Existing law requires a health care provider to allow an adult patient who inspects his or her patient records to provide to the health care provider a written addendum with respect to any item or statement in his or her records that the patient believes to be incomplete or incorrect. Existing law authorizes any minor patient authorized by law to consent to a medical treatment to inspect his or her patient records, as specified. A violation of these provisions is punishable as a crime.

This bill would require a health care provider to allow a patient, regardless of his or her age, who inspects his or her patient records to provide to the health care provider a written addendum with respect to any item or statement in his or her records that the patient believes to be incomplete or incorrect. By increasing the scope of a crime, this bill would create a state-mandated local program. The bill would additionally correct an erroneous cross reference.

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that no reimbursement is required by this act for a specified reason.

Existing law requires a health care provider to allow an adult patient who inspects his or her patient records to provide to the health care provider a written addendum with respect to any item or statement in his or her records that the patient believes to be incomplete or incorrect. Existing law authorizes any minor patient authorized by law to consent to a medical treatment to inspect his or her patient records, as specified. A violation of these provisions is punishable as a crime.

This bill would require a health care provider to allow a patient, regardless of his or her age, who inspects his or her patient records to provide to the health care provider a written addendum with respect to any item or statement in his or her records that the patient believes to be incomplete or incorrect. By increasing the scope of a crime, this bill would create a state-mandated local program. The bill would additionally correct an erroneous cross reference.

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that no reimbursement is required by this act for a specified reason.

Existing law requires a health care provider to allow an adult patient who inspects his or her patient records to provide to the health care provider a written addendum with respect to any item or statement in his or her records that the patient believes to be incomplete or incorrect. Existing law authorizes any minor patient authorized by law to consent to a medical treatment to inspect his or her patient records, as specified. A violation of these provisions is punishable as a crime.

This bill would require a health care provider to allow a patient, regardless of his or her ages, who inspects his or her patient records to provide to the health care provider a written addendum with respect to any item or statement in his or her records that the patient believes to be incomplete or incorrect. By increasing the scope of a crime, this bill would create a state-mandated local program. The bill would additionally correct an erroneous cross reference.

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that no reimbursement is required by this act for a specified reason.

 THIRD READING  

Bill No: AB 2088

Author:

:

Vote:

SENATE HEALTH COMMITTEE: 8-0, 6/13/18

AYES: Pan, Nguyen, Hernandez, Leyva, Mitchell, Monning, Nielsen, Roth

NO VOTE RECORDED: Newman

SENATE APPROPRIATIONS COMMITTEE: Senate Rule 28.8

ASSEMBLY FLOOR: 68-0, 4/12/18 (Consent) - See last page for vote

SUBJECT:

SOURCE: California Association of Marriage and Family Therapists

DIGEST:

This bill permits a minor patient, in addition to the existing ability of an adult patient, to provide a written addendum to his or her medical records if the patient believes the records to be incomplete or incorrect.

ANALYSIS:

Existing law:

1. Requires, under the Patient Access to Health Records (PAHR) law, any adult patient of a health care provider, any minor patient authorized by law to consent to medical treatment, and any patient representative, to be entitled to inspect patient records upon presenting a health care provider with a written request for those records and upon payment of reasonable clerical costs incurred in locating and making the records available. Limits a patient who is a minor to inspect patient records pertaining only to health care of a type for which the minor is lawfully authorized to consent. [HSC §123110]
2. Defines “patient records” as records in any form or medium maintained by, or in the custody or control of, a health care provider relating to the health history, diagnosis, or condition of a patient, or relating to treatment provided or proposed to be provided to the patient. [HSC §123105]
3. Requires any patient or patient’s representative to be entitled to copies of all or any portion of the patient records that he or she has a right to inspect, upon presenting a written request of the health care provider specifying the records to be copied, together with a fee to defray the cost of copying, that does not exceed $.25 per page of $.50 per page for records that are copied from microfilm and any additional reasonable clerical costs incurred in making the records available. [HSC §123110]
4. Requires any adult patient who inspects his or her patient records under PAHR to have the right to provide to the health care provider a written addendum with respect to any item or statement in his or her records that the patient believes to be incomplete or incorrect. Requires the addendum to be limited to 250 words per alleged incomplete or incorrect item in the patient’s record and to clearly indicate in writing that the patient wishes the addendum to be made a part of his or her record. [HSC §123111]
5. Permits a minor who is 12 years of age or older to consent to mental health treatment or counseling services if, in the opinion of the attending professional, the minor is mature enough to participate intelligently in the mental health treatment or counseling services. [HSC §124260]
6. Permits a minor to consent to the minor’s medical care or dental care if the minor is 15 years of age or older, is living apart from parents or guardians with or without their consent, and is managing his or her own financial affairs. [FC §6922]
7. Permits a minor to consent to medical care related to the prevention or treatment of a pregnancy, or for medical care related to the prevention of a sexually transmitted disease. [FC §6925 and §6926]

