Armstrong's medical records and legalese.

[Dave B]

According to this article the govt is trying to get Lance's medical records stating he admitted to doping that we all know he admitted to...just ask Betsy.

However, isn't there patient confidentiality with your doctor that is protected by law? How do lawyers circumvent this in the subpoena of said records?

http://www.cyclingnews.com/news/lance-armstrong-medical-records-critical-to-whistleblower-case-says-us-government/

[SlackMan]

I don't know the answer to your specific question, but the patient privacy laws seem crazy strict. An article in the WSJ over the weekend discussed how people who are victims of medical identify theft (i.e., another person uses your ID and possible health benefits to procure medical services) can't even examine THEIR OWN medical records because the criminal's medical records are blended with their own.

[velomonkey]

However, isn't there patient confidentiality with your doctor that is protected by law? How do lawyers circumvent this in the subpoena of said records?



The effective compliance date of the Privacy Rule was April 14, 2003 - Armstrong's hospital room incident was back in the late 90s.

And not sure if you are jabbing at Betsy, but LeMond has the woman who worked for Oakley who was in the room tapped saying "yea, he disclosed all his doping" and then changed her tune under testimony cause her testimony was taken at Oakley.

Funny how the doctors who asked were given a huge donation just the next day after Armstrong testified that Betsy was a liar. Huh. . . . .

Lots of people gonna be in some trouble with this one, that's why LA didn't comment on Oprah.

[BobO]

The effective compliance date of the Privacy Rule was April 14, 2003 - Armstrong's hospital room incident was back in the late 90s.

I would think that medical data critical to an ongoing legal action may be open for discovery even with HIPAA rules in effect. Kind of like a breathalyzer or a tox screen used to determine DUI states aren't confidential medical data.

[54ny77]

here's the moral quandry for the handlebar ethicists.

let's assume at least one doc was dirty with respect to his dealings with armstrong. what is the appropriate punishment here for the docs?

check this out:

http://cancer.iu.edu/news-publications/Einhorn.shtml

based on that profile alone, i would venture a guess that anyone cured from testicular cancer as a result of dr. einhorn's lifelong research couldn't care less about what happened to some guy on a bike, and to punish the guy (in whatever form, including preventing the practice of medicine) makes no sense.

[93legendti]

http://www.cga.ct.gov/2001/rpt/2001-R-0465.htm


FEDERAL LAW

Medical Record Privacy Law

Regulations governing medical records privacy took effect April 14, 2001; full compliance with them is required by April 14, 2003. They implement the Health Insurance Portability and Accountability Act and will affect how physicians and other health care providers must treat their patients'records. These regulations generally require physicians to obtain a patient's written consent or authorization before disclosing a patient's medical records or other individually identifiable health information, but they contain an exception for disclosing information about child abuse.

The regulations allow a physician to disclose otherwise protected health information without written consent or authorization:

1. to the extent it is required by law and the disclosure complies with and is limited to the relevant requirements of the law and

2. to a public health or other appropriate government entity that is legally authorized to receive child abuse and neglect reports (45 CFR ｧ164.512(b)(i)(ii), Federal Register, 12/28/00, p.82813).

The regulations also permit physicians to disclose health information to legally authorized government agencies in cases where they believe a spouse, an elderly person, or someone else specially protected under a state's law is being abused. In these cases, but not in cases of child abuse or neglect, the physician must inform the person whose information they disclosed unless the physician believes doing so would place the person in harm or is informing someone who is responsible for that person, such as a guardian or conservator (45 CFR ｧ164.512(c)(2), Federal Register, 12/28/00, p.82813).

[djg21]

According to this article the govt is trying to get Lance's medical records stating he admitted to doping that we all know he admitted to...just ask Betsy.

