patients who are developmentally disabled and have a mental health disorder, between a physician and surgeon, licensed psychologist, social worker with a master’s degree in social work, licensed marriage and family therapist, licensed professional clinical counselor, nurse, emergency medical personnel at the scene of an emergency or in an emergency medical transport vehicle, or other professional person or emergency medical personnel at a licensed health facility, as specified.
- Prohibits the authority in 1) above, related to the communication of patient information during the provision of emergency services and care, from being limited by existing exceptions to the sharing of information in current law during emergency situations.
- Makes other technical, nonsubstantive changes.
Background
A California HealthCare Foundation (CHCF) report from July 2015, “Fine Print: Rules for Exchanging Behavioral Health Information in California,” described the legal framework for sharing behavioral health (mental health and substance use disorder) patients’ information in California under both federal and state law. According to the CHCF report, the Lanterman-Petris-Short (LPS) Act, rather than the CMIA, governs the exchange of patient information by some mental health providers. The LPS Act applies to federal, state, and county mental hospitals; institutions that treat involuntarily detained mental health patients; and residential programs, such as mental health rehabilitation centers and community residential treatment systems. The LPS Act can also apply to outpatient providers to the extent they participate in certain government-funded programs covered under the LPS Act, such as gambling treatment programs, homeless outreach programs, or the provision of care to judicially committed people under the Forensic Conditional Release Program. Like HIPAA and CMIA, the LPS Act contains an exception that allows for the exchange of mental health information for treatment purposes. “Qualified professional persons” may share patient medical information with one another in the course of providing services without obtaining patient consent. The statute does not define a “qualified professional person.” This language is potentially narrower than the language in the treatment exception of the CMIA, which makes clear that a provider may share information with a broad range of health care organizations and professionals treating the patient. At a minimum, the LPS Act allows a health care professional to share patient information with another health care professional who treats that patient, even if the two professionals work at different facilities or locations.
The CHCF report states that, in practice, the LPS Act exception appears to be interpreted more broadly to permit the sharing of information by mental health facilities or programs at the organizational level, with access by nonprofessional personnel who provide support for the professional’s activities. Given the way in which data are shared between institutions, there may be no other practical way to interpret the exception according to the CHCF report. CHCF states that the precise scope of the exception is subject to interpretation, and this lack of clarity likely leads to different interpretations across the state with respect to the type of sharing that is permitted. CHCF further notes that existing California initiatives have implemented different approaches to sharing mental health data, with some requiring prior patient consent and some not.
The CHCF report concludes that clarification of the LPS Act would facilitate more consistent exchange of mental health information. California law permits providers to share physical and mental health information with one another for treatment purposes without the individual’s consent. Under the CMIA and the LPS Act, providers engaged in organized data exchange initiatives do not have to obtain consent, but the experience of initiative participants interviewed for the CHCF article suggests there is not a universal, consistent understanding of the LPS Act. According to CHCF, the state could ease the administrative burden on providers by clarifying that the LPS Act does not require patient consent for the sharing of mental health information.
Author’s statement. According to the author, lack of information is a substantial barrier to effective care in the emergency department setting where patients are in crisis and timely consent is not always possible. This bill provides emergency physicians with improved access to important medical records to allow them to deliver critical care to patients in need. For example, having a patient’s complete medical information allows an emergency physician to restart a medication or follow an existing treatment plan. Health care providers have interpreted existing confidentiality laws differently, resulting in incomplete health records and others not released to emergency physicians at all.
FISCAL EFFECT: Appropriation: No Fiscal Com.: No Local: No
California Chapter of the American College of Emergency Physicians (source)
Steinberg Institute
Tenet Health
OPPOSITION: (Verified 7/24/17)
None received
ARGUMENTS IN SUPPORT: The California Chapter of the American College of Emergency Physicians (CalACEP), sponsor of this bill, states that while HIPAA, the LPS Act, and the CMIA allow providers to share patient information for treatment purposes, there is confusion on the part of many providers who have interpreted the law to require patient consent to share that information, which creates a substantial barrier to effective care in the emergency department setting where patients are in crisis and timely consent is not always possible. CalACEP states that this bill seeks to provide the clarification recommended by the CHCF report to provide emergency physicians with improved access to important medical records, allowing them to provide better care for their patients. The Steinberg Institute states that AB 1119 facilitates a more consistent exchange of mental health information and improves the safety of clients by providing emergency physicians with improved access to important medical records to allow them to deliver critical care to patients in need. The Steinberg Institute gives the example that having a patient’s complete medical information allows an emergency physician to restart a medication or follow an existing treatment plan. The Steinberg Institute and Tenet Health state that this bill will expedite patient care and in some cases should reduce the need for hospitalization.
