Friday, November 30, 2007

HIPAA, Guns, and Public Health

A while ago I was called to the Psych floor to see a patient with a cardiac arrhythmia. I thought I would check on the patient’s history via our fancy electronic medical record (EMR) before making the trek to an area rarely visited by this outsider, but I was surprised to see that I could not access charts electronically from outside the Psych ward. It seems there are some checks and balances installed in our EMR to avoid prying eyes. Although I was initially perturbed, I must admit I thought it was a smart move to limit access to psychiatric charts – especially since I might be up there as an inpatient myself given all the bureaucracy surrounding medicine these days.

But then this news appeared today about how the feds have miraculously increased their "Mental Defective File" database size to limit the sales of guns to goofy people. On first blush, I thought, “Thank God! I really don’t one of these crazy people with a gun.”

But then I looked into HOW the FBI expanded their database from 150,000 to over 400,000 people in the blink of an eye:
The vast majority of the individuals who were added to the FBI's list were identified by the state of California, which provided more than 200,000 names to the FBI in October, the Justice Department said. Ohio also provided more than 7,000 new names, and the number of states reporting mental health data to the FBI this year grew from 23 to 32, officials said.
So where did these states get these names from? Well it seems hospitals may have supplied the names:
A Virginia state court found (Seung Hui) Cho (remember, he caused the largest on-campus killing spree of anyone to date) to be dangerously mentally ill in 2005 and ordered him to receive outpatient treatment. But because Cho was not ordered into hospital treatment, the court's order was never provided to the FBI and incorporated in its database, which two gun dealers checked before selling Cho the 9mm Glock 19 and a Walther .22-caliber pistol used in the shootings.
The debate about this has been heated:
House Democrats reached an agreement earlier this year with the National Rifle Association on legislation meant to encourage states to submit timely background check data to the FBI, by offering monetary awards and threatening penalties.

"Our position has always been that those who have been adjudicated as mentally defective or a danger to themselves or to others or suicidal should not have access to firearms" and should be added to the FBI's list, said NRA spokesman Andrew Arulanandam.

The measure passed easily in the House, but it has stalled in the Senate due to a hold by Sen. Tom Coburn, R-Okla. He has said he opposes the legislation because its implementation would cost too much and because it lacks a mechanism to challenge inclusion on the list. He was joined by some veterans' groups, which argued that former soldiers might be denied gun-owning rights without due process.
Now, most of us assume such sensitive health records are protected in the interest of “privacy.” Isn’t that what we’ve been assured by HIPAA? So what’s the loophole that permits the feds access to sensitive hospital records to make their lists? What if I had an anxiety disorder or depression in my medical history requiring inpatient admission. Would I end up on the FBI’s “Mental Defective File?” Would I have any recourse to remove myself from that list if my condition improved? Who’s responsible for this information? If we take this a step further, what’s to stop the feds from forming another database in the interest of public health like, say, an “HIV Defective File” or other “Sexually-transmitted Disease Defective File?”

Probably nothing.


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