This bill revises a provision of law that permits an adult patient who inspects his or her patient records to provide the health care provider with a written addendum with respect to any item or statement in his or her records that the patient believes to be incomplete or incorrect, by deleting the word “adult,” and thereby permitting minor patients who are authorized by law to consent to medical treatment to also have the right to provide a written addendum.

Comments

1. Author’s statement. According to the author, current law allows minors to consent to medical treatment under certain circumstances and gives them the right to inspect their treatment records, but only authorizes adult patients, not minors, to add their own brief statements to those records when they believe those records are incomplete or inaccurate. This bill simply authorizes minors who already have the right of inspection to add their own, short statement to their records.

Related/Prior Legislation

SB 241 (Monning, Chapter 513, Statutes of 2017) revised and recast provisions of law governing the right of patients to access and copy their medical records by conforming these requirements to the federal Health Information Portability and Accountability Act of 1996 requirements, including requiring health care providers to provide the records in an electronic format if they are maintained electronically and if the patient requests the records in an electronic format, more clearly specifying the reasonable clerical costs that can by charged by the providers, and by making other technical, clarifying and conforming changes.

SB 575 (Leyva, Chapter 626, Statutes of 2017) expanded a provision of law that entitles a patient to a copy, at no charge, of the relevant portion of the patient’s records that are needed to support an appeal regarding eligibility for certain public benefit programs, by including initial applications in addition to appeals, and by expanding the list of public benefit programs to include In-Home Supportive Services, the California Work Opportunity and Responsibility to Kids program, CalFresh, and certain veterans related benefits.

SB 1903 (Speier, Chapter 1066, Statutes of 2000), among other provisions, authorized an adult patient to prepare an addendum to his or her patient records and required a health care provider to attach the addendum to the patient records.

FISCAL EFFECT: Appropriation: Fiscal Com.: Local:

SUPPORT: (Verified 7/2/18)

California Association of Marriage and Family Therapists (source)

Board of Behavioral Sciences

OPPOSITION: (Verified 7/2/18)

None received

ARGUMENTS IN SUPPORT: This bill is sponsored by the California Association of Marriage and Family Therapists (CAMFT), which states that although California does not give patients the right to amend their medical records, state law does give adult patients the right to add addendums to their records. However, CAMFT states that this right does not extend to minors, and this right to addend a treatment record is critical given that these records may be subject to disclosure and have the potential to impact patients’ lives and their ability to pursue various endeavors. CAMFT states that since minor 12 years of age and older can consent to their own treatment, are generally the holders of the psychotherapist-patient privilege, and are entitled to inspect or copy their records, minors should have the right to addend their treatment records in situations where the patient believes the records are inaccurate or incomplete.

The Board of Behavioral Sciences states in support that it believes that minors who are able to consent to treatment and inspect their records should also be able to provide an addendum to those records, just as adults do.

ASSEMBLY FLOOR: 68-0, 4/12/18

AYES: Acosta, Aguiar-Curry, Travis Allen, Arambula, Baker, Berman, Bigelow, Bonta, Brough, Burke, Caballero, Calderon, Carrillo, Cervantes, Chau, Chávez, Chen, Chiu, Choi, Chu, Cooley, Cooper, Cunningham, Dahle, Daly, Eggman, Flora, Fong, Frazier, Friedman, Gallagher, Eduardo Garcia, Gipson, Gloria, Gonzalez Fletcher, Grayson, Harper, Holden, Irwin, Kalra, Kiley, Lackey, Levine, Maienschein, Mathis, Mayes, McCarty, Medina, Melendez, Muratsuchi, Nazarian, Obernolte, O'Donnell, Patterson, Quirk, Quirk-Silva, Reyes, Rodriguez, Rubio, Salas, Mark Stone, Thurmond, Ting, Voepel, Waldron, Weber, Wood, Rendon