ASSEMBLY FLOOR: 69-0, 5/18/17
AYES: Acosta, Travis Allen, Arambula, Baker, Berman, Bigelow, Bloom, Bocanegra, Bonta, Brough, Burke, Caballero, Cervantes, Chávez, Chen, Chiu, Choi, Chu, Cooley, Cooper, Cunningham, Dababneh, Dahle, Daly, Eggman, Flora, Fong, Gallagher, Cristina Garcia, Eduardo Garcia, Gomez, Gonzalez Fletcher, Gray, Grayson, Harper, Irwin, Jones-Sawyer, Kalra, Kiley, Lackey, Levine, Limón, Low, Maienschein, Mathis, Mayes, McCarty, Medina, Melendez, Muratsuchi, Nazarian, Obernolte, O'Donnell, Patterson, Quirk, Quirk-Silva, Reyes, Ridley-Thomas, Rodriguez, Rubio, Salas, Steinorth, Mark Stone, Thurmond, Ting, Voepel, Waldron, Weber, Wood
NO VOTE RECORDED: Aguiar-Curry, Calderon, Chau, Frazier, Friedman, Gipson, Gloria, Holden, Mullin, Santiago, Rendon
8/17/17 11:22:07
**** END ****
Senator Hannah-Beth Jackson, Chair
2017-2018 Regular Session
Bill No: AB 1119 (Author:Limón)
Version: March 30, 2017
Hearing Date: July 18, 2017
Fiscal: No
Urgency: No
Consultant: MS
SUBJECT
Developmental and mental health services: information and records: confidentiality
DESCRIPTION
Existing law requires all information and records obtained in the course of providing specified developmental services and mental health services to either voluntary or involuntary recipients of services to be confidential, and authorizes disclosure only in specified cases. Existing law allows for disclosure in communications between qualified professional persons in the provision of services or appropriate referrals, and to the designated officer of an emergency response employee, and from that designated officer to an emergency response employee regarding possible exposure to the human immunodeficiency virus or the acquired immune deficiency syndrome.
This bill would additionally authorize, during the provision of emergency services and care, the communication of patient information and records between specified individuals. The bill would also make technical, nonsubstantive changes.
BACKGROUND
Existing California and federal law contain a number of provisions relating to the use of a patient’s medical information. These statutory frameworks favor the privacy of the patient, with caveats to the sharing of patient’s medical information when necessary for treatment.
The Health Insurance Portability and Accountability Act (HIPAA), enacted in 1996, guarantees privacy protection for individuals with regards to specific health information. (Pub.L. 104–191, 110 Stat. 1936.) Generally, protected health information is any information held by a covered entity which concerns health status, provision of healthcare, or payment for healthcare that can be connected to an individual. HIPAA privacy regulations require healthcare providers and organizations to develop and follow procedures that ensure the confidentiality and security of personal health information when it is transferred, received, handled, or shared. HIPAA further requires reasonable efforts when using, disclosing, or requesting protected health information, to limit disclosure of that information to the minimum amount necessary to accomplish the intended purpose.
California’s Confidentiality of Medical Information Act (CMIA) (Civ. Code Sec. 56 et seq.) allows adult patients in California to keep personal health information confidential and decide whether and when to share that information. An existing exception within the CMIA allows providers to disclose information without the individual’s authorization to other providers, health plans, or contractors for the purposes of diagnosis or treatment. (Civ. Code Sec. 56.10.)
Additionally, the Lanterman-Petris-Short (LPS) Act was enacted in the 1960s to develop a statutory process under which individuals could be involuntarily held and treated in a mental health facility in a manner that safeguarded their constitutional rights. The LPS Act was intended to balance the goals of maintaining the constitutional right to personal liberty and choice in mental health treatment, with the goal of safety when an individual may be a danger to oneself or others, or is gravely disabled. The LPS Act allows peace officers and staff-members of county-designated evaluation facilities to take an individual into custody and place him in a facility for 72-hour treatment and evaluation if they believe that, due to a mental disorder, the individual is a danger to themselves or others, or is gravely disabled. (Welf. & Inst. Code Sec. 1550.) Additionally, the LPS Act is found to govern the communication of patient information between mental health service providers.
SB 364 (Steinberg, Ch. 567, Stats. 2013) updated the LPS Act in 2013 to address both the needs and rights of patients and the ability of counties to adequately serve those patients. Specifically, SB 364 updated outmoded language related to mental health and clarified rights of patients by better defining what information and services must be afforded to them. SB 364 also authorized county mental health directors to develop procedures for the training of professionals who perform specified mental health procedures and expand the types of facilities available for LPS Act services.
