by Russell Madden
The LFE Times
I recently completed my annual eye exam at the University of Iowa Hospitals and Clinics in Iowa City, Iowa. As I checked in at the registration desk, I discovered a new wrinkle in the procedure. The clerk at the desk informed me that - by law - the hospital was now required to provide written notification of new privacy policies that the hospitals were implementing. These rules came in response to a federal law that - we were told - would help ensure and protect our medical privacy, i.e., the information about our medical condition that is held by hospitals and doctors and clinics. (The Health Insurance Portability and Accountability Act of 1996 ["HIPAA"] apparently even mandates that my wife sign a privacy form for the meds we purchased at a local pharmacy for our sick cat.)
This became my first direct encounter with this particular effort of my government to protect me from those with evil-intent who seem more and more to inhabit this wild and crazy world: identity-thieves, stalkers, tele-marketers...
The four-by-nine inch pamphlet I received - "University of Iowa Health Care Notice" - is definitely well done. After all, as the largest teaching hospital in the country, UIHC has the resources necessary to place a pleasant public relations face on whatever policies they develop. The small, black-and-white photos of blacks and Orientals and women and even white men assure us that the UIHC takes very seriously its commitment to affirmative action and diversity. And, oh, yes, privacy.
Given what I know about how the average citizen deals with political issues beyond their immediate concerns, I imagine most patients and family members glance at the cover and toss the pamphlet. At best, they probably flip through the pages, note the headings, and nod in acceptance or shrug in indifference to the main points listed there.
Exciting though the material was, I decided to take the risk and actually read what was written by the public relations and legal departments of the hospitals. Given that the national law applies to all medical care providers, every such organization must adhere essentially to identical requirements.
First, the UIHC assures its patients that:
"As your health care provider, we are legally required to protect the privacy of your health information, and to provide you with this notice about our legal obligations and privacy practices."
Hmm. I would hope the UIHC would protect my privacy whether they were "legally required" to do so or not. But I don't suppose they want to cloud the issue by bringing in any considerations of ethics in regard to privacy. Despite this quirk, the booklet generally adopts an earnest tone in discussing the PHI - "protected health information" - the UIHC is supposed to protect.
On page four, there is a statement that sounds imminently promising:
"The medical record [a patient's health information kept in a chart or computer] is the property of University of Iowa Hospitals and Clinics or Student Health service, but the information in the medical record belongs to you." [emphasis added]
If something "belongs to you," that means it is yours, you own it. If you own something, you control it. If you control something, you are the one who has the right and the responsibility to determine and to decide how and whether that thing will or will not be used. If you have the right to something, no one may morally or legally violate your (peaceful, voluntary) wishes and/or actions regarding that thing without your direct permission.
Wow. Sounds great. Nothing to worry about. We can all go home now. Grab a beer. Kick back. Rest assured that all is well...
As difficult as it was for me to write that with a straight face, I'll continue my exploration.
Many of the reasons the UIHC offers for when it will "disclose health information" sound logical and necessary:
”Treatment." It would obviously be difficult for doctors and hospital staff to deal properly with your injury or disease or problem unless they were able to communicate with one another. To require separate and direct verbal or written permission from a patient before a doctor could, for example, convey each and every care order to a nurse would be impractical and result in negative consequences for medical care.
"Payment." If you expect your insurance carrier to reimburse the hospital for your care, again, a general permission from the patient should suffice; a distinct permission for each and every charge would consume huge amounts of time and resources and result in even higher costs that would eventually be passed on to you.
"Health care operations." Hmm. A rather generic statement for evaluating "the quality of health care services" or "the performance of health care professionals." This sounds like internal quality control, so let that pass.
"Appointment reminders and health-related benefits or services." Advertising. Hey. I'm all for that.
"Public health activities." This hands over information to "government officials in charge of collecting" stats on "births, deaths, and various diseases." Well... This is really none of the State's business. If a crime is suspected, then, fine, "coroners, medical examiners" might need to know what killed me, but since I object even to census questions, I consider any other such information illicit if given to the State.