NO VOTE RECORDED: Bloom, Cristina Garcia, Gray, Jones-Sawyer, Limón, Low, Mullin, Santiago, Steinorth

Prepared by:

7/3/18 15:35:58

**** END ****

SENATE COMMITTEE ON HEALTH

Senator Dr. Richard Pan, Chair

BILL NO: AB 2088

SUBJECT: Patient records: addenda

SUMMARY:

Permits a minor patient, in addition to the existing ability of an adult patient, to provide a written addendum to his or her medical records if the patient believes the records to be incomplete or incorrect.

Existing law:

1. Requires, under the Patient Access to Health Records (PAHR) law, any adult patient of a health care provider, any minor patient authorized by law to consent to medical treatment, and any patient representative, to be entitled to inspect patient records upon presenting a health care provider with a written request for those records and upon payment of reasonable clerical costs incurred in locating and making the records available. Limits a patient who is a minor to inspect patient records pertaining only to health care of a type for which the minor is lawfully authorized to consent. [HSC §123110]
2. Defines “patient records” as records in any form or medium maintained by, or in the custody or control of, a health care provider relating to the health history, diagnosis, or condition of a patient, or relating to treatment provided or proposed to be provided to the patient. [HSC §123105]
3. Requires any patient or patient’s representative to be entitled to copies of all or any portion of the patient records that he or she has a right to inspect, upon presenting a written request of the health care provider specifying the records to be copied, together with a fee to defray the cost of copying, that does not exceed $.25 per page of $.50 per page for records that are copied from microfilm and any additional reasonable clerical costs incurred in making the records available. [HSC §123110]
4. Requires any adult patient who inspects his or her patient records under PAHR to have the right to provide to the health care provider a written addendum with respect to any item or statement in his or her records that the patient believes to be incomplete or incorrect. Requires the addendum to be limited to 250 words per alleged incomplete or incorrect item in the patient’s record and to clearly indicate in writing that the patient wishes the addendum to be made a part of his or her record. [HSC §123111]
5. Permits a minor who is 12 years of age or older to consent to mental health treatment or counseling services if, in the opinion of the attending professional, the minor is mature enough to participate intelligently in the mental health treatment or counseling services. [HSC §124260]
6. Permits a minor to consent to the minor’s medical care or dental care if the minor is 15 years of age or older, is living apart from parents or guardians with or without their consent, and is managing his or her own financial affairs. [FC §6922]
7. Permits a minor to consent to medical care related to the prevention or treatment of a pregnancy, or for medical care related to the prevention of a sexually transmitted disease. [FC §6925 and §6926]

This bill revises a provision of law that permits an adult patient who inspects his or her patient records to provide the health care provider with a written addendum with respect to any item or statement in his or her records that the patient believes to be incomplete or incorrect, by deleting the word “adult,” and thereby permitting minor patients who are authorized by law to consent to medical treatment to also have the right to provide a written addendum.

FISCAL EFFECT:

According to the Assembly Appropriations Committee, any costs to state agencies are expected to be minor and absorbable. For instance, California Department of Corrections would need to account for the possibility of such addenda to be added to health records maintained by the Division of Juvenile Justice, but the adjustments in training, policy updates, and process would be minor.

PRIOR VOTES:

COMMENTS:

1. Author’s statement. According to the author, current law allows minors to consent to medical treatment under certain circumstances and gives them the right to inspect their treatment records, but only authorizes adult patients, not minors, to add their own brief statements to those records when they believe those records are incomplete or inaccurate. This law would simply authorize minors who already have the right of inspection to add their own, short statement to their records.
2. Prior legislation. SB 241 (Monning, Chapter 513, Statutes of 2017) revised and recast provisions of law governing the right of patients to access and copy their medical records by conforming these requirements to the federal Health Information Portability and Accountability Act of 1996 (HIPAA) requirements, including requiring health care providers to provide the records in an electronic format if they are maintained electronically and if the patient requests the records in an electronic format, more clearly specifying the reasonable clerical costs that can by charged by the providers, and by making other technical, clarifying and conforming changes.
   
