When healthcare providers refuse to release medical records, they may violate patient privacy rights. Refusal to release sensitive patient health information (PHI) also signifies a concern that, if left unaddressed, could lead to financial, legal, and reputational consequences.
This article explores what happens if specific circumstances drive healthcare entities to refuse to release medical records and the consequences that it entails.
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Patient Rights to Access Medical Records
Efficient access to personal health information empowers individuals to make informed decisions and take control of their overall well-being. For instance, people who can access their health data are better equipped to keep track of chronic conditions, stick to treatment plans, identify and correct errors, and monitor health progress as opposed to those who do not have or have been refused access.
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) has set standards prioritizing patient health information privacy and safety. Thus, recognizing the significance of granting access to health data, the HIPAA Privacy Rule ensures individuals have a legally enforceable right to view and receive copies of the medical and other health records held by their healthcare providers and health plans.
Individuals can also access PHI as long as the entity or its business associate holds the information, regardless of its creation date, mode of storage, format, or source.
Exploring the Legal Aspects of Medical Record Release
Understanding the legal regulations surrounding requests and verifications of medical records is essential. Below are the common requisites for requesting the release of medical records:
Request and verification
Individuals who wish to access their protected health information may be required to submit a written request. The covered entity should communicate this requirement properly as per 45 CFR 164.524(b)(1). Alternatively, electronic methods such as email or secure web portals may be provided for making access requests.
It is also important to note that the form provided by the healthcare provider or entity should not hinder or unreasonably delay access to the requested PHI.
Verifying identity
When someone requests access, the covered entity must reasonably confirm their identity (45 CFR 164.514(h)). The manner of verification is flexible and at the entity’s discretion as long as it doesn’t hinder or delay access. Verification can be done orally or in writing, depending on how the request is made (in person, via phone, email, fax, etc.).
Take paper patient access forms, for instance. It can ask for basic details to verify the requester’s identity. On the other hand, patient web portals must comply with security requirements (45 CFR 164.312(d)).
Avoiding unreasonable obstacles
Imposing unreasonable requirements that delay or hinder patient information access is not permitted. For instance, a doctor can’t ask an individual to physically visit the office to request access to a mailed medical record. Similarly, mandating a web portal for access might exclude specific individuals. Delay-inducing methods like mailing requests are discouraged. Covered entities should also offer various ways to request access, ensuring accessibility.
Valid Reasons for Refusing to Release Medical Records
According to HIPAA guidelines (45 CFR 164.524), a covered entity can decline requests for PHI in certain situations. These situations include:
- Requests for psychotherapy notes.
- Information compiled for legal purposes.
- Requests from prison inmates that could compromise safety, custody, etc.
- Records from ongoing research studies.
- Health records under the protection of the Privacy Act.
- PHI obtained with confidentiality promises.
- PHI that could endanger lives or safety.
- PHI that could harm referenced individuals.
- Requests by personal representatives that might cause harm.
Also, it is worth noting that even when health providers refuse to release medical records under the abovementioned situations, patients can still access the rest of their health information. The provider or entity can also review the request and refuse to release medical records, especially if it deems that doing so could cause problems or harm.
Common Mistakes to Avoid When Releasing Medical Records
Here are some common mistakes that healthcare providers should avoid when granting patient requests to access medical records:
- Failure to identify and validate the identity of the person making the request
- Taking too long to process the release of the health documents requested by patients or their authorized representatives
- Disclosing information beyond what is requested
- Taking too long to respond to revocation of authorization requests
- Charging patients unreasonable or excessive fees in exchange for medical record copies
- Failing to implement proper security and privacy measures to safeguard medical records from unauthorized sharing or access
The bottom line is healthcare providers can refuse to release medical records, granting that it has a valid reason. Otherwise, patients can request access to these records anytime. Doing so promotes transparency, encouraging patients to become more involved in their healthcare journey.
