Biden moves to shield patients’ abortion records from GOP threats - The Washington Post

https://www.washingtonpost.com/health/2024/04/22/abortion-medical-records-patients-biden-hipaa/

The Biden administration on Monday announced new rules intended to protect the privacy of patients seeking abortions, and the health workers who may have provided them, from Republican prosecutors who have threatened to crack down on the procedure.

The rules strengthen a nearly 30-year-old health privacy law — known as the Health Insurance Portability and Accountability Act, or HIPAA — to offer more robust legal protections to those who obtain or provide reproductive health care in a state where it is legal to do so. The final policy prohibits physicians, insurers and other health-care organizations from disclosing health information to state officials for the purposes of conducting an investigation, filing a lawsuit or prosecuting a patient or provider. It covers women who cross state lines to legally terminate a pregnancy and those who qualify for an exception to their state’s abortion ban, such as in cases of rape, incest or a medical emergency.

Under previous rules, organizations were allowed to disclose private medical information to law enforcement in certain cases, such as a criminal investigation. Officials at the Department of Health and Human Services said they had heard from patients and providers who were confused about their legal risks or had even deferred care amid GOP threats in the nearly two dozen states with abortion restrictions.

Trudy Ring at The Advocate:

Planned Parenthood must turn over some records on transgender health care to Missouri Attorney General Andrew Bailey, a judge has ruled. Bailey, a Republican, is investigating providers of gender-affirming care in the state, which has outlawed the provision of such care to minors and certain adults. His demand for information from Planned Parenthood of the St. Louis Region and Southwest Missouri came in March 2023 as part of his investigation of whether Washington University’s Pediatric Transgender Center or other health care entities in Missouri “have engaged in or are engaging in any practices declared to be unlawful,” as he stated in a letter to Planned Parenthood. The Planned Parenthood affiliate then sued Bailey in an attempt to block his demand, saying it was unauthorized and that the attorney general hadn’t shown how Planned Parenthood is directly involved in his investigation. Bailey argued that his request “should stand because he has an affidavit that alleges intentional dishonesty in Plaintiff's medical and billing practices,” St. Louis Circuit Judge Michael Stelzer wrote in his ruling. Ruling in Bailey’s favor, Stelzer said the AG’s office has “broad investigative powers” and that Bailey has the right to obtain any documents that aren’t protected by the federal Health Insurance Portability and Accountability Act, which provides for patient privacy.

Missouri AG Andrew Bailey (R) has been granted snooping powers on Planned Parenthood of St. Louis Region and Southwest Missouri's records for transgender health services.

The problem with most identity verification systems is that they're designed to prevent financial fraud by strangers, rather than privacy violations (and resulting interference/abuse) by family members, partners, and acquaintances. You let me pick up my prescriptions by giving my name and phone number? Do you think my abusive husband doesn't know my phone number? You let me verify my bank account with my name and birthdate? Do you think my controlling parents don't know my birthdate? You confirm my doctor's appointment with my name and address? Do you think my meddling daughter doesn't know my address? Other people have written about the sexism inherent in "mother's maiden name" as a verification question (the assumption that everyone's mother is married, that every married woman changes her name, that every child has their father's and not their mother's surname), but the bigger problem is: Do you think my abusive mother doesn't know her own name? This is why I like photo ID requirements -- my response to "Not everyone has or can afford photo ID" is "Then fix THAT, and make state ID unrelated to driving." We should all demand universal, free state ID cards. In the meantime, of course, we should support policies that offer alternative ID options for things like voting and healthcare -- but we should not compromise on mandatory individuation. Before my father passed away, his motor disabilities left him with limited abilities to write or type or speak, so he signed over power of attorney to me (which wouldn't have been necessary if he'd had access to universal design forms of communication, but that's another day's topic). I was horrified to discover that he needn't have bothered, because no one (with one exception) ever asked for the power of attorney paperwork. I signed documents for him, took money from his bank account, and consented to surgery on his behalf, and through all of it, no one ever asked for evidence that I was acting with his consent. I was horrified by how easy it was. No one questioned me. They assumed that as his daughter and caregiver, I had a right to control him. Most people, by default, are ableist, ageist, and sexist. Most people, by default, assume that people have a right to make decisions on behalf of their family members, especially if those family members are disabled. Most receptionists, doctors, nurses, bankers, and other professionals will, without a second thought, share information about a client to the client's family member, especially if the client is disabled. It doesn't occur to them to question it. Of course you can tell a wife's information to her husband -- he's her husband. Of course a woman can make an appointment for her disabled elderly father -- she's his daughter. Of course a mother can ask if her 23-year-old disabled son has picked up his medication -- she's his mother. If the decision is left to the individual professionals, most of them will, unquestioningly, defer to their own ableist, ageist, sexist biases. Individuation has to be enforced. Intra-family privacy has to be enforced. And identity verification requirements that don't protect against family members don't do that.

Poor Catherine 💔

So sad 😥

Correction: The unfortunate prank was NOT after giving birth, but rather during Catherine's hospitalization for hyperemesis gravidarum.

Today We're Talking About Ethics and Dual Relationships!

One more thing that bothered me was an anecdote DIDadoseofreality mentioned where they engineered a scenario that allowed their student, who they were also the therapist of, to talk about trauma in front of the whole class.

Now, in this anecdote, they're sure to make it clear that they asked their student if he was okay participating in this exercise. And the student had allegedly expressed a desire before to be able to talk about his trauma in a way that wouldn't make him feel foolish. So they present this as doing the student a favor.

And maybe that is how the student perceived it.

