A group of University of Iowa law students is helping health care and social service agencies negotiate an array of federal and state health privacy laws to better help mental health and substance abuse clients get the services they need.
The students have created a handbook and toolkit that help mental health care providers decide if, when, and how to disclose confidential and protected health and mental health information. The students will use the materials to conduct workshops for care providers, agencies, and consumers around the state in 2013 under the supervision of Len Sandler, clinical professor in the UI College of Law.
The handbook was put together at the request of the Johnson County System of Care Group, a network of organizations that treat and provide services to clients who have complex medical, mental health, and substance abuse disorders. The organizations in the group were having a difficult time determining what information they could share with other agencies and health care providers without running afoul of privacy laws.
The agencies could include law enforcement, hospitals, clinics, emergency shelters, and numerous social service agencies. Michael Flaum, clinical professor of psychiatry in the UI Hospitals and Clinics and member of the System of Care Group, says the agencies interpreted health care privacy laws differently, making it difficult for all parties to share information that would help.
“Some of us are more likely to pick up a phone and call another agency and ask for information, while others are reluctant to do that for fear of violating privacy laws, or because they don’t want to bombard a patient with a lot of information and paperwork,” says Flaum. “We found there are real barriers and perceived barriers to good communication. We have to make sure the only barriers are real barriers, and overcome the perceived barriers.”
Which is why they turned to the law clinic for help. Sandler and a team of 10 law students spent about seven months researching federal and state health care privacy laws, primarily HIPAA; 42 Code of Federal Regulations Part 2, that establishes privacy parameters for substance abuse patients; and Iowa Code Chapter 228, that governs the disclosure of mental health records and information.
What they found was the laws were immensely confusing, filled with overlap, contradictions, and gaps. The caregivers had hoped the guide would be a series of questions with fairly simple yes-no answers, but the students quickly found that wasn’t possible.
“While we were doing our research, it was hard to confirm, even with experts, what the law says in certain circumstances because nobody really knows,” says Phillip Van Liew, a third year law student who worked on the project. Instead, the group developed a series of flow charts designed to account as much as possible the various exceptions, overlap, and gaps in the three sets of laws.
Still, despite the confusion, Sandler says the laws provide greater latitude for sharing information than many agencies thought.
“People believe they can’t share information because federal law ties their hands, when it turns out that they are free to share information in many circumstances,” says Sandler.
Ultimately, he says the best advice to health care providers is to talk to their patients, encourage them to provide written consent, and get the patient the help they need now; in immediate life and death situations you might have to worry about legal ramifications later.
The law students have started conducting workshops with the guide and workshop toolkit handbook in Johnson County—including before the UI Hospitals and Clinics Department of Psychiatry—and Sandler says they will likely hold similar workshops with agencies around the state in the spring.