This bill seeks to clarify when a patient’s mental health medical information may be shared. Specifically, this bill seeks to clarify that a patient’s mental health medical information may be shared, during the provision of emergency services and care, with a physician and surgeon, licensed psychologist, social worker with a master’s degree in social work, licensed marriage and family therapist, licensed professional clinical counselor, nurse, emergency medical personnel at the scene of an emergency or in an emergency medical transport vehicle, or other professional person or emergency medical personnel at the licensed health facility, as provided.
CHANGES TO EXISTING LAW
Existing law, the California Constitution, provides that all people have inalienable rights, including the right to pursue and obtain privacy. (Cal. Const., art. I, Sec. 1.)
Existing federal law, the Health Insurance Portability and Accountability Act (HIPAA), specifies privacy protections for patients’ protected health information and generally provides that a covered entity, as defined (health plan, healthcare provider, and healthcare clearinghouse), may not use or disclose protected health information except as specified or as authorized by the patient in writing. (45 C.F.R. Sec. 164.500 et seq.)
Existing federal law provides that if HIPAA’s provisions conflict with a provision of state law, the provision that is the most protective of patient privacy prevails. (45 C.F.R. Sec. 164.500 et seq.)
Existing law prohibits, under the State Confidentiality of Medical Information Act (CMIA), providers of healthcare, healthcare service plans, or contractors, as defined, from intentionally sharing, selling, using for marketing, or otherwise using any medical information, as defined, for any purpose not necessary to provide health care services to a patient, except as expressly authorized by the patient, enrollee, or subscriber, as specified, or as otherwise required or authorized by law. (Civ. Code Sec. 56 et seq.)
Existing law provides for the disclosure, pursuant to the CMIA, of clinical records and information between providers for the purpose of diagnosis or treatment of the patient, including in an emergency situation, the communication of patient information by radio transmission or other means between emergency medical personnel at the scene of an emergency, or in an emergency medical transport vehicle, and emergency medical personnel at a licensed health facility. (Civ. Code Sec. 56.10.)
Existing law provides that, for the purposes of the CMIA, medical information means any 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. (Civ. Code Sec. 56.05(j).)
Existing law provides that all information and records obtained in the course of providing specified developmental services and mental health services to either voluntary or involuntary recipients of services to be confidential, and authorizes disclosure only in specified cases, including in communications between qualified professional persons in the provision of services or appropriate referrals, and to the designated officer of an emergency response employee, and from that designated officer to an emergency response employee regarding possible exposure to the human immunodeficiency virus or the acquired immune deficiency syndrome. (Welf. & Inst. Code Sec. 5328.)
Existing law declares the intent of the Legislature to end the inappropriate, indefinite, and involuntary commitment of persons with mental health disorders, developmental disabilities, and chronic alcoholism, and to eliminate legal disabilities. (Welf. & Inst. Code Sec. 5100.)
Existing law provides, among other things, that the Legislative intent of the LPS Act, is to end inappropriate, indefinite, and involuntary commitment of mentally disordered persons, developmentally disabled persons, and persons impaired by chronic alcoholism. Existing law also establishes that the LPS Act is intended to eliminate legal disabilities and protect mentally disordered and developmentally disabled persons. (Welf. & Inst. Code Sec. 5001.)
Existing law provides that a peace officer, member of the attending staff of an evaluation facility designated by the county for evaluation and treatment, member of the attending staff, as defined, or other professional person designated by the county, upon probable cause, may take a person with a mental health disorder who is a danger to himself or others, or who is gravely disabled, into custody and place him in a facility designated by the county. (Welf. & Inst. Code Sec. 5150(a).)
Existing law provides that facilities, for the purposes of a 72-hour treatment and evaluation, must be designated by the county for evaluation and treatment and approved by the State Department of Health Care Services. (Welf. & Inst. Code Sec. 5150(a).)
Existing law provides that a patient, who is involuntarily detained for the purposes of a mental health evaluation or treatment, may designate a person to whom information or records may be released with the approval of the physician and surgeon, licensed psychologist, social worker with a master’s degree in social work, licensed marriage and family therapist, or licensed professional clinical counselor, who is in charge of the patient, but does not compel the licensed health care professional to reveal information that has been given to them in confidence by members of a patient’s family. (Welf. & Inst. Code Sec. 5328(b).)
Existing law defines “emergency services and care” as the medical screening, examination, and evaluation by a physician or, to the extent permitted by applicable law, by other appropriate personnel under the supervision of a physician to determine the care, treatment, and surgery by a physician necessary to relieve or eliminate the emergency medical condition or active labor, within the capacity of the facility. (Health & Saf. Code Sec. 1317.1.)