"Health oversight activities." This deals with external "audits, investigations, inspections, and licensure, as authorized by law." Uh-oh. Guarding against fraud is fine, but what does "the Department of Health and Human Services Office for Civil Rights" have to do with me and my eyes?
"Research studies." Here the UIHC is going "to balance research needs with the need for the privacy of your health information." That's fine if I agree to be a study participate, but this section leaves wide open the possibility that for "some research activities" I will not be asked for my agreement before my PHI is handed over to someone else without my knowledge.
"Organ donation." "Workers' compensation." Okay as long as the related organizations have my explicit permission.
I have left the last two sections (not in this order in the pamphlet) till now:
"Law enforcement." "...when the law requires it." Unfortunately, the law is rarely congruent these days with rights. Again, if a crime is suspected, fine, but none of this "automatic" reporting nonsense. If John Law wants to know about gunshot wounds or other such problems, let him seek a subpoena. Let him prove the necessity for providing such information without my consent. The fishing-expeditions that modern law has become and a statement such as "when ordered to do so in judicial or administrative proceedings" leaves a loophole a mile wide and just as deep.
And finally: "National security and intelligence activities."
I don't believe that the chill dancing along my spine or that hollow pit sinking into my stomach represent symptoms of any impending disease.
National security and intelligence activities.
At last we reach the core of this particular charade.
"We may release PHI to authorized federal officials when required by law. This information may be used to protect the President; other authorized persons or foreign heads of state; to conduct special investigations; for intelligence and other national security activities authorized by law."
Take a moment. Reread that list of uses that will "justify" the release of your PHI, that will obliterate your privacy, that will turn you into a criminal without recourse to protection of your rights.
Your medical information "belongs to you"? What a joke! What a sad, sick, disgusting joke.
We're supposed to swallow the fantasy that private individuals and corporations who can legally force us to do NOTHING form the primary threat to our privacy...while giving the State carte blanche to anything and everything about our most intimate bodily and personal concerns should evoke zero worries and should, in fact, guarantee our medical privacy.
The "protection" of a bunch of rights raping, property stealing, morally bankrupt politicians warrants and sanctions this obscene, unconstitutional law personified as a defense of "privacy"?!?
As for "intelligence and other national security activities," I'm sure you feel all warm-and-fuzzy that the folks who gave us the Rico Act and the PATRIOT Act and who are busy stretching that later filth (as they did the former) into a catchall that pries into any and every aspect of life, holds innocent people till doomsday without recourse, and chases down AWOL state politicians will likewise never, ever, no-way, no-how abuse or expand the range of activities and behaviors subject to their scrutiny and control.
(And don't forget to sign here so I can transfer the deed to the Brooklyn Bridge over to you...)
As for any "ownership" you supposedly have to your medical information, the UIHC tells me that they are not "legally required to accept" any request for restrictions on that information. Beyond that, I "may not limit the uses and disclosures that [they] are legally required or allowed to make."
"Ownership" without control. The hallmark of a fascist society. The trademark of our own.
The strategy is always the same: enact good or at least good-sounding policies then bury the destructive time bomb that is the actual rationale for the sham deep beneath the pleasant exterior.
Privacy laws that are anti-privacy. Keep out the coyotes while letting in the lions.
This slowly tightening noose around a "privacy" that in no fashion excludes the State echoes the remarks of our U.S. Attorney General who said he supports the right of individuals to keep and bear arms but believes that every single gun control (i.e., victim disarmament) law on the books is right and proper.
Anti-self-defense self-defense.
Then there are the recent schizophrenic Supreme Court decisions that say affirmative action is bad if you're too blatant about practicing it but a really wonderful policy if you're subtle in how you implement this "diversity" enhancer.
Racist anti-racism
And don't you forget these lessons when you hand over your fingerprints to purchase the fireworks you are permitted to buy - or not - to celebrate the Fourth of July, to be known henceforth as:
Anti-Independence Independence Day!