But... this is also a really uncomfortable power dynamic where your therapist who you share privileged information with is using that privileged information in your classroom to pressure you into sharing traumatic events with all your classmates.

And while the student allegedly gave consent for his teacher/therapist to blog about it the incident later, his therapist is his teacher.

There is a huge power dynamic in play there for pressuring a patient into waiving their HIPAA rights.

And while I sure do hope the teacher/therapist had the presence of mind to at least use a pseudonym for their student/patient and that their student/patient's name isn't actually Zac, it really doesn't matter because anyone in that class or told what happened by people in the class could stumble upon the blog post and now know that Zac's in therapy with their teacher.

Because after describing this event in the class in detail they also thank Zac for letting them tell everyone what Zac did Monday. Which, for a post made 4 days ago, places this incident multiple people know about on October 30th.

Unless some of the details were falsified beyond the name of the students, I'm going to hazard a guess and say that there was only one class anywhere where a student participated in an exercise that followed the exact sequence of events described on that blog, including Zac's specific trauma, on October 30th 2023.

...

I tried doing further research to find out if this was common or if it was even ethical. What I found first was a Quora thread with a bunch of different opinions. Well, the same opinion mostly but from different people.

I wasn't clear on dual-relationships or how they worked, so I decided to do further reading and came across this article. (Since I'm not one to just trust Quora at its word when there are better sources to be had.) Here are some excerpts.

This is not a simple "all dual relationships are bad." There is clearly nuance to this.

But if this relationship could impair their objectivity or competence in their role as a therapist, then they're supposed to avoid that relationship.

Now, one answer in that Quora thread described an example of a therapist-professor relationship working well for them with proper precautions and going to extraordinary lengths to keep those lines separate.

This is clearly not how DIDadoseofreality behaved though.

They used privileged information to influence how they treat their student in the classroom, got their student to open up about a traumatic event in front of everyone, then while having power over their client in their dual relationship as a teacher, they got their client to waive their HIPAA rights and allow their story to be posted on the internet for all to see. And potentially reveal to their classmates that the student is seeing their teacher as a therapist.

These are massive ethical violations.

I frankly would not trust them as a therapist OR a teacher.

If I were Zac, I would be shopping for a new therapist because mine could clearly not be trusted to keep their dual relationships separate.

If I were DIDadoseofreality, I would be looking for a colleague I could recommend Zac to for the same reason. I would also promptly delete my post describing the events of October 30th before a student or someone connected to me in real life identifies me and reports me for what are obviously ethics violation as both a therapist and a teacher.

Watch "No 2A If You Take THIS LIST of Medications!" on YouTube

Wow.

"We can't violate HIPAA to get the information we want, so we will just force you to sign away your HIPAA rights if you want to be able to fill your prescription."

"Also, if you are taking a medication we don't like then you will lose the Right to protect yourself."

That Most Intimate of Thrones

The most recent edition of Shed Letters is available!

I fell down a rabbit hole about the ethical, legal, and existential issues (and potential!) of smart toilets and now I'm making it everyone's problem! Please I stayed up too late researching this. Please read it.

(the pic of Scribble is there because I start almost all my newsletters with pictures of my cats. Because obviously why wouldn't I?)

In Case You Haven't Heard

The Attorneys General of Mississippi, Alabama, Alaska, Arkansas, Georgia, Idaho, Indiana, Kentucky, Louisiana, Missouri, Montana, Nebraska, North Dakota, Ohio, South Carolina, South Dakota, Tennessee, Texas, and Utah want to be able to access out-of-state medical records of state residents who have gone out of state for medical care — not just for abortion, but also for gender-affirming care. (x)

You know what to do in November 2024.

The DeSantis style anti-LGTBQ in education legislation has made it to the federal level and New York LGBTQ+ organizations are rightfully pissed at politicians who are even attempting to support this.

One of them had a very public meeting with Congressman Lawler (NY-17) for being the massive hypocrite he is.

I want to have some faith in the Democrats in the Senate, many who are up for re-election in 2024 and 2026, to block this garbage of a bill.

Contact your US Congressperson and tell them not to support HR 5/Parents Bill of Rights Act. This act is literally terrifying.

This is breaking hipaa code. you shouldn't be complaining about people with mental health problems. you have no right blabbing your mouth about people who ask for help or seek treatment. if you want to talk to someone you should get a therapist. get a notebook where you can't bitch about your experience. i have been a patient of psych wards and what i see other patients do and don't will always stay with me. obviously, it doesn't go both ways. what stays in a psych ward isn't to be talked about. let alone a psych nurse. this blog is the reason why the mental health system is failing. you have no right writing about patients personal info. yes this is "your experience" but its theirs's to which in the end gives you no right. if you need to write get a journal or put yourself on private. it's their story not yours.

See, I disagree. I'm so often surrounded by people in my personal life and professional life who think that psych patients are to be sequestered away and forgotten about. "What stays in the psych ward isn't to be talked about" is their attitude, too, after all. It frustrated me so much watching patients leave and come back as frequent fliers, for what I determined was not enough community support, that I decided I'd start keeping a public, anonymous journal. The intent has always been to convince anyone who reads it that these are people I'm treating, and not cattle.

I'd like to reiterate, though, like I said in an earlier ask, that I liberally change details in my posts. Here's a teaser for example: I don't actually look like Harry Potter. If someone reads one of my diary entries and finds it to be a little too relatable or familiar, it's very likely the case that what they're reading is just relatable. Even between patients and entries, I see lots of similar presentations to my unit.

If anything, I'm sad that anyone who read my posts thought I was complaining about my patients. I'm here because I love my job!

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