This bill would provide for the communication of patient information and records during the provision of emergency services and care, as defined, between a physician and surgeon, licensed psychologist, social worker with a master’s degree in social work, licensed marriage and family therapist, licensed professional clinic counselor, nurse, emergency medical personnel at the scene or an emergency or in an emergency medical transport vehicle, and other professional person or emergency medical personnel at a licensed health facility.
This bill would provide that the communication of patient information and records is not limited by a person being taken into custody or involuntarily detained for the purposes of a mental health examination, as provided.
This bill would make technical, nonsubstantive changes.
COMMENT
- Stated need for this bill
According to the Author:
Lack of information is a substantial barrier to effective care in the emergency department setting where patients are in crisis and timely consent is not always possible. AB 1119 provides emergency physicians with improved access to important medical records to allow them to deliver critical care to patients in need. For example, having a patient’s complete medical information allows an emergency physician to restart a medication or follow an existing treatment plan. Healthcare providers have interpreted existing law differently resulting in incomplete health records and others not released to emergency physicians at all.
- Lack of clarity around the exchange of a patient’s mental health information
In 2015, the California HealthCare Foundation released the results of their study exploring the coordination and information sharing among physical, mental health, and substance abuse treatment providers. This study found providers would benefit from clarification regarding the exchange of patient information between mental health providers and physical health providers. Better communication between these providers had been recommended previously by the Institute of Medicine in order to have better care coordination, and thus treatment. (McGraw, et el., Fine Print: Rules for Exchanging Behavioral Health Information in California (July 2015) <http://www.chcf .org/~/media/MEDIA%20LIBRARY%20Files/PDF/PDF%20F/PDF%20FinePrintExchangingBehavioral.pdf> [as of July 10, 2017].) It seems that some of the confusion stems from whether a provider primarily deals with the LPSA Act or the CMIA. (Id.)
Under existing law, the LPS Act applies when determining whether the following providers may share a patient’s mental health medical information: federal, state, and county mental health hospitals; institutions that treat involuntarily detained mental health patients; and residential programs such as mental health rehabilitation centers and community residential treatment systems. (Welf. & Inst. Code Sec. 5328.) As written, the LPS Act provides that communications between qualified professional persons in the provision of services or appropriate referrals may share a patient’s mental health medical information. It further provides that the provider has to obtain the consent of the patient or of their guardian or conservator to share patient information with a professional person employed by a facility who does not have the medical or psychological responsibility for the patient’s care. (Welf. & Inst. Code Sec. 5328(a).)
The CMIA allows a provider of health care or a health care service plan to disclose medical information to providers of health care, health care service plans, contractors, or other health care professionals or facilities for the purposes of diagnosis or treatment of the patient. This medical information may be shared by the provider, or the health care service plan, without consent from the patient. (Civ. Code Sec. 56.10(c).) Though both the LPS Act and the CMIA allow a patient’s information to be shared for treatment or referral purposes, the requirement for patient consent in some circumstances under the LPS Act seems to result in unequal application.
The California HealthCare Foundation report found that because the LPS Act is what most mental health providers are familiar with, they often believe they are not able to share a patient’s information with health care providers, including emergency health care providers, unless they have the patient’s consent. (McGraw, et el., Fine Print: Rules for Exchanging Behavioral Health Information in California (July 2015) <http://www. chcf.org/~/media/MEDIA%20LIBRARY%20Files/PDF/PDF%20F/PDF%20FinePrintExchangingBehavioral.pdf> [as of July 10, 2017].) One of the resulting conclusions of this report was that:
Clarification of California’s LPS Act would facilitate more consistent exchange of mental health information. California law permits providers to share physical and mental health information with one another for treatment purposes without the individual’s consent. Under both the CMIA and the LPS Act, providers engaged in organized data exchange initiatives in California should not have to obtain consent to share information for treatment purposes – but the experience of initiative participants interviewed for this paper suggests there is not a universal consistent understanding of the LPS Act. The state could ease the administrative burden on providers by clarifying that the LPS Act does not require patient consent for the sharing of mental health information.
The California Chapter of the American College of Emergency Physicians (California ACEP), the sponsor of this bill, writes:
While both the Health Insurance Portability and Accountability Act (HIPAA) and the even more protective California laws, the Lanterman Petris Short (LPS) Act and the Confidentiality of Medical Information Act (CMIA), allow providers to share patient information for treatment purposes, there is confusion on the part of many providers who have interpreted the law to require patient consent to share that information. This is a substantial barrier to effective care in the emergency department (ED) setting where patients are in crisis and timely consent is not always possible. Different interpretations mean that some health records are incomplete and others aren’t released to emergency physicians at all.
