1
MANAGEMENT OF
CONFIDENTIAL MEDICAL ISSUES BETWEEN THE IH AND
MEDICAL PROVIDER

• Murray L. Cohen, PhD, CIH
• Jill Niland, CIH,CSP
• Jennifer Cole, MSW
• Consultants in Disease and Injury Control, Inc.

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TOPICS

• PRIVACY AND CONFIDENTIALITY
• WHAT MEDICAL INFORMATION DOES THE IH REALLY NEED?
• GUIDANCE ON PRIVACY ISSUES

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PRIVACY AND CONFIDENTIALITY

• Web site horror stories re employment and
  promotion discrimination
• Loss of privacy leads to stigmatization,
  discrimination, job actions, loss of health
  insurance
• Corporate conflict of interest due to
  self-insurance or controlling interest in
  healthcare contract provider

4
WHAT MEDICAL INFORMATION DOES THE IH REALLY NEED?

• Medical monitoring data? Action levels?
• Sensitivities or medical conditions incompatible
  with workplace exposure limits or PELs?
• Unknown chemical or physical exposure limits?
• Employee-volunteered information?
• Is this about protecting the most sensitive, or
  pregnant workers?

5
WHAT MEDICAL INFORMATION DOES THE IH REALLY NEED?

• OSHA 29 CFR 1910.1020 mandates worker access to
  own medical records, and written consent for any
  release of records
• (Lead) 29 CFR 1910.1025 employer reqd to
  instruct physicians not to reveal in any written
  opinion or other communication with employers any
  findings, lab results, or diagnoses unrelated to
  occupational exposure to lead.

6
WHAT MEDICAL INFORMATION DOES THE IH REALLY NEED?

• HIV-test confidentiality
• Patient HIV privacy rights, vs workers right to
  know
• Federal guidelines vs state laws vs case law

7
WHAT HAPPENS IN THE REAL WORLD?

• Confidential medical information may be released
  by health plan/insurer, worker comp, life or
  other insurance carrier, or even by physicians!
• IHs are offered confidential medical files or
  information without asking
• Such data were known to managers, safety or human
  resources staff, co-workers

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HOT BUTTONS!

• Regulatory/Congressional efforts to protect
  privacy of medical information
• 1997 Presidential Commission Consumers have the
  right to communicate with healthcare providers in
  confidence, and to have the confidentiality of
  their healthcare information protected.
• Legislative efforts to protect confidentiality of
  genetic-testing and family history information

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GUIDANCE ON PRIVACY ISSUES

• Maintain (or at least avoid transfer of)
  confidential medical information
• Safeguard volunteered information by not
  recording it anywhere
• Avoid it youre not a medical provider
• THE INFORMATION HIGHWAY FROM THE IH TO THE
  HEALTHCARE PROVIDER IS A ONE-WAY STREET!

10
WEB RESOURCES

• www.staff.uiuc.edu/dlinowes/survey.htm
• www.aclu.org/privacy
• www.hcqualitycommission.gov/cborr/chap6.html
• www.cciw.com/content/confidentiality.html
• www.eff.org/pub/Privacy/Medical/

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WEB RESOURCES - CONTINUED

• www.privacyrights.org/CASES/case9697.htm
• www.acl.lanl.gov/TeleMed/
• www.dol.gov/dol/_sec/public/media/reports/genetics
  .htm