The LFE Times
I recently completed my annual eye exam at the University of Iowa Hospitals and Clinics in Iowa City, Iowa. As I checked in at the registration desk, I discovered a new wrinkle in the procedure. The clerk at the desk informed me that - by law - the hospital was now required to provide written notification of new privacy policies that the hospitals were implementing. These rules came in response to a federal law that - we were told - would help ensure and protect our medical privacy, i.e., the information about our medical condition that is held by hospitals and doctors and clinics. (The Health Insurance Portability and Accountability Act of 1996 ["HIPAA"] apparently even mandates that my wife sign a privacy form for the meds we purchased at a local pharmacy for our sick cat.)
This became my first direct encounter with this particular effort of my government to protect me from those with evil-intent who seem more and more to inhabit this wild and crazy world: identity-thieves, stalkers, tele-marketers...
The four-by-nine inch pamphlet I received - "University of Iowa Health Care Notice" - is definitely well done. After all, as the largest teaching hospital in the country, UIHC has the resources necessary to place a pleasant public relations face on whatever policies they develop. The small, black-and-white photos of blacks and Orientals and women and even white men assure us that the UIHC takes very seriously its commitment to affirmative action and diversity. And, oh, yes, privacy.
Given what I know about how the average citizen deals with political issues beyond their immediate concerns, I imagine most patients and family members glance at the cover and toss the pamphlet. At best, they probably flip through the pages, note the headings, and nod in acceptance or shrug in indifference to the main points listed there.
Exciting though the material was, I decided to take the risk and actually read what was written by the public relations and legal departments of the hospitals. Given that the national law applies to all medical care providers, every such organization must adhere essentially to identical requirements.
First, the UIHC assures its patients that:
"As your health care provider, we are legally required to protect the privacy of your health information, and to provide you with this notice about our legal obligations and privacy practices."
Hmm. I would hope the UIHC would protect my privacy whether they were "legally required" to do so or not. But I don't suppose they want to cloud the issue by bringing in any considerations of ethics in regard to privacy. Despite this quirk, the booklet generally adopts an earnest tone in discussing the PHI - "protected health information" - the UIHC is supposed to protect.
On page four, there is a statement that sounds imminently promising:
"The medical record [a patient's health information kept in a chart or computer] is the property of University of Iowa Hospitals and Clinics or Student Health service, but the information in the medical record belongs to you." [emphasis added]
If something "belongs to you," that means it is yours, you own it. If you own something, you control it. If you control something, you are the one who has the right and the responsibility to determine and to decide how and whether that thing will or will not be used. If you have the right to something, no one may morally or legally violate your (peaceful, voluntary) wishes and/or actions regarding that thing without your direct permission.
Wow. Sounds great. Nothing to worry about. We can all go home now. Grab a beer. Kick back. Rest assured that all is well...
As difficult as it was for me to write that with a straight face, I'll continue my exploration.
Many of the reasons the UIHC offers for when it will "disclose health information" sound logical and necessary:
”Treatment." It would obviously be difficult for doctors and hospital staff to deal properly with your injury or disease or problem unless they were able to communicate with one another. To require separate and direct verbal or written permission from a patient before a doctor could, for example, convey each and every care order to a nurse would be impractical and result in negative consequences for medical care.
"Payment." If you expect your insurance carrier to reimburse the hospital for your care, again, a general permission from the patient should suffice; a distinct permission for each and every charge would consume huge amounts of time and resources and result in even higher costs that would eventually be passed on to you.
"Health care operations." Hmm. A rather generic statement for evaluating "the quality of health care services" or "the performance of health care professionals." This sounds like internal quality control, so let that pass.
"Appointment reminders and health-related benefits or services." Advertising. Hey. I'm all for that.
"Public health activities." This hands over information to "government officials in charge of collecting" stats on "births, deaths, and various diseases." Well... This is really none of the State's business. If a crime is suspected, then, fine, "coroners, medical examiners" might need to know what killed me, but since I object even to census questions, I consider any other such information illicit if given to the State.