AB 1119 seeks to provide the clarification recommended by the California HealthCare Foundation report. This will provide emergency physicians with improved access to important medical records allowing them to provide better care for their patients. For example, an emergency physician can restart a medication or follow an existing care plan if they have access to the patient’s medical record. Additionally, and equally as important, having access to a complete medical record means the emergency physician can consult with a patient’s primary care provider, psychiatrist, or therapist. Improved information could also allow them to make a follow up appointment before discharging the patient.
This bill seeks to provide the sought clarification by providing that during the provision of emergency services and care, the communication of patient information between a physician and surgeon, licensed psychologist, social worker with a master’s degree in social work, licensed marriage and family therapist, licensed professional clinical counselor, nurse, emergency medical personnel at the scene of an emergency or in an emergency medical transport vehicle, or other professional person or emergency medical personnel at a licensed health facility would be allowed under the LPS Act. This is a limited clarification that would arguably ensure health care providers have access to the patient’s mental health medical information as needed during their course of treatment.
In support, the Steinberg Institute writes:
AB 1119 provides emergency physicians with improved access to important medical records to allow them to deliver critical care to patients in need. For example, having a patient’s complete medical information allows an emergency physician to restart a medication or follow an existing treatment plan. Healthcare providers have interpreted existing law differently resulting in incomplete health records or information not released to emergency physicians at all.
AB 1119 will contribute to improved communication and client safety, will expedite patient care and in some cases should reduce the need for hospitalization. We respectfully ask for your “Aye” vote on AB 1119.
Support: Steinberg Institute; Tenet Health
Opposition: None Known
HISTORY
Source: California Chapter of the American College of Emergency Physicians
Related Pending Legislation: None Known
Prior Legislation: SB 364 (Steinberg, Ch. 567, Stats. 2013) See Background.
Prior Vote:
Senate Health Committee (Ayes 9, Noes 0)
Assembly Floor (Ayes 69, Noes 0)
Assembly Health Committee (Ayes 14, Noes 0)
**************
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: AB 1119
AUTHOR: | Limón | ||
VERSION: | March 30, 2017 | ||
HEARING DATE: | June 14, 2017 | ||
CONSULTANT: | Reyes Diaz | ||
SUBJECT: Developmental and mental health services: information and records: confidentiality
SUMMARY:
Authorizes, during the provision of emergency services and care, the communication of patient information and records between specified health care professionals and others to effectively treat patients with developmental disabilities and mental health disorders during emergency situations.
Existing federal law: Establishes, under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), standards for privacy of individually identifiable health information and security standards for the protection of electronic protected health information, including, through regulations, that a HIPAA covered entity may not condition the provision to an individual of treatment, payment, enrollment in the health plan, or eligibility for benefits on the provision of an authorization, except under specified circumstances. Provides that if its provisions conflict with a provision of state law, the provision that is most protective of patient privacy prevails.
Existing state law:
- Prohibits, pursuant to the Confidentiality of Medical Information Act (CMIA), a provider of health care, a health care service plan, a contractor, a corporation and its subsidiaries and affiliates, or any business that offers software or hardware to consumers, including a mobile application or other related device, as defined, from intentionally sharing, selling, using for marketing, or otherwise using any medical information, as defined, for any purpose not necessary to provide health care services to a patient, except as expressly authorized by the patient, enrollee, or subscriber, as specified, or as otherwise required or authorized by law.
- Authorizes, pursuant to the CMIA, disclosure of clinical records and information between providers for the purpose of diagnosis or treatment of the patient, including, in an emergency situation, the communication of patient information by radio transmission or other means between emergency medical personnel at the scene of an emergency, or in an emergency medical transport vehicle, and emergency medical personnel at a licensed health facility.
- Defines, for purposes of the CMIA, medical information to mean any 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.
- Requires all information and records obtained in the course of providing specified developmental services and mental services to either voluntary or involuntary recipients of services to be confidential, and authorizes disclosure only in specified cases, including in communications between qualified professional persons in the provision of services or appropriate referrals, and to the designated officer of an emergency response employee, and from that designated officer to an emergency response employee regarding possible exposure to the human immunodeficiency virus or the acquired immune deficiency syndrome.
- Defines “emergency services and care” as the medical screening, examination, and evaluation by a physician or, to the extent permitted by applicable law, by other appropriate personnel under the supervision of a physician to determine the care, treatment, and surgery by a physician necessary to relieve or eliminate the emergency medical condition or active labor, within the capacity of the facility.
