Public Health Law Map - Beta 5 - Medical and Public Health Law Site

unauthorized release of private medical information. The issue because preventing the
discovery of a patient's HIV status, and, if the patient knew he was HIV positive,
keeping the information out the patient's medical records and even keeping the
information from the patient's physician. As discussed in the section on Public Health,
this had a profound effect on public health practice and research. Medical privacy soon
became a general patient's rights issue and not just a concern for persons with AIDS.
The fear was discrimination in the workplace and the loss of health insurance.
Workplace discrimination was a real problem related to medical privacy and lead to
the passage of the Americans with Disabilities Act, which is discussed later in this
section. Although fears about having losing one's medical insurance were used to drive
medical privacy laws, insurability is not really a privacy issue.
People with individual, as opposed to group, medical insurance policies often lose their
insurance if they develop a chronic disease. People with chronic diseases who are
uninsured, or whose employers quit offering group medical insurance, have a lot of
trouble finding coverage, and when they do it is very expensive. Until fairly recently,
persons with chronic illness who were covered by group insurance could have
coverage for their illness excluded from coverage if they changed employers. Many
people saw this as a privacy problem that could be solved if they just had stronger
privacy laws to protect medical information.
B. A Historical Perspective
Medical records evolved as part of the development of modern medicine in the late
19th and early 20the century. Medical records started as simple notes to remind
physicians who their patients were, what they had been seen for, and what has been
prescribed for them. There was no team care and few patients went to hospital.
Physicians saw relatively few patients and would see the same patients for years,
making it less important to record every detail of the encounter. There was also much
less to record because there were few diagnostic tests and a limited pharmacy. Even if
a patient were admitted to hospital, hospitals provided nursing, custodial, food, and
hotel services, not modern day medical services. Nursing was low- technology patient
care. What laboratory work that was performed was often done by the physician. The
nurses, often nuns, were available night and day and knew the patient’s condition and
needs. Medical records served as documentation but were not a primary vehicle for
communication between medical care providers. Simple narrative reporting was used
because there were few events to record and little need for retrieving information from
the record.
Medical records were kept as much for business purposes as for medical care. They
were used to make out bills and to allow the physician to send letters to patients if he
were to move his practice. There was no medical insurance so there was no reason to
share medical information with anyone else. The records might be transferred to
another physician if the physician died or went out of practice. Patient access to
records was not an issue, both because the records were so limited and because there
was little occasion for patients to need access for insurance or legal purposes. The law
assumed that medical records were simply business records that belonged to the
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