PacifiCare Backs Limits on Access to Care Records

PacifiCare Health Systems Inc. is pushing legislation that would limit the state’s power to investigate health maintenance organizations.

The measure, SB 2061, set for a state Senate committee vote today, would limit state access to confidential health-plan documents, including patient records, those involving review of physician activities and plan decisions, and its internal financial and administrative operations.

Critics say the bill reflects assertions the Cypress-based health maintenance organization tried--but failed--to make in its ongoing legal dispute with the state’s Department of Corporations over release of confidential health-plan records. The department regulates health maintenance organizations.

The bill’s progress through the Legislature is being closely monitored by the HMO industry, doctors and consumers’ groups. Consumer advocates oppose it, saying it would limit the state’s mandate to protect patients.

The California Medical Assn., the state’s largest professional organization of physicians, supports it.

The bill would overturn a state law that gives the Department of Corporations access to records normally deemed confidential because of its mandate to ensure good health care for Californians.

“The bill protects the confidentiality of patient records and would restrict regulators from accessing medical records without patient approval,” said Susie Swatt, spokeswoman for state Sen. Ross Johnson (R-Irvine), who is sponsoring the bill.

Opponents say state law would restrict the department’s access to such records, which are routinely available to regulatory agencies investigating or reviewing health care matters. Other agencies with such access include the Department of Insurance and the Workers’ Compensation Appeals Board.

The bill would also require the department to hold a public hearing before it could compel an HMO to turn over its books and records. It would limit the scope of the department’s review and prevent copying records off-site. And it would prohibit the agency from examining records outside of the HMO’s place of business.

Last November, Orange County Superior Court Judge John M. Watson ordered PacifiCare’s California HMO to hand over records involving people who’d complained to the state about its health care.

The judge said the state could copy and take possession of records to pursue an investigation, so long as it took steps to prevent disclosure of confidential information.

PacifiCare argued unsuccessfully in court that the department should only be allowed to examine members’ medical records and peer-review records at company quarters. It had also sought to prevent the state from copying records.