However, isn't there patient confidentiality with your doctor that is protected by law? How do lawyers circumvent this in the subpoena of said records?

http://www.cyclingnews.com/news/lance-armstrong-medical-records-critical-to-whistleblower-case-says-us-government/

Medical records are confidential under HIPAA but may may be subpoenaed if relevant to a claim. The Government likely can get an order requiring Armstrong to provide a HIPAA authorization. Federal courts generally require that medical records be filed or used under seal when used to support motions, at deposition or at trial. In any event, the Government likely would get the records subject to a protective order (an order requiring that they not be further disclosed and allowing their use only for purposes of the litigation).

[93legendti]

"1996 HIPAA:

Protected

Protected Health Information. The Privacy Rule protects all "individually identifiable health information" held or transmitted by a covered entity or its business associate, in any form or media, whether electronic, paper, or oral. The Privacy Rule calls this information "protected health information (PHI)."12

çš„ndividually identifiable health information is information, including demographic data, that relates to:

the individualç—´ past, present or future physical or mental health or condition,
the provision of health care to the individual, or
the past, present, or future payment for the provision of health care to the individual,
and that identifies the individual or for which there is a reasonable basis to believe it can be used to identify the individual.13 Individually identifiable health information includes many common identifiers (e.g., name, address, birth date, Social Security Number).

The Privacy Rule excludes from protected health information employment records that a covered entity maintains in its capacity as an employer and education and certain other records subject to, or defined in, the Family Educational Rights and Privacy Act, 20 U.S.C. ｧ1232g.

De-Identified Health Information. There are no restrictions on the use or disclosure of de-identified health information.14 De-identified health information neither identifies nor provides a reasonable basis to identify an individual. There are two ways to de-identify information; either: (1) a formal determination by a qualified statistician; or (2) the removal of specified identifiers of the individual and of the individualç—´ relatives, household members, and employers is required, and is adequate only if the covered entity has no actual knowledge that the remaining information could be used to identify the individual.15"


His records are privileged/private and should be undiscoverable.

[velomonkey]

let's assume at least one doc was dirty with respect to his dealings with armstrong. what is the appropriate punishment here for the docs?

Not much as it was an ethics violation . . . he knew what he was doing . . .he knew Armstrong wasn't going to disclose and as long as these docs claimed privacy, which they did, they got a big pay day, which they did.

Unlike Lance and Stephanie these docs didn't commit perjury.

Let's not hide behind cancer like Lance.

[djg21]

"1996 HIPAA:

Protected

Protected Health Information. The Privacy Rule protects all "individually identifiable health information" held or transmitted by a covered entity or its business associate, in any form or media, whether electronic, paper, or oral. The Privacy Rule calls this information "protected health information (PHI)."12

çš„ndividually identifiable health information is information, including demographic data, that relates to:

the individualç—´ past, present or future physical or mental health or condition,
the provision of health care to the individual, or
the past, present, or future payment for the provision of health care to the individual,
and that identifies the individual or for which there is a reasonable basis to believe it can be used to identify the individual.13 Individually identifiable health information includes many common identifiers (e.g., name, address, birth date, Social Security Number).

The Privacy Rule excludes from protected health information employment records that a covered entity maintains in its capacity as an employer and education and certain other records subject to, or defined in, the Family Educational Rights and Privacy Act, 20 U.S.C. ｧ1232g.

De-Identified Health Information. There are no restrictions on the use or disclosure of de-identified health information.14 De-identified health information neither identifies nor provides a reasonable basis to identify an individual. There are two ways to de-identify information; either: (1) a formal determination by a qualified statistician; or (2) the removal of specified identifiers of the individual and of the individualç—´ relatives, household members, and employers is required, and is adequate only if the covered entity has no actual knowledge that the remaining information could be used to identify the individual.15"


His records are privileged/private and should be undiscoverable.

You are wrong.

http://www.hhs.gov/ocr/privacy/hipaa/faq/judicial_and_administrative_proceedings/704.html

[Dave B]

The effective compliance date of the Privacy Rule was April 14, 2003 - Armstrong's hospital room incident was back in the late 90s.