   SB 575 (Leyva, Chapter 626, Statutes of 2017) expanded a provision of law that entitles a patient to a copy, at no charge, of the relevant portion of the patient’s records that are needed to support an appeal regarding eligibility for certain public benefit programs, by including initial applications in addition to appeals, and by expanding the list of public benefit programs to include In-Home Supportive Services, the California Work Opportunity and Responsibility to Kids program, CalFresh, and certain veterans related benefits.
   
   SB 1903 (Speier, Chapter 1066, Statutes of 2000) among other provisions, authorized an adult patient to prepare an addendum to his or her patient records and requires a health care provider to attach the addendum to the patient records.
3. Support. This bill is sponsored by the California Association of Marriage and Family Therapists (CAMFT), which states that although California does not give patients the right to amend their medical records, state law does give adult patients the right to add addendums to their records. However, CAMFT states that this right does not extend to minors, and this right to addend a treatment record is critical given that these records may be subject to disclosure and have the potential to impact patients’ lives and their ability to pursue various endeavors. CAMFT states that since minor 12 years of age and older can consent to their own treatment, are generally the holders of the psychotherapist-patient privilege, and are entitled to inspect or copy their records, minors should have the right to addend their treatment records in situations where the patient believes the records are inaccurate or incomplete.
   
   The Board of Behavioral Sciences states in support that it believes that minors who are able to consent to treatment and inspect their records should also be able to provide an addendum to those records, just as adults do.

SUPPORT AND OPPOSITION:

Support: California Association of Marriage and Family Therapists (sponsor)

Board of Behavioral Sciences

Oppose: None received

-- END --

Date of Hearing: April 4, 2018

ASSEMBLY COMMITTEE ON APPROPRIATIONS

Lorena Gonzalez Fletcher, Chair

ABPCA Bill Id:AB 2088

Author:(Santiago) – As Introduced Ver:February 7, 2018

Urgency: No State Mandated Local Program: Yes Reimbursable: No

SUMMARY:

This bill removes the age limit on the ability of a patient to offer a correction or addition to their own health care record by attaching an addendum to the record, thereby allowing minors to provide such addenda.

FISCAL EFFECT:

Any costs to state agencies are expected to be minor and absorbable. For instance, California Department of Corrections would need to account for the possibility of such addenda to be added to health records maintained by the Division of Juvenile Justice, but the adjustments in training, policy updates, and process would be minor.

COMMENTS:

1. Purpose. This bill is sponsored by the California Association of Marriage and Family Therapists, who state it is critical to allow minors— who legally may consent to certain types of medical treatment including mental health treatment— to insert addenda to correct or add to their medical records. This bill has no opposition.
2. Background. SB 1903 (Speier), Chapter 1066, Statutes of 2002, among other provisions, authorizes an adult patient to prepare an addendum to his or her patient records and requires a health care provider to attach the addendum to the patient records. This bill removes the reference to an "adult" patient and provides this right to any patient. Under current law, minors 12 years or older may consent to specified behavioral health services and health services related to communicable diseases, among other services.

Analysis Prepared by: Lisa Murawski / APPR. / (916) 319-2081

Date of Hearing: March 20, 2018

ASSEMBLY COMMITTEE ON HEALTH

Jim Wood, Chair

ABPCA Bill Id:AB 2088

Author:(Santiago) – As Introduced Ver:February 7, 2018

SUBJECT: Patient records: addenda.

SUMMARY: Expands existing law to allow a minor patient authorized by law to consent to medical treatment to provide a health care provider with a written addendum with respect to any item or statement in his or her record that the patient believes to be incomplete or incorrect. Makes other technical and non-substantive changes.

