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

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.

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

3. 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 PEL’s? • 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 req’d 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! • IH’s are “offered” confidential medical files or information without asking • Such data were known to managers, safety or human resources staff, co-workers

8. 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

9. GUIDANCE ON PRIVACY ISSUES • Maintain (or at least avoid transfer of) confidential medical information • “Safeguard” volunteered information by not recording it anywhere • Avoid it; you’re 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/

11. WEB RESOURCES - CONTINUED • www.privacyrights.org/CASES/case9697.htm • www.acl.lanl.gov/TeleMed/ • www.dol.gov/dol/_sec/public/media/reports/genetics.htm