"Health oversight activities." This deals with external "audits, investigations, inspections, and licensure, as authorized by law." Uh-oh. Guarding against fraud is fine, but what does "the Department of Health and Human Services Office for Civil Rights" have to do with me and my eyes?
"Research studies." Here the UIHC is going "to balance research needs with the need for the privacy of your health information." That's fine if I agree to be a study participate, but this section leaves wide open the possibility that for "some research activities" I will not be asked for my agreement before my PHI is handed over to someone else without my knowledge.
"Organ donation." "Workers' compensation." Okay as long as the related organizations have my explicit permission.
I have left the last two sections (not in this order in the pamphlet) till now:
"Law enforcement." "...when the law requires it." Unfortunately, the law is rarely congruent these days with rights. Again, if a crime is suspected, fine, but none of this "automatic" reporting nonsense. If John Law wants to know about gunshot wounds or other such problems, let him seek a subpoena. Let him prove the necessity for providing such information without my consent. The fishing-expeditions that modern law has become and a statement such as "when ordered to do so in judicial or administrative proceedings" leaves a loophole a mile wide and just as deep.
And finally: "National security and intelligence activities."
I don't believe that the chill dancing along my spine or that hollow pit sinking into my stomach represent symptoms of any impending disease.
National security and intelligence activities.
At last we reach the core of this particular charade.
"We may release PHI to authorized federal officials when required by law. This information may be used to protect the President; other authorized persons or foreign heads of state; to conduct special investigations; for intelligence and other national security activities authorized by law."
Take a moment. Reread that list of uses that will "justify" the release of your PHI, that will obliterate your privacy, that will turn you into a criminal without recourse to protection of your rights.
Your medical information "belongs to you"? What a joke! What a sad, sick, disgusting joke.
We're supposed to swallow the fantasy that private individuals and corporations who can legally force us to do NOTHING form the primary threat to our privacy...while giving the State carte blanche to anything and everything about our most intimate bodily and personal concerns should evoke zero worries and should, in fact, guarantee our medical privacy.
The "protection" of a bunch of rights raping, property stealing, morally bankrupt politicians warrants and sanctions this obscene, unconstitutional law personified as a defense of "privacy"?!?
As for "intelligence and other national security activities," I'm sure you feel all warm-and-fuzzy that the folks who gave us the Rico Act and the PATRIOT Act and who are busy stretching that later filth (as they did the former) into a catchall that pries into any and every aspect of life, holds innocent people till doomsday without recourse, and chases down AWOL state politicians will likewise never, ever, no-way, no-how abuse or expand the range of activities and behaviors subject to their scrutiny and control.
(And don't forget to sign here so I can transfer the deed to the Brooklyn Bridge over to you...)
As for any "ownership" you supposedly have to your medical information, the UIHC tells me that they are not "legally required to accept" any request for restrictions on that information. Beyond that, I "may not limit the uses and disclosures that [they] are legally required or allowed to make."
"Ownership" without control. The hallmark of a fascist society. The trademark of our own.
The strategy is always the same: enact good or at least good-sounding policies then bury the destructive time bomb that is the actual rationale for the sham deep beneath the pleasant exterior.
Privacy laws that are anti-privacy. Keep out the coyotes while letting in the lions.
This slowly tightening noose around a "privacy" that in no fashion excludes the State echoes the remarks of our U.S. Attorney General who said he supports the right of individuals to keep and bear arms but believes that every single gun control (i.e., victim disarmament) law on the books is right and proper.
Anti-self-defense self-defense.
Then there are the recent schizophrenic Supreme Court decisions that say affirmative action is bad if you're too blatant about practicing it but a really wonderful policy if you're subtle in how you implement this "diversity" enhancer.
Racist anti-racism
And don't you forget these lessons when you hand over your fingerprints to purchase the fireworks you are permitted to buy - or not - to celebrate the Fourth of July, to be known henceforth as:
Anti-Independence Independence Day!
