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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 19 of 19. This is the beginning of the thread.
Posted by mair on January 30, 2003, at 10:20:01
Jane d's thread about peer review got me thinking about this. I have an ex-pdoc/therapist who is now retired? Can I assume that he took his files with him when he closed his office? What typically happens to a doctor's files when he dies? I'm guessing that he said something about the current disposition of his records in his final letter, but I can't really recall. I guess I'm more concerned about what happens if he dies or leaves the area.
Mair
Posted by IsoM on January 30, 2003, at 14:17:58
In reply to What happens to our records?, posted by mair on January 30, 2003, at 10:20:01
I'm curious too, mair, as I had heard that sometimes medical records are sold to the next doctor that takes over the practice or buys the practice, even if it's re-established in another part of town. I hope this isn't true. I'm not sure what kind of medical records - if it includes all kinds.
Posted by Dinah on January 30, 2003, at 17:05:07
In reply to What happens to our records?, posted by mair on January 30, 2003, at 10:20:01
I think there are laws that vary from state to state. The clinic my therapist works from is closing so we've discussed this recently.
They're giving him a copy of my records, but they're required to keep the records for so many years after which they are supposed to incinerate or shred or otherwise dispose of them confidentially.
In the case of a private practioner, where the records end up in the hands of the family, I'm not sure that could be enforced. I imagine the family could just put them in the trash or something without knowing any better. I'm almost positive I heard of a therapist's records sitting in his basement until his wife died. Then the family threw them out.
I'll have to ask my therapist if he has provisions for the disposal of patient records in the case of a sudden ummm.... incapacitation.
Fortunately he takes minimal notes. He's read me back the notes from the prior session sometimes and it's usually just a comment on my overall mood, and notes on any med changes.
Posted by Alii on January 30, 2003, at 17:56:23
In reply to Re: What happens to our records? » mair, posted by Dinah on January 30, 2003, at 17:05:07
> I think there are laws that vary from state to state. The clinic my therapist works from is closing so we've discussed this recently.
>
> They're giving him a copy of my records, but they're required to keep the records for so many years after which they are supposed to incinerate or shred or otherwise dispose of them confidentially.
>
> In the case of a private practioner, where the records end up in the hands of the family, I'm not sure that could be enforced. I imagine the family could just put them in the trash or something without knowing any better. I'm almost positive I heard of a therapist's records sitting in his basement until his wife died. Then the family threw them out.
>After my father (a psychiatrist) died back in the early eighties we (his family) became the holders of his patients medical files. I was very young and the only thing I remember is that we had these files all along the wall of our garage for at least seven years after his death.
Then (after seven years had passed) we called out a shredder and dumpster team to get rid of the files that were never requested by patients or other doctors.
I'm sure there are some changes now but this was California back in the start of the Reagan years.
~Alii
Posted by Dinah on January 30, 2003, at 18:23:24
In reply to Re: What happens to our records? » Dinah, posted by Alii on January 30, 2003, at 17:56:23
Did someone from the state professional society help you with it or follow through on it?
I can imagine scenarios where the family would have no interest in or knowledge of proper procedures. I was just wondering if it was regulated by an outside source.
I'm glad that your family handled the matter properly. I'm sure your father's patients would be relieved.
Posted by Alii on January 30, 2003, at 18:27:20
In reply to Re: What happens to our records? » Alii, posted by Dinah on January 30, 2003, at 18:23:24
> Did someone from the state professional society help you with it or follow through on it?
>
> I can imagine scenarios where the family would have no interest in or knowledge of proper procedures. I was just wondering if it was regulated by an outside source.
>
> I'm glad that your family handled the matter properly. I'm sure your father's patients would be relieved.
>
Dinah,I was really too young to know who was involved in arranging for his records to be kept in our garage for seven years but obviously someone who knew the laws back at that time.
As a kid I just remember them against one whole wall of the garage covered up with sheets over them.
