A Medical Information Crackdown   

Police reporters nationwide are finding that getting hospital information isn't as easy as it used to be.

Aisling Swift was freaking out. The Durham crime reporter for the News & Observer in Raleigh, North Carolina, was working her beat, calling hospitals to check the condition of gunshot victims. But hospitals repeatedly told her they had no record of those patients. As she grew suspicious, a sympathetic spokesperson finally clued her in: Swift was having a "HIPAA problem." Translation: The shooting victims might have been patients, but hospital officials believed new federal rules barred them from sharing that information.

Patient privacy regulations stemming from the Health Insurance Portability and Accountability Act are reshaping the way hospitals dispense patient information to reporters. The Clinton-era rules, which took effect April 14 for health-care providers and most health plans, are intended to protect patient confidentiality. But they also could suppress information needed to cover public health problems and incidents with injuries.

The rules do not specifically address how to release information to the media. But health-care workers could incur civil and criminal penalties of up to $250,000 and 10 years in prison for releasing protected information. Media attorneys and press advocates worry the threat of such penalties will freeze the dispersal of even innocuous facts and silence whistleblowers who have sought reporters to expose wrongdoing in hospitals or doctors' offices.

"Many medical institutions will simply close the doors and windows rather than risk an error in their interpretation," warned Tonda Rush, counsel to the National Newspaper Association, in a recent posting to a freedom of information listserv.

Rebecca Daugherty, director of the FOI Service Center for the Reporters Committee for Freedom of the Press, predicts "an effect on newsgathering that I don't think anyone was willing to consider in passing HIPAA rules. What happens when you have a Columbine? What happens when you can't find out who was shot and who wasn't? They won't be able to put out the lists they put out at Ground Zero of who's at the hospital."

Hospital directory information, now largely off-limits, enabled journalists and the public to track victims felled during the September 11 terrorist attacks, the Oklahoma City bombing, the anthrax scares and school shootings.

Such stories could be "severely stifled without reporter and public access to hospital directory information and other record sources," Phillip Taylor, an Atlanta freelance writer, wrote in a reporters committee guide. "Such information helped the public fully understand the effect and extent of the tragedies."

No longer can reporters call a hospital spokesperson and request a condition report on a 37-year-old male with a gunshot wound to the abdomen. The American Hospital Association has interpreted the rules to mean that reporters must have a patient's first and last name to obtain a condition report. And even if reporters have the name, the hospital can only release a one-word description of the patient's condition--undetermined, good, fair, serious or critical--unless the patient or the patient's representative has signed a release.

Patients also can opt out of the directory, prohibiting administrators from even confirming their presence in the hospital. A mayor or governor "could disappear into the hospital with no explanation, and you would be unable to get the hospital to tell you he was there," Rush says.

And without permission from the next-of-kin or another legal representative, hospitals can no longer give the media specific information on sudden, violent or accidental deaths, or deaths from natural causes, according to American Hospital Association guidelines. If state laws or hospital polices are more restrictive than the federal privacy regulations, the more stringent rules apply.

If, say, a school bus crashed, hospitals could release general information about the number of children being treated, but "they might not give you ages," says Joan Lewis, senior vice president of the District of Columbia Hospital Association. "They might say elementary school children. I don't know whether they would identify the school, but they might because it would help parents find kids." In case of a public-health threat such as anthrax, hospitals might defer to public-health agencies to release information, Lewis says.

"Every institution is interpreting the HIPAA rule differently," says Lynn Cantwell, spokeswoman at Children's National Medical Center in Washington, D.C. "We tend to be fairly conservative because we're a pediatric institution. But instead of closing the door on reporters, we're trying to work with them and help them" by educating them about the rules.

Although the new rules have been percolating for years, many reporters and editors are only learning about them now. Congress passed HIPAA in 1996, and the Clinton administration subsequently drafted privacy rules. While Bush administration officials loosened some of those regulations, media attorneys say those changes don't affect reporters.

"We're being told that if we don't provide the hospital with a name, they won't give us a condition," Doug Cummings, crime reporter for WGN-AM in Chicago, wrote to the Cops & Courts Reporters listserv. "We can get the (one word) condition if we have the name. Pretty silly, when you think about it. If we don't have the name, how are we invading the person's privacy by reporting their condition?"

Cummings says most hospitals are "just refusing to give us any information at all." While the police sometimes provide patient information, Cummings worries about its accuracy. "My guess is that we will start having less and less information to the point where a lot of these stories are just not going to make sense to the public."