This bill:
- Authorizes, during the provision of emergency services and care, the communication of patient information , for patients who are developmentally disabled and have a mental health disorder, between a physician and surgeon, licensed psychologist, social worker with a master’s degree in social work, licensed marriage and family therapist, licensed professional clinical counselor, nurse, emergency medical personnel at the scene of an emergency or in an emergency medical transport vehicle, or other professional person or emergency medical personnel at a licensed health facility, as specified.
- Prohibits the authority in 1) above, related to the communication of patient information during the provision of emergency services and care, from being limited by existing exceptions to the sharing of information in current law during emergency situations.
- Makes other technical, nonsubstantive changes.
FISCAL EFFECT:
This bill has been keyed nonfiscal.
PRIOR VOTES:
Assembly Floor: | 69 - 0 |
Assembly Health Committee: | 14 - 0 |
COMMENTS:
- Author’s statement. According to the author, lack of information is a substantial barrier to effective care in the emergency department setting where patients are in crisis and timely consent is not always possible. This bill provides emergency physicians with improved access to important medical records to allow them to deliver critical care to patients in need. For example, having a patient’s complete medical information allows an emergency physician to restart a medication or follow an existing treatment plan. Health care providers have interpreted existing confidentiality laws differently, resulting in incomplete health records and others not released to emergency physicians at all.
- Background. A California HealthCare Foundation (CHCF) report from July 2015, “Fine Print: Rules for Exchanging Behavioral Health Information in California,” described the legal framework for sharing behavioral health (mental health and substance use disorder) patients’ information in California under both federal and state law. According to the CHCF report, the Lanterman-Petris-Short (LPS) Act, rather than the CMIA, governs the exchange of patient information by some mental health providers. The LPS Act applies to federal, state, and county mental hospitals; institutions that treat involuntarily detained mental health patients; and residential programs, such as mental health rehabilitation centers and community residential treatment systems. The LPS Act can also apply to outpatient providers to the extent they participate in certain government-funded programs covered under the LPS Act, such as gambling treatment programs, homeless outreach programs, or the provision of care to judicially committed people under the Forensic Conditional Release Program. Like HIPAA and CMIA, the LPS Act contains an exception that allows for the exchange of mental health information for treatment purposes. “Qualified professional persons” may share patient medical information with one another in the course of providing services without obtaining patient consent. The statute does not define a “qualified professional person.” This language is potentially narrower than the language in the treatment exception of the CMIA, which makes clear that a provider may share information with a broad range of health care organizations and professionals treating the patient. At a minimum, the LPS Act allows a health care professional to share patient information with another health care professional who treats that patient, even if the two professionals work at different facilities or locations.
The CHCF report states that, in practice, the LPS Act exception appears to be interpreted more broadly to permit the sharing of information by mental health facilities or programs at the organizational level, with access by nonprofessional personnel who provide support for the professional’s activities. Given the way in which data are shared between institutions, there may be no other practical way to interpret the exception according to the CHCF report. CHCF states that the precise scope of the exception is subject to interpretation, and this lack of clarity likely leads to different interpretations across the state with respect to the type of sharing that is permitted. CHCF further notes that existing California initiatives have implemented different approaches to sharing mental health data, with some requiring prior patient consent and some not.
The CHCF report concludes that clarification of the LPS Act would facilitate more consistent exchange of mental health information. California law permits providers to share physical and mental health information with one another for treatment purposes without the individual’s consent. Under the CMIA and the LPS Act, providers engaged in organized data exchange initiatives do not have to obtain consent, but the experience of initiative participants interviewed for the CHCF article suggests there is not a universal, consistent understanding of the LPS Act. According to CHCF, the state could ease the administrative burden on providers by clarifying that the LPS Act does not require patient consent for the sharing of mental health information.
- Double referral. Should this bill pass out of this committee, it will be referred to the Senate Judiciary Committee.
- Related legislation. SB 350 (Galgiani) would require the disclosure of medical, dental, and mental health information, by electronic transmission when possible, between a county correctional facility, a county medical facility, a state correctional facility, a state hospital, or a state-assigned mental health provider when an inmate is transferred from or between state and county facilities, as specified. SB 350 was held on the Senate Appropriations Committee suspense file.
- Prior legislation. AB 1300 (Ridley-Thomas of 2016) would have, among other things, allowed specified individuals who participate in the examination, consultation, treatment, placement, referral, or transport of a detained person, or for whom there may be probable cause for detainment, to engage in communication of patient information among each other, as specified. AB 1300 was held in the Senate Rules Committee.