I don't know if existing laws are in the books to cover this very kind of thing (deceased doctor and what to do with his/her files).
Food for thought.
--Alii
Posted by noa on January 30, 2003, at 18:38:40
In reply to What happens to our records?, posted by mair on January 30, 2003, at 10:20:01
I think that by law, health care providers have to provide for records in their wills.
Posted by judy1 on January 31, 2003, at 9:58:57
In reply to Re: What happens to our records?, posted by noa on January 30, 2003, at 18:38:40
My ex-shrink told me he would keep them in storage under lock and key. We didn't discuss openly what would happen when he dies, but my impression was the scenario that Alii wrote about. I think I'll ask my present shrink what the law is about disposal. thanks for the thread- judy
Posted by Mashogr8 on January 31, 2003, at 15:40:21
In reply to Re: What happens to our records?, posted by judy1 on January 31, 2003, at 9:58:57
I asked my psychologist that question yesterday -- what happens to the records -- just after he told me he would be going skiing for two weeks at the end of February. (The funny part was in the last three years of January skiing, he has come back injured. So now he wants to know why I am worrying about his dying or being abandoned by him in such a very definitive way. LOL). But I explained it was just a poi not a premonition of impending doom.
His answer: When someone meets an untimely death, the records would be held by the individual's estate. Those records would be transferred to new physicians as requested. The unclaimed recrocds would remain in storage until seven years had passed and would then be destroyed. When an individual retires, the records that are not forwarded to new phsycians would stay with the physician/psychologist who took over the practice. They would be available for at least seven years (for legal purposes). After that they would go into permanent storage or be destroyed per the psy/md orders.
Seems logical to me. I just hope I haven't jinxed his ski vacation.
MA
Posted by mair on January 31, 2003, at 17:29:47
In reply to Re: What happens to our records?, posted by Mashogr8 on January 31, 2003, at 15:40:21
The notion of permanent storage is almost as frightful as the notion that they're in the hands of anyone other than the treating pdoc or therapist. Do I really want his wife and kids rifling through them? I haven't been a person who has ever had any great desire to review my own records - I actually think it would be pretty upsetting. On the other hand, I'm wondering if I should ask for them back so that I control what happens to them. Any thoughts?
Mair
When I switched pdocs after mine retired, I had to sign a release form and he then wrote a brief summary of my treatment and my meds history. I don't think he actually sent her any of my records. It took me at least 2 therapy session and 1 session with my new pdoc to work through all my issues about what pdoc #1 wrote in his summary. I can't imagine how I'd react to actually seeing my records.
Does anyone know if written notes are part of the file that has to be tendered? I know in some professions written notes are considered "work product" which belongs to the professional not the client.
Posted by noa on January 31, 2003, at 18:01:54
In reply to Re: What happens to our records?, posted by Mashogr8 on January 31, 2003, at 15:40:21
Just today, I found some info on this. Apparently the laws differ by state. But, the American Psychological Association recommends that psychologists have a professional will in addition to their personal will. The professional will will have its own executor, preferably another mental health professional. The executor takes charge of the files, and is supposed to separate active from inactive files. If the patient is transferring to another therapist/doctor, the executor is responsible for transferring the file. The will is supposed to indicate how to notify patients of the death as well as of how patients can access their files. The executor of the professional will is also supposed to be in contact with the executor of the personal will.
I wonder how many therapists/pdocs have this taken care of?
They didn't go into this, but I supposed the person named executor then needs to ammend their own professional will to indicate how to dispose of the "inherited" files of the deceased therapist.