EXISTING LAW:

1. Requires a health care provider to allow an adult patient who inspects his or her patient records to provide to the health care provider a written addendum with respect to any item or statement in his or her records that the patient believes to be incomplete or incorrect.
2. Limits the addendum to 250 words per alleged incomplete or incorrect item in the patient’s record and provides that it clearly indicate in writing that the patient wishes the addendum to be made a part of his or her record.
3. Requires the health care provider to attach the addendum to the patient’s records and to include that addendum whenever the health care provider makes a disclosure of the allegedly incomplete or incorrect portion of the patient’s records to any third party.
4. Authorizes any adult patient of a health care provider, any minor patient authorized by law to consent to a medical treatment, and any patient’s personal representative to inspect his or her patient records, as specified.
5. Allows a minor who is 12 years of age or older to consent to medical treatment, as specified, including mental health treatment or counseling on an outpatient basis, or to residential shelter services if the minor, in the opinion of the attending professional person, is mature enough, and if the minor would present a danger, as specified, or is the alleged victim of incest or child abuse.

FISCAL EFFECT: This bill has not yet been analyzed by a fiscal committee.

COMMENTS:

1. PURPOSE OF THIS BILL. According to the author, current law allows minors to consent to medical treatment under certain circumstances and gives them the right to inspect their treatment records, but only authorizes adult patients, not minors, to add their own brief statements to those records when they believe those records are incomplete or inaccurate. This law would simply authorize minors who already have the right of inspection to add their own, short statement to their records.
2. BACKGROUND. Existing law establishes a patient's right to see and receive copies of his or her medical records, under specific conditions. The law only addresses the patient's request for copies of his or her own medical records and does not cover a patient's request to transfer records between health care providers or to provide the records to an insurance company or an attorney. Existing law also provides that any adult patient, or any minor patient who by law can consent to medical treatment (or certain patient representatives), is entitled to inspect patient records upon written request to a physician and upon payment of reasonable clerical costs to make such records available. The physician must then permit the patient to view his or her records during business hours within five working days after receipt of the written request. The patient or patient's representative may be accompanied by one other person of his or her choosing. Prior to inspection or copying of records, physicians may require reasonable verification of identity, so long as this is not used oppressively or discriminatorily to frustrate or delay compliance with this law.

There are some exceptions in that a physician may refuse the request of a minor's representative to inspect or obtain copies of the minor's records if a physician determines that access to the patient records requested by the representative would have a detrimental effect on the physician's professional relationship with the minor patient or the minor's physical safety or psychological well-being. A physician may also refuse a patient's request to see or copy his or her mental health records if the physician determines there is a substantial risk of significant adverse or detrimental consequences to the patient if such access were permitted.

Existing law also provides that an adult patient can write an addendum to be placed in his or her medical file. The original information will not be removed, but the new information, signed and dated by the patient, will be placed in the file.

1. SUPPORT. The California Association of Marriage and Family Therapists, sponsor of this bill, states that the right to addend a treatment record is critical given that these records may be subject to disclosure and have the potential to impact the patients’ lives and their ability to pursue various endeavors. Since minors 12 years of age and older can consent to their own treatment, are generally the holders of the psychotherapist-patient privilege, and are entitled to inspect or copy their records, minors should have the right to addend their treatment records in situations where the patient believes the records are inaccurate and/or incomplete. Allowing minors to addend their medical records will empower them to take control of their own healthcare.
2. PREVIOUS LEGISLATION.
   1. SB 1903 (Speier), Chapter 1066, Statutes of 2000, authorizes an adult patient to prepare a specified addendum to his or her patient records and require the health care provider to attach that addendum to the patient’s records.
   2. SB 1415 (Kuehl) of 2008 would have required certain health care providers who create patient records, at the time the initial patient record is created, to provide a statement to the patient, or the patient’s representative, that sets forth the patient’s rights, including the patient’s right to provide a written addendum, as specified, and the intended retention period for the records, as specified in applicable law or by the health care provider’s retention policy. The Governor vetoed SB 1415 and indicated that “The historic delay in passing the 2008-2009 State Budget has forced me to prioritize the bills sent to my desk at the end of the year's legislative session. Given the delay, I am only signing bills that are the highest priority for California. This bill does not meet that standard and I cannot sign it at this time.”

REGISTERED SUPPORT / OPPOSITION:

Support

California Association of Marriage and Family Therapists (sponsor)

California Association for Licensed Professional Clinical Counselors

Opposition

None on file.

Analysis Prepared by: Kristene Mapile / HEALTH / (916) 319-2097