Esta Soler

(WOMENSENEWS)–Karen was repeatedly turned down for health coverage after insurers reviewed her medical records, which detailed beatings by her husband.

Donna, who was injured by her partner, was afraid to enter a hospital because of a law that would require doctors to notify police about the abuse she suffered. She never got the care she needed.

Other battered women have had their medical records disclosed to their spouses, leading to violent retaliation and sometimes murder. Still others have faced discrimination when their health information was disclosed to their employers.

Privacy issues affecting battered women who seek help from the health care system are complex and difficult. The Clinton administration took a huge step forward to address these issues responsibly when the Department of Health and Human Services issued new health care privacy regulations in December. These rules are a significant advance for victims of domestic violence who, either deliberately or inadvertently, disclose abuse when they seek medical care.

But more work is needed to protect the privacy, and ultimately the safety, of battered women.

For years, the Family Violence Prevention Fund and other groups working to stop domestic violence have pressed for routine medical screening for abuse. We are convinced that health care providers have a unique opportunity to help victims. But as the information age has made the widespread use and disclosure of health information more common, it has become increasingly clear that disclosure can put victims of domestic violence at risk.

Conversations With Health Care Providers Remain Confidential

The new regulations go a long way toward protecting women facing abuse–now they will know that conversations with their health care providers will remain confidential. The new rules give battered women a good measure of protection by prohibiting the improper use and disclosure of personal information–disclosure that can result in retaliatory violence, workplace and insurance discrimination, harassment and danger to victims of domestic violence.

In fact, the new rules penalize health care providers, health insurance plans or clearinghouses that improperly use or disclose medical information; doing so can result in criminal and civil penalties, including as much as $250,000 in fines and 10-year prison terms.

Other aspects of the new rules will protect battered women. Health care providers must obtain authorization from the patient to use or disclose her health information, and must inform the patient about how the information will be used and disclosed. Banks, insurers and employers must get permission from a patient to access her health records.

Health care providers must allow patients to have health care bills and correspondence sent to alternate addresses to avoid notifying an abuser of the treatment received.

Employers may only access an employee’s health information for purposes of paying health claims.

Police May Not Access Patient Records Without Legal Warrant, Court Order

Law enforcement is restricted from accessing patient data until after obtaining legal process, including a warrant, court order or administrative subpoena.

Minors who lawfully receive care on their own will not automatically have parents receive their health information, eliminating a powerful deterrent that can prevent young people from seeking needed medical care.

These new rules provide a much-needed baseline of protections, but they are not enough. We still urgently need federal and state legislation to fill in the gaps. Many entities that receive health information, such as life insurers, employers and marketing firms, are not covered by the new rules. Patients do not have legal recourse to enforce the new rules.

And the rules do not sufficiently address potentially dangerous mandatory reporting laws in some states where health care providers are required to report all cases of domestic violence to the police, without the consent of the victim. This type of law, in place in California, can place battered women in danger and can discourage them from seeking medical care.

California’s dangerous mandatory reporting law, which prevented Donna from seeking medical care in the example above, is unaffected by the new privacy rules.

In addition, health care providers, advocates, administrators and state lawmakers need to implement privacy safeguards that go beyond the federal standards and respond to the particular needs of their practices, communities and institutions. It is crucial that they work together to protect patient privacy while still promoting domestic violence identification, documentation and response. Proper documentation improves the quality of care by drawing links between violence and other health issues, provides documentation of vital evidence for victims who seek future legal recourse and it can improve the health care system’s response to domestic violence.

Ultimately, privacy must be the first line of defense for battered women seeking health care. The lives of millions of women and children depend on our nation taking the next steps to build on these new regulations. Only by doing that can we ensure that seeking medical care will make battered women safer, rather than put them at greater risk.

Esta Soler is executive director and Peter Sawires is senior program specialist of the San Francisco-based Family Violence Prevention Fund.