When the city of Cranston required its police and firefighters this spring
to sign a form authorizing “any health care provider” to release all their medical
records, including HIV tests and psychiatric notes, before they could get injured-on-duty
status, officials said they were following The Beacon Mutual Insurance Co.’s
advice.
The city had no formal system to secure medical records in IOD cases, especially from firefighters, director of administration Paul Grimes said, so it couldn’t protect its interests adequately – a real problem in cases that can be very expensive.
“The notion of employers having access to medical information relevant to the injury is nothing new,” Grimes said in an interview. “It’s new in Cranston. Beacon Mutual advised us, ‘You guys really need to tighten up your IOD procedures, because they’re too loose.’”
But the way the city did that has drawn a protest from the American Civil Liberties Union and led to an angry confrontation in City Council chambers between Mayor Stephen P. Laffey and firefighters that had to be quelled by police.
The Beacon, meanwhile, is quietly distancing itself from the controversial form.
Out of the fray
Speaking to the City Council last month, Elizabeth Grady, Cranston’s contact at Beacon, said the company had never asked for such a broad medical authorization, and, in fact, all it needed were medical records regarding the specific on-the-job injury.
Asked for more detail, Jeffrey C. Johnson, vice president for community relations at The Beacon, generally confirmed Grady’s statement but didn’t want to elaborate.
“We’re basically trying to stay out of the fray, but our standard form (which is injury-specific) is all we need,” Johnson said. The company doesn’t want to say more, he said, because “we don’t want to alienate our client.”
Johnson did dispel any question that the Cranston case might reflect a trend toward broader-based, more intrusive medical reviews in IOD or workers’ compensation cases. Although the privacy protections from the federal Health Insurance Portability and Accountability Act (HIPAA) don’t apply to workers’ comp, Johnson said, “in fact the trend would probably be the other way” – the medical profession is becoming “a lot more conservative” about patients’ confidentiality.
The Cranston IOD form, which is still in use but is being heavily revised in the wake of the controversy, is definitely not conservative.
Although it starts by citing the relevant state law, the Confidentiality of Health Care Information Act, it never mentions, as required by the law, why the release is being sought, and never limits, as also required, the scope of the records to be released.
That’s one of the criticisms noted in a July letter to the city from the ACLU’s Rhode Island Affiliate. The ACLU also objected to the form’s scope – covering “any health care provider” – and its requirement that the records be accessible not only to the city of Cranston, but to “any person, firm or corporation deemed necessary by the city of Cranston in order to represent the city of Cranston’s interests.”
Both those flaws, the ACLU argued, put the form in violation of the intent of the state law, and “may also violate federal laws.”
Both the police and firefighters’ unions raised similar objections, but they were also upset by another section: an authorization to release medical records “including alcohol and drug abuse, records of my condition and HIV test, psychiatric notes and/or venereal disease and/or other sensitive or confidential related information.”
Asked about that clause, Grimes said it’s being taken out of the revised form, but it was never meant to apply to all IOD cases anyway.
“That information would only come up if it was relevant,” he said. “For example, if someone had a cut, and if they are diabetic, they can’t heal as quickly as other people would – then we need to know that person has an issue. … It doesn’t mean that we’re going to start digging into their records looking for HIV or some kind of psychiatric condition.”
As for the scope of the form in general, Grimes said “it’s implied that it’s relevant to the injury, and Beacon Mutual, they’re the ones that advised us on what to do. I will acknowledge that it was a fairly broad form, but it was vetted by several attorneys.”
A compromise
Both unions filed grievances about the original form, but while the firefighters refused to use the form while they awaited a hearing in December, the police have been using it, union president Stephen Antonucci said – but “with the recommendation that they cross out the objectionable language.”
Without the form, firefighters’ IOD applications have all been turned down. Valletta said union members were willing to pay their own bills and seek reimbursement after they won the arbitration, but then last month, one of the firefighters injured in a crash on Warwick Avenue couldn’t get an emergency MRI because he didn’t have coverage, and that forced the union to pursue an immediate resolution.
Despite this, the city and the unions are working out a compromise. The form will now specify that it covers only records relevant to the injury, Grimes said, and the sentence about HIV tests and other sensitive items has been removed.
Grimes said he’d offered months ago to revise the language of the form, but the unions didn’t take him up on it. Antonucci said he didn’t recall any such offer, but he’s now “hopeful” that the issue will be resolved. Valletta said as long as objectionable language is removed, his union is also fine with a form.
“We always felt that if the city’s paying the bill, they have a right to know
what’s going on,” he said.