And not sure if you are jabbing at Betsy, but LeMond has the woman who worked for Oakley who was in the room tapped saying "yea, he disclosed all his doping" and then changed her tune under testimony cause her testimony was taken at Oakley.

Funny how the doctors who asked were given a huge donation just the next day after Armstrong testified that Betsy was a liar. Huh. . . . .

Lots of people gonna be in some trouble with this one, that's why LA didn't comment on Oprah.



No jab at Betsy, I think she and Frankie deserve some sort of retribution. She has been a bit...hmmmm, emotional in some of her statements, but I surely don't begrudge her that.

Thanks folks, a few conflicting points, but I was just curious if this was even possible as I understood doctor patient confidentiality to be iron clad. Looks like there are some avenues to get what is desired in this case.


I do wonder now though what Dr. Nichols punishment would/could be for fibbing under oath.

[93legendti]

You are wrong.

http://www.hhs.gov/ocr/privacy/hipaa/faq/judicial_and_administrative_proceedings/704.html

Disagree.

Where the covered entity is not a party to the proceeding, the covered entity may disclose protected health information for the litigation in response to a court order, subpoena, discovery request, or other lawful process, provided the applicable requirements of 45 CFR 164.512(e) (GPO) for disclosures for judicial and administrative proceedings are met.

http://edocket.access.gpo.gov/cfr_2002/octqtr/45cfr164.512.htm

[peanutgallery]

So when HBO turns this whole circus into a running show things like this will bump up the season count fer sure. Will this ever end? In addition to legal teams employed for decades - gaffers, show runners, wardrobe assistants and so on will get quite a run out of this. Heck, they'll have to find actors to play different stages of life for many of the characters if this keeps dragging on. -7 sure is good at keeping cycling in the hearts and minds of Americans and create jobs in order to stimulate the economy. Win/win for all involved:)

I would like to see Gary Busey play either Dr. Ferrari or Chris Carmichael. Andy Dick would be a good Jonathan Vaughters and Rhonda Rousey has Betsy written all over her. DeNiro => motoman. The Olsen twin he didn't date can play the one he dated and Cheryl Crow could play his mother. This could get to be a lot of fun

Game of Thrones would get cancelled to make this masterpiece. At the very least it would have to be better than the second season of True Detective

[djg21]

Disagree.

Where the covered entity is not a party to the proceeding, the covered entity may disclose protected health information for the litigation in response to a court order, subpoena, discovery request, or other lawful process, provided the applicable requirements of 45 CFR 164.512(e) (GPO) for disclosures for judicial and administrative proceedings are met.

http://edocket.access.gpo.gov/cfr_2002/octqtr/45cfr164.512.htm

What will happen is that the U.S. Attorney will demand that Armstrong provide a HIPAA authorization. Assuming that Armstrong refuses, the Government will go to the Court, explain why the medical records are sought and that they may contain information both relevant to the claims (or Armstrong's defenses) and admissible. The U.S. Attorney then will request an Order requiring Armstrong to provide an Authorization. The Court most probably will issue the Order, and Armstrong will be in contempt if he fails to comply.

Once the Authorization is provided, it will be served with a subpoena (which has the effect of a Court Order) on the medical provider, and the medical provider will disclose the records.

This is a very common litigation practice.

On edit: Armstrong apparently either has refused the request for an Authorization or has moved to quash the Government's subpoena. The motion practice is what is being reported. Given Betsy's testimony, Armstrong's argument is low probability.

On edit again: it was a motion to quash. It's on PACER. You can read about the Government's opposition argument here: http://cyclingtips.com.au/2015/08/did-armstrongs-doctor-cover-up-his-doping-us-federal-government-chasing-details-in-court/

[CunegoFan]

Keep in mind that Postal's sponsorship of the team ended before the SCA suit. Whatever Dr. Nichols may have done during the SCA arbitration had no effect on what Postal knew about doping by Armstrong or the rest of the team.