- Support. The California Chapter of the American College of Emergency Physicians (CalACEP), sponsor of this bill, states that while HIPAA, the LPS Act, and the CMIA allow providers to share patient information for treatment purposes, there is confusion on the part of many providers who have interpreted the law to require patient consent to share that information, which creates a substantial barrier to effective care in the emergency department (ED) setting where patients are in crisis and timely consent is not always possible. CalACEP states that this bill seeks to provide the clarification recommended by the CHCF report to provide emergency physicians with improved access to important medical records, allowing them to provide better care for their patients. The Steinberg Institute states that AB 1119 would facilitate a more consistent exchange of mental health information and improve the safety of clients by providing emergency physicians with improved access to important medical records to allow them to deliver critical care to patients in need. The Steinberg Institute gives the example that having a patient’s complete medical information allows an emergency physician to restart a medication or follow an existing treatment plan. The Steinberg Institute and Tenet Health state that this bill will expedite patient care and in some cases should reduce the need for hospitalization.
SUPPORT AND OPPOSITION:
Support: California Chapter of the American College of Emergency Physicians (sponsor)
Steinberg Institute
Tenet Health
Oppose: None received
-- END --
Date of Hearing: May 9, 2017
ASSEMBLY COMMITTEE ON HEALTH
Jim Wood, Chair
ABPCA Bill Id:AB 1119
Author:(Limón) – As Amended Ver:March 30, 2017
SUBJECT: Developmental and mental health services: information and records: confidentiality.
SUMMARY: Authorizes the disclosure of patient information and records of individuals with developmental and mental health disabilities who are voluntarily or involuntarily detained, including those detained under the Lanterman-Petris-Short (LPS) Act, during the provision of emergency services and care, as defined, including the communication of patient information between a physician and surgeon, licensed psychologist, social worker with a master’s degree in social work, licensed marriage and family therapist, licensed professional clinical counselor, nurse, emergency medical personnel at the scene of an emergency or in an emergency medical transport vehicle, or other professional person or emergency medical personnel at a health facility, as specified. Makes other technical and non-substantive changes.
EXISTING LAW:
- Defines emergency services and care as medical screening, examination, and evaluation by a physician and surgeon, or, to the extent permitted by applicable law, by other appropriate licensed persons under the supervision of a physician and surgeon, to determine if an emergency medical condition or active labor exists and, if it does, the care, treatment, and surgery, if within the scope of that person’s license, necessary to relieve or eliminate the emergency medical condition, within the capability of the facility; and to determine if a psychiatric emergency medical condition exists, and the care and treatment necessary to relieve or eliminate the psychiatric emergency medical condition, within the capability of the facility.
- Declares the intent of the Legislature to end the inappropriate, indefinite, and involuntary commitment of persons with mental health disorders, developmental disabilities, and chronic alcoholism, and to eliminate legal disabilities. Establishes a statutory process, the LPS Act, under which individuals could be involuntarily held and treated in a mental health facility in a manner that safeguards their constitutional rights.
- Requires all information and records obtained in the course of providing specified developmental services and mental health services to either voluntary or involuntary recipients of services to be confidential and authorizes disclosure in specified cases, including the communication of patient information and records between qualified professional persons in the provision of services or appropriate referrals or in conservatorship proceedings and requires consent of the patient, or his or her guardian or conservator, before information or records may be disclosed by a professional person employed by a facility to professional person not employed by the facility who does not have the medical or psychological responsibility for the patient’s care.
- Prohibits, pursuant to the state Confidentiality of Medical Information Act (CMIA), a provider of health care, a health care service plan, a contractor, a corporation and its subsidiaries and affiliates, or any business that offers software or hardware to consumers, including a mobile application or other related device, as defined, from intentionally sharing, selling, using for marketing, or otherwise using any medical information, as defined, for any purpose not necessary to provide health care services to a patient, except as expressly authorized by the patient, enrollee, or subscriber, as specified, or as otherwise required or authorized by law. States a violation of the provisions of this act that results in economic loss or personal injury to a patient is a crime.
- Defines, for purposes of the CMIA, medical information to mean any 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. Defines individually identifiable to mean that the medical information 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, social security number, or other information that, alone or in combination with other publicly available information, reveals the individual’s identity.
- Establishes under federal law Health Insurance Portability and Accountability Act of 1996 (HIPAA) standards for privacy of individually identifiable health information and security standards for the protection of electronic protected health information, including, through regulations, that a HIPAA covered entity may not condition the provision to an individual of treatment, payment, enrollment in the health plan, or eligibility for benefits on the provision of an authorization, except under specified circumstances. Provides that if its provisions conflict with a provision of state law, the provision that is most protective of patient privacy prevails.
