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Bush Lets Medical Privacy Rules Take Effect, With Caveats


WASHINGTON — In a rare defeat for business, the Bush administration said Thursday it would let a set of controversial medical privacy regulations take effect immediately but would later seek to modify the regulations to address health care industry concerns.

The surprising decision clears the way for implementation of the first federal medical privacy protections. The health care industry had launched an aggressive campaign to kill or postpone the rules, which were issued in the waning days of the Clinton administration under the authority of a 1996 law.

The regulations, which will limit the disclosure and distribution of patient records, had been put on hold by Health and Human Services Secretary Tommy G. Thompson, who appeared sympathetic to industry complaints.

As late as Wednesday, it was widely expected that Thompson would push back the original April 14 effective date to buy time to review more than 24,000 comments submitted during the last two months. But President Bush, who has expressed a strong personal interest in protecting the privacy of medical and financial records, directed otherwise.

"President Bush wants strong patient privacy protections put in place now," Thompson said in a statement issued Thursday.

Bush, in a statement of his own, said: "For the first time, patients will have full access to their medical records and more control over how their personal information will be used and disclosed."

The American Civil Liberties Union and Public Citizen had threatened to sue HHS if the rules were delayed. Others suggested the White House was swayed by growing public anxiety over the privacy of personal information.

In a nod to industry groups, however, Bush asked HHS to recommend making the rules more appealing to hospitals, insurers and drug companies.

Health care lobbyists had complained that the rules would cost billions of dollars to implement and might interfere with patient care by making it harder for doctors to discuss cases with one another. Pharmacists claimed the rules would complicate even simple tasks, such as picking up a prescription at the drugstore.

Thompson said the agency would seek to clarify that the rules would not prevent doctors, hospitals or pharmacists from obtaining medical information needed to treat patients or fill prescriptions. Such changes could not take effect without a months-long process of public comment and review.

In a move certain to stir controversy, Thompson also said the agency would consider giving parents access to medical information about their children, including details about substance abuse, abortion and mental health problems.

Privacy advocates, while expressing concern about the proposed modifications, praised the Bush administration for allowing the rules to take effect.

"We're very pleased that the administration did not give in to industry pressure," said Janlori Goldman, director of the Health Privacy Project at Georgetown University. "It seems there was a reversal internally."

But she and other privacy advocates said they would continue to monitor the proposed modifications to ensure the rules were not weakened.

Many groups expressed opposition to giving parents access to their children's medical records, saying it would conflict with several state laws and might discourage teenagers from seeking treatment for sexually transmitted diseases and during pregnancy.

"The Bush administration's signal that they will undo these protections is immoral, dangerous and unconstitutional," said Catherine Weiss, director of the ACLU's Reproductive Freedom Project.

Industry groups expressed surprise and disappointment but said they would attempt to work with HHS to modify the rules.

"There's going to be a continuing debate as to exactly what the revisions should look like," said Mary Grealy, president of Healthcare Leadership Council, a trade group of health care executives that had pushed to delay the rule.

The privacy rules were mandated by Congress in the 1996 Health Insurance Portability and Accountability Act. They require doctors, hospitals and other health care providers to get a patient's written permission before disclosing medical records. Health care professionals must be in full compliance by 2003.

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