Posted by noa on January 31, 2003, at 18:08:31
In reply to Re: Records retrieval, posted by mair on January 31, 2003, at 17:29:47
I was also reading about written session notes today--in an article about HIPAA (I think this stands for Health Information Privacy Act or something to that effect). Anyway, apparently, HIPAA allows therapists to keep separate "process notes" that are not actually part of the medical file. The medical file requires certain basic info, like diagnosis, dates and times and lenghts of sessions, treatment plan, and I think probably major events or incidents, like hospitalization,etc. But if they are kept separately, the therapist can keep written notes on their impressions from the therapy session, and these are not supposed to be considered part of the main record. The article said that this doesn't totally prevent the process notes from being subpoenaed, but they would have to be subpoenaed specifically and are not automatically sent with subpoenaed treatment records. I hope I'm conveying this correctly. Maybe someone else can chime in here with more info....
Posted by noa on January 31, 2003, at 18:29:33
In reply to Re: Records retrieval, posted by noa on January 31, 2003, at 18:08:31
Sorry--I was way off about what HIPAA is an acronym for. It is the Health Insurance Portability and Accountability Act of 1996. The privacy part of the act is now going into effect.
The Coalition for Mental Health Professionals and Consumers has a newsletter, with articles on the HIPAA privacy rules. Below is the link. See especially page 26 to 27, article by Dr. Mosher on psychotherapy privacy rules.
http://www.nomanagedcare.org/NCMHPC3-01.PDF
BTW, I find the CMHPC a great resource organization. Their web site is www.nomanagedcare.org. Great name, yes? They also have good info on dealing with managed care hassles.
Posted by noa on January 31, 2003, at 18:47:45
In reply to Re: Records retrieval, posted by noa on January 31, 2003, at 18:29:33
Here is a great fact sheet on privacy of medical records:
http://www.privacyrights.org/fs/fs8-med.htm
And this is called "Health Privacy 101":
http://www.healthprivacy.org/info-url_nocat2302/info-url_nocat.htm
The health privacy project also has a good summary of the HIPAA laws:
http://www.healthprivacy.org/usr_doc/RegSummary2002.pdf
The Health Privacy Project also has a document describing state health privacy laws:
http://www.healthprivacy.org/info-url_nocat2304/info-url_nocat.htm
Posted by Dinah on January 31, 2003, at 21:11:29
In reply to Re: Records retrieval, posted by mair on January 31, 2003, at 17:29:47
Mair, in my state you're legally entitled to a copy of your file, including notes, unless the professional thinks it would be harmful for you. But you aren't entitled to the originals. In fact, I don't think they could give you the originals if they wanted to.
My concern is enforcement. All this may be law, but who's to say that the family will follow the rules. Or everyone might die with the records in the house or storage, and they might get ditched inappropriately. If there is no follow-up by the governing bodies, how do we know that the rules will be followed?
Posted by mair on February 2, 2003, at 14:14:35
In reply to Re: Records retrieval » mair, posted by Dinah on January 31, 2003, at 21:11:29
Posted by Dinah on February 5, 2003, at 16:47:46
In reply to My point exactly (nm) » Dinah, posted by mair on February 2, 2003, at 14:14:35
He is leaving the clinic he's been associated with and striking out on his own.
He hadn't thought of the issue at all, and thanked me for bringing it to his attention. :)
Sometimes I wonder who should be paying whom.
Posted by mair on February 6, 2003, at 13:31:49
In reply to Re: I asked my therapist » mair, posted by Dinah on February 5, 2003, at 16:47:46
>" He is leaving the clinic he's been associated with and striking out on his own."
This is a good thing, right? Don't you think this signifies a commitment to stay in the area and keep his private practice active?
Mair
Posted by Dinah on February 6, 2003, at 14:13:28
In reply to Re: I asked my therapist, posted by mair on February 6, 2003, at 13:31:49
Not exactly. The clinic is closing, and he's trying really hard to come up with alternatives that don't require a substantial investment on his part. It's not unlikely that he will take on a full or part time job and do therapy on the side.
He says that even if he takes a full time job, he'd still want to do part time therapy, but from past experience I'd say he doesn't do therapy as well when stressed from a full time job. :(
This is the end of the thread.
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