FISCAL EFFECT: None
COMMENTS:
- PURPOSE OF THIS BILL. According to the author, lack of information is a substantial barrier to effective care in the emergency department setting where patients are in crisis and timely consent is not always possible. This bill provides emergency physicians with improved access to important medical records to allow them to deliver critical care to patients in need. For example, having a patient’s complete medical information allows an emergency physician to restart a medication or follow an existing treatment plan. Healthcare providers have interpreted existing law differently resulting in incomplete health records or information not released to emergency physicians at all.
- BACKGROUND. The CMIA authorizes disclosure of clinical records and information between providers for the purpose of diagnosis or treatment of the patient. This includes, in an emergency situation, the communication of patient information by radio transmission or other means between emergency medical personnel at the scene of an emergency, or in an emergency medical transport vehicle, and emergency medical personnel at a licensed health facility. A California HealthCare Foundation July 2015 (CHCF) article, “Fine Print: Rules for Exchanging Behavioral Health Information in California,” described the legal framework for sharing behavioral health information in California, under both federal and state law. According to the CHCF article, the LPS Act, rather than the CMIA, governs the exchange of patient information by some mental health providers. The LPS Act applies to federal, state, and county mental hospitals; institutions that treat involuntarily detained mental health patients; and, residential programs such as mental health rehabilitation centers and community residential treatment systems. The LPS Act can also apply to outpatient providers to the extent they participate in certain government-funded programs covered under the LPS Act, such as gambling treatment programs, homeless outreach programs, or the provision of care to judicially committed people under the Forensic Conditional Release Program. Like HIPAA and the CMIA, the LPS Act contains an exception that allows for the exchange of mental health information for treatment purposes. “Qualified professional persons” may share patient medical information with one another in the course of providing services without obtaining patient consent. The statute does not define a “qualified professional person.” This language is potentially narrower than the language in the treatment exception of the CMIA, which makes clear that a provider may share information with a broad range of health care organizations and professionals treating the patient. At a minimum, the LPS Act allows a health care professional to share patient information with another health care professional who treats that patient, even if the two professionals work at different facilities or locations.
In practice, the exception appears to be interpreted more broadly to permit the sharing of information by mental health facilities or programs at the organizational level, with access by nonprofessional personnel who provide support for the professional’s activities. Given the way in which data are shared between institutions, there may be no other practical way to interpret the exception according to the CHCF article. But the precise scope of the exception is subject to interpretation, and this lack of clarity likely leads to different interpretations across the state with respect to the type of sharing that is permitted. The CHCF article further notes that existing California initiatives have implemented different approaches to sharing mental health data, with some requiring prior patient consent and some not.
The CHCF article concluded that clarification of California’s LPS Act would facilitate more consistent exchange of mental health information. California law permits providers to share physical and mental health information with one another for treatment purposes without the individual’s consent. Under the CMIA and the LPS Act, providers engaged in organized data exchange initiatives in California do not have to obtain consent but the experience of initiative participants interviewed for the CHCF article suggests there is not a universal, consistent understanding of the LPS Act. According to the CHCF article, the state could ease the administrative burden on providers by clarifying that the LPS Act does not require patient consent for the sharing of mental health information.
- SUPPORT. The California Chapter of the American College of Emergency Physicians (California ACEP), sponsor, writes that there is confusion on the part of many providers who have interpreted the law to require patient consent to share information and that this is a substantial barrier to effective care in the emergency department. California ACEP also states that different interpretations mean that some health records are incomplete and others are not released to emergency physicians. Tenet Health states that this bill will contribute to improved communication and patient safety, will expedite patient care and in some cases reduce should reduce the need for hospitalization.
- PREVIOUS LEGISLATION. AB 1300 (Ridley-Thomas) of 2016 would have allowed an emergency physician or psychiatric professional, as specified, to detain a person who is a danger to self or others, or is gravely disabled, for up to 72 hours for evaluation and treatment, and would have allowed specified individuals who participate in the examination, consultation, treatment, placement, referral, or transport of a detained person, or for whom there may be probable cause for detainment, to engage in communication of patient information among each other and with county behavioral health professionals and staff, including when examining a person at the scene of an emergency or in transport to a hospital, and at a designated facility or other agency, at which the person may be evaluated, treated, placed, referred, or transported. AB 1300 was held in the Senate Rules Committee.
REGISTERED SUPPORT / OPPOSITION:
Support
California Chapter of the American College of Emergency Physicians, sponsor
Tenet Health
Opposition
None on file.
Analysis Prepared by: Kristene Mapile / HEALTH / (916) 319-2097
Discussed in Hearing
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Bill Co-Author(s):