Those medical tests are yours

Los Angeles resident Rose Cohen says all she wanted was a copy of her laboratory test results.

She’d been given a routine blood panel during an annual visit to her gynecologist and wanted to show the report to her internist. The results had already been returned to her gynecologist from the lab, meaning they were now legally part of her medical record. (In California, a laboratory cannot give patients their results directly unless the patient’s doctor has given consent.)

The doctor “gave me my cholesterol levels and then told me that I should discuss the other test results with my internist,” Cohen says. “So I said, ‘OK, send me a copy of it and I’ll walk it to my doctor.’ They said, ‘We’d like to fax it to your doctor rather than give it to you.’ ”

When Cohen asked why, the nurse she spoke with simply cited office policy as the reason. “She told me, ‘We do this as a courtesy for doctors.’ ”

After a series of heated exchanges, Cohen says she was finally told she could have her laboratory results, but that she had to a pay $25 administrative fee for the copy. She was incensed.

“I don’t know what’s going on there but this seems absurd,” she says. “I told them, ‘You’re holding my test results hostage for $25. It’s my blood, my test results.’ ”

Patient protections

Gaining access to medical records shouldn’t be so hard for patients.

Under both a federal law known as HIPAA (Health Insurance Portability and Accountability Act) and California state law, consumers have the right to access records documenting their health conditions, diagnoses and treatments.

What this effectively means is that consumers in California must be able to see their records within five business days of a written request and must be given a copy of the requested record within 15 business days.

HIPAA also explains when healthcare providers can share protected health information with other people.

Most providers are required to follow both HIPAA and the California law, deferring to whichever offers greater consumer protection in cases where the laws differ. As a result, Cohen’s doctor had no legal basis for charging the $25 administrative fee for her lab results.

Under California law, healthcare providers are allowed to charge a fee for the cost of copying a patient’s medical record and for the postage to mail it. But the cost cannot exceed 25 cents per page for photocopies and 50 cents per page for microfilm.

The law in California also permits doctors to charge a “retrieval fee” for locating patient records and for making them available. But HIPAA does not allow it. Because HIPAA offers consumers greater protection than California law in this area, doctors in the state cannot charge patients fees beyond those allowed for photocopying. Still, like Cohen’s doctor, many do it anyway.

To avoid paying the $25 administrative fee, Cohen asked her doctor’s office staff to fax her the lab results free of charge just as they were willing to do for her internist. The staff refused. “They told me it was because they were trying to abide by the confidentiality laws and that they can’t take the risk that someone else is going to see it before I see it,” Cohen says.

But under HIPAA, sending health information by fax is not prohibited. In addition, the law states that the provider must give patients the information they ask for in the format they request.

A full listing of HIPAA regulations and consumers’ rights under the law can be found on the Health and Human Services website, www.hhs.gov/ocr.

Trouble accessing medical records from doctors is a common complaint received by the Medical Board of California, which licenses and disciplines medical doctors.

Candis Cohen, a spokeswoman for the board, says physicians and their office staffs frequently confuse details of the HIPAA privacy law and, even with the best intentions of protecting patients’ privacy rights and complying with the law, deny consumers access to their medical records.

The traditional medical culture doesn’t help, policy and healthcare experts say, pointing out that, historically, doctors haven’t valued patients’ access to their own records.

“Some providers still have this paternalistic attitude that patients don’t have the right to their own health information,” says Joy Pritts, associate professor and director of the Center on Medical Records Rights and Privacy at Georgetown University.

Getting it right

In the end, Cohen’s persistence with her doctor’s office staff paid off. Her doctor learned that she was being denied her lab results and took Cohen’s side. “My doctor called me to say she was angry to learn that her staff had refused to give me my results. She apologized and faxed them to me immediately.”

The fax was sent free of charge